Impact of a post-partum family planning intervention on contraception and fertility in Tanzania: two-year follow-up of a cluster-randomised controlled trial

Abstract

Purpose

We evaluate contraceptive use and pregnancy two years following an intervention in Tanzania, which provided antenatal post-partum family planning counselling and post-partum intrauterine device (PPIUD) services following delivery.

Methods

We analyse data from five hospitals in Tanzania using a difference-in-difference cluster randomised design, with randomisation at the hospital level. We use women-level data collected at the index birth and a follow-up survey two years later among 6,410 women. Outcomes (overall modern contraceptive use, contraceptive type, pregnancy) are modelled with an intent-to-treat (ITT) approach using linear regression. We compare with the complier average causal effect (CACE) of the intervention among those counselled.

Results

The intervention increased long-term PPIUD use by 5.8 percentage points (95% CI: 0.7–11.2%) through substitution away from other modern methods. There was no impact on overall modern contraceptive prevalence or pregnancy. Only 29% of women reported receiving PPIUD counselling. When accounting for this in the CACE analysis we saw a larger impact with 25.7% percentage point increase in PPIUD use (95% CI: 22.7–28.6%).

Conclusion

The intervention provided women an additional contraceptive choice, resulting in higher use of PPIUD over two years. Increase in PPIUD use was brought about by shifting methods, not creating new modern contraceptive users.

SHORT CONDENSATION

The post-partum family planning intervention in Tanzania offered women a new contraceptive option and increased sustained use of post-partum IUD. The intervention did not attract new modern contraception users and could have a greater impact if implemented more widely.

摘要

目的：我们在坦桑尼亚开展了一项干预措施, 提供产前产后计划生育咨询和分娩后放置宫内节育器（PPIUD）服务, 两年后我们对避孕措施的使用和妊娠情况进行了评估。

方法：我们分析了坦桑尼亚五家医院的数据, 采用双重差分整群随机设计, 在医院层面进行随机化。我们使用了6410名妇女在出生时收集的数据和两年后的跟踪调查数据。结果（现代避孕药具总体使用情况、避孕类型、妊娠情况）通过使用线性回归的意向性治疗（ITT）方法来建模。我们比较了被咨询者中干预的依从者平均因果效应（CACE）。

结果：通过替代其他现代方法, 干预使PPIUD的长期使用率提高了5.8个百分点（95%CI：0.7-11.2%）。对整体现代避孕普及率或怀孕率没有影响。只有29%的女性报告接受了PPIUD咨询。在CACE分析中考虑到这一点时, 我们看到了更大的影响, PPIUD使用率增加了25.7%（95%CI：22.7-28.6%）。

结论：该干预为妇女提供了额外的避孕选择, 导致两年内PPIUD的使用率较高。PPIUD使用量的增加是由方法的转变带来的, 而不是创造新的现代避孕用具使用者。

Keywords:

• Post-partum IUD
• counselling
• contraception
• Tanzania

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Correction

Acknowledgements

The authors thank the members of the Tanzania research team for their contributions to this research study, as well as the women who participated in the study.

Author contributions

JKR ran the analysis and drafted the manuscript. SHK provided significant input into the design of the statistical analysis. JKR, AR, EP, JMF, MG and HS were involved in the data collection, data review and data quality control for the intervention evaluation. IS, DC, NU and TWB designed the intervention evaluation study and oversaw the implementation of the evaluation. All authors assisted in the interpretation of the data and findings, and in the review of the final manuscript.

Disclosure statement

The authors declare they have no competing interests.

Data availability statement

De-identified project data is hosted by the Harvard Centre for Population & Development Studies. Data access can be applied for and accessed here: www.hsph.harvard.edu/population-development/harvard-research/harvard-research-resources/available-research-data.

Correction Statement

This article was originally published with errors, which have now been corrected in the online version. Please see Correction (http://dx.doi.org/10.1080/13625187.2024.2337483).

Additional information

Funding

This study was supported by the Susan Thompson Buffett Foundation.