Academic journal article International Perspectives on Sexual and Reproductive Health

Increasing Postpartum Contraception in Rural India: Evaluation of a Community-Based Behavior Change Communication Intervention

Academic journal article International Perspectives on Sexual and Reproductive Health

Increasing Postpartum Contraception in Rural India: Evaluation of a Community-Based Behavior Change Communication Intervention

Article excerpt

CONTEXT: The Indian family planning program, though successful in increasing contraceptive use among couples who have achieved their desired family size, has not been equally successful in educating couples about the use of contraceptive methods for birth spacing.

METHODS: An evaluation was conducted of a behavior change communication intervention integrated into the existing government program to increase knowledge and use of the lactational amenorrhea method and postpartum contraception through counseling by community workers. The intervention, which ran between September 2006 and January 2007, was conducted among 959 pregnant women aged 15-24 who lived in Uttar Pradesh, India. The evaluation used logistic regression analyses to measure differences in knowledge and contraceptive use between baseline and the four- and nine-month postpartum follow-up surveys within and between the intervention and comparison groups.

RESULTS: The follow-up data show increases in knowledge of the lactational amenorrhea method and spacing methods and in use of spacing methods. At four months postpartum, women in the intervention group were more likely to know the healthy spacing messages than those in the comparison group (odds ratio, 2.1). At nine months postpartum, women in the intervention group, those with higher knowledge of healthy spacing practices and those with correct knowledge of two or more spacing methods were more likely than others to be using a contraceptive method (1.5-3.5). Use of modern contraceptives for spacing at nine months postpartum was 57% in the intervention group versus 30% in the comparison group.

CONCLUSIONS: Targeted behavior change communication using community workers is an effective and feasible strategy for promoting postpartum contraception.

International Perspectives on Sexual and Reproductive Health, 2012,38(2)68-77, doi:10.1363/3806812

More than half a million women die each year as a result of complications related to pregnancy and childbirth in developing countries across the world; (1), (2) in India, there were 68,000 maternal deaths in 2008.3 Of the 7.7 million child deaths reported worldwide in 2010, 22% occurred in India. (1-3) Recent Indian National Family Health Survey (NFHS) data further show that 12% of children ever born to currently married women have died. (4) Available studies demonstrate that the chances of infant and maternal survival would be 2.5 times as high with birth intervals of 3-5 years as with intervals of two or fewer years. (5-8) In this context, the postpartum period is particularly important.

Family planning method use in India leans heavily toward methods that limit fertility. The latest NFHS shows that 77% of sterilized women did not use a family planning method before sterilization. (4) Between the 1970s and the 1990s, the Indian Family Planning Program emphasized sterilization and set targets for the number of procedures. (9) As a consequence, the name Faintly Planning Program became associated with sterilization. Despite changing its name to the Family Welfare Program and removing the target approach, the program has not been successful in educating people about the concept and advantages of interpregnancy spacing or the use of contraceptive methods for spacing births.

Although contraceptive methods are available for free through the public health system at the village level, promotion of spacing methods is not considered important by health workers. Studies suggest that providers tend to focus their counseling on limiting methods and find it challenging to counsel young couples about spacing methods. (9-13) Counseling about spacing methods can be time-consuming and providers must work against the myths and misconceptions about family planning use that are prevalent in the community. In addition, the lack of decision-making power about contraceptive use among young women makes providers view this counseling as futile. …

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