By: Muleta Befkene (MD, Ass.Prof . in OBG/GYN)

1. Focused Family Planning Counseling Increases Immediate Post-partum Intra Uterine Contraceptive Device Uptake: A Quasi Experimental Study By: MuletaBefkene (MD, Ass.Prof. in OBG/GYN) Declaration of Good Standing and Conflict of Interest Disclosure Hilton Addis 2019

2. Presentation Outlines • Introduction • Objectives • Methods • Results and Discussion • Conclusions and Recommendations • Acknowledgements

3. Introduction • Recently, there is expansion of modern FP worldwide • Family planning is important throughout an individual’s and couple’s reproductive life • PPFP focuses on the prevention of unintended and closely spaced pregnancies • It works through the first 12 months following childbirth

4. Introduction...Cont’d • Postpartum is crucial in the continuum of points of contact within the health care system • It provide an opportunities to gate into FP services • The use of IUCD is low; • Ethiopia=0.8% and Oromia=1% • Married = 2% and unmarried =1%

5. Introduction... Cont’d • Although there is provision of routine family planning counseling, the postpartum IUCD uptake is low which might be attributable to the counseling modality.

6. Learning objectives • To assess if the newly designed family panning counseling approach will increase IUCD uptake among mothers delivered in public health facilities of Adamsa city and Olenchiti town from April 01 to May 30, 2017

7. Methods • Study setting: • In public health facilities of Adama city and Olenchiti town • Study Period: • From April 01 to May 30, 2017. • Study Design: • Quasi-experimental study design • Source Population: • All pregnant women who gave birth in public health facilities of Adama city and Olenchiti town • Study Population: • Those women who gave birth in selected hospitals during this period

8. Methods…Cont’d • Intervention group • Women who gave birth in selected public health facilities from Adama city (AHMC and Adama Health Center) and counseled for IUCD based on the newly designed counseling tool, that is cue card • Cue card was developed based on the four constructs of Health Belief Model (HBM).

9. Intervention & non-intervention groups • Non-Intervention group • Women who gave birth in Olenchiti hospital counseled by national family planning counseling procedure was provided • Midwifery were trained on data collection methods, not for counseling.

10. Methods…Cont’d • Inclusion criteria • Woman who came for delivery service to the selected public health facilities • Woman who gave birth in other health facilities then came to post natal units of the selected health facilities during immediate postpartum period.

11. Methods…Cont’d • Exclusion criteria • Mothers who completed family size and opted for permanent method • Woman who had intra-partum fetal loss (optionally, based on number of alive children & desire) • Woman with contra indication for IUCD were excluded from the study.

12. Methods…Cont’d • Sample size; sample was calculated based • Objective of the study • Testing difference between proportions of IUCD uptake in two groups • Study designs • Experimental design • Ratio of intervention-–to- non-intervention; 1 to 2

13. Methods…Cont’d • Sample size was calculated considering assumptions • = 0.01 fornon-intervention group • =0.053 for intervention group • P = 0.0315 for average of the proportions • = 1.95 for 95% confidence • = 0.84 for 80% power • n1(non-intervention) = 484 • n2(intervention) = 242

14. Methods…Cont’d • Data collection tools: • Interviewer administered questionnaire and decision form were used for data collection • Data collection procedures: • Mothers who fulfill the inclusion criteria were identified by data collectors • First baseline socio-demographic characteristics data were collected

15. Methods…Cont’d • Then counseled for family planning options • Finally, her decision was asked to provide the choice and her choice was recorded • Log book was also reviewed to retrieve important data

16. Methods…Cont’d • Data quality assurance • Training was provided on data collection tool • Questionnaire was translated to the Afan Oromo and Amharic languages • Data were supervised • Midwifes were assigned for data collection

17. Methods…Cont’d • Study Variables • Dependent Variable: IUCD uptake (Yes vs. No) • Independent variable • Socio-demographic variables: • Obstetric variable • Others

18. Methods…Cont’d • Data analysis • Data entered into SPSS version 20 • Descriptive analysis was used to explore the characteristics of mothers • The difference in the proportion of IUCD uptake in intervention and non-intervention area was tested using an independent Z-test statistics at alpha 5%

19. Methods…Cont’d • Binary logistic regression analysis was used to identify determinants of postpartum IUCD uptake • Magnitude of association was estimate OR with 95% CI • Significance of associations was declared at p-value < 0.05

20. Results

21. Results…Cont’d

22. Results…Cont’d

23. Results…Cont’d

24. Discussion • Counseling by cue card increased using post-partum IUCD compared routine counseling approach • May be due to lack of focus and difficulty/unfriendly/ nature of routine counseling guideline whereas using scientifically accepted model /health belief model/

25. Discussion…Cont’d • Being unmarried was associated with higher using of IUCD compared to married • Unmarried women do not want to have birth or limit the number of birth usually

26. Discussion…Cont’d • Higher education were associated with higher using of IUCD Compared to those not having any formal education at post-partum period. • Higher educated women prefer birth spacing and limiting number of children they want to have

27. Discussion…Cont’d • Mothers who had limited education and those who deliver at home were at highest risk for having unmet need of contraceptive use • Woman having five &more previous pregnancies has higher Postpartum IUCDuse than those who having less pregnancies • Who had more than five children do not want to have additional child

28. Discussion…Cont’d • Couples reached their desired family size would like to prevent future pregnancies • Making decision to have a child solely by husband associated with higher using of IUCD • Cultural reason that husband’s decision is accepted more likely.

29. Discussion…Cont’d • Having higher level of knowledge on family planning has higher using IUCD • Mother with better knowledge on Family planning prefer IUCD at post-partum because IUCD had no effect on breast feeding and satisfy long term need of family planning after birth

30. Conclusions • Intervening post-partum family planning counseling based on health belief model increased IUCD uptake. • Factors like being unmarried women, higher education level, having five and more pregnancies, husband decision to use LAFP and having knowledge on family planning previously contributing for IUCD uptake.

31. Conclusions... Cont’d III Accordingly, counsel married women for IUCD, lower educational mothers, mothers with less than five children, educating community so that husbands involve in long acting FP use and improving mothers’ knowledge on FP need special attention.

32. Recommendations • From finding • Recommend FMOH, Regional and zonal health offices to use such tools improve IUCD uptake • Government and NGOs need to provide Health education for married, low educational level, who had less than five pregnancies and mothers that decide choice of family planning alone • Need to improve knowledge of reproductive age mothers on family planning

33. Acknowledgements • Our special appreciation goes to CIRHT • For the opportunity given to conduct this research • Financially supporting the project • Extend our gratitude to Adama Hospital Medical College for time

34. Some of References • Novak, E. and J.S. Berek, Berek & Novak's gynecology. 2007: Lippincott Williams & Wilkins. • 2. Arrowsmith, M.E., et al., Strategies for improving the acceptability and acceptance of the copper intrauterine device. The Cochrane Library, 2012. • 3. Organization, W.H., Programming strategies for postpartum family planning. 2013. • 4. Novak, et al., Berek & Novak's gynecology. 2007: Lippincott Williams & Wilkins. • 5. El Beltagy, N., et al., Comparison between Cupper T380 IUD and Multiload 375 IUD in early post partum insertion. Middle East Fertility Society Journal, 2011. 16(2): p. 143-148. • 6. DeCherney, et al., Current Diagnosis and Treatment: Obstetrics and Gynecology 11e Inkling Chapter. 2006: McGraw Hill Professional.

35. Thank you!