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" Postpartum Family Planning Among Women Attending Group-based Antenatal and Postnatal Care in Kenya and Nigeria: A Cluster Randomized Control Trial "
Whiting-Collins, Lillian Joyce
Winch, Peter
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Latin Dissertation
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English
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| Record Number
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1054139
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| Doc. No
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TL53256
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| Main Entry
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Whiting-Collins, Lillian Joyce
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| Title & Author
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Postpartum Family Planning Among Women Attending Group-based Antenatal and Postnatal Care in Kenya and Nigeria: A Cluster Randomized Control Trial\ Whiting-Collins, Lillian JoyceWinch, Peter
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| College
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The Johns Hopkins University
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| Date
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2020
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| Degree
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Ph.D.
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2020
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| Note
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142 p.
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| Abstract
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Background: Postpartum family planning (PPFP), or modern contraceptive practice within one year postpartum, promotes maternal and infant health through healthy pregnancy spacing. Although most postpartum women in low-and-middle income countries prefer to avoid pregnancy, few practice PPFP. Research suggests that group based antenatal and postnatal care increases PPFP uptake; however, the mechanisms behind this relationship are not yet understood. This dissertation aims to fill this gap by investigating PPFP among women who participated in a cluster randomized control trial of group versus individual antenatal and postnatal care in Kenya and Nigeria. Methods: Qualitative and quantitative methods were employed. Inductive content analysis of qualitative data from women and providers in group care explored how this model of care may influence PPFP. Survival analysis methods, including Cox proportional hazards regressions, Lifetable analysis, and Kaplan-Meier curves, assessed time to modern contraception uptake among women in both study arms. Understanding of return to fertility was investigated and LAM practices compared between groups by t-tests for proportion. Lastly, a new scale to measure contraceptive self-efficacy among the study population was developed and validated by psychometric analyses using data from the control arms in both countries. Results: Qualitative findings revealed a process through which group care influenced PPFP, outlined by the following five themes: 1) Having enough time; 2) Engaging women in care; 3) Creating an environment where women feel “free”; 4) Equipping women with tools to facilitate discussions with their husband/partner; and 5) Continuing care through 12 months postpartum. Women in group care had higher rates of modern contraceptive uptake in the first 12 months postpartum compared to women in standard care, although this difference was insignificant. Significant differences were found between study arms in understanding of LAM requirements, and more LAM users in group care met these criteria. In contraceptive self-efficacy scale development, three domains emerged: 1) husband/partner communication, 2) provider communication, and 3) choosing and managing a method. Scale score was associated with use of a modern contraceptive method at 12-months postpartum. Conclusions: Results highlight how group care influences PPFP. Findings should inform PPFP policies and programs for women in low-and-middle income countries.
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| Descriptor
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Public health
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Winch, Peter
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The Johns Hopkins University
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