Increasing access to postpartum contraception by linking family planning and infant vaccination services

项目摘要/摘要： 计划生育(FP)，包括提供避孕，是支持个人实现其 所需的子项数量、时间和间隔。扩大产后计划生育的机会可以预防孕产妇和 通过减少意外怀孕和缩短两次怀孕间隔来降低婴儿发病率和死亡率。印度是 避孕需求未得到满足的妇女人数最多的国家和农村产后妇女 是未得到满足的需求最高的人群之一。印度农村地区的社区婴儿疫苗接种计划是 提供产后计划生育护理的理想环境，因为他们得到了很好的照顾，而且婴儿疫苗接种时间表 提供多种机会提供计划生育护理，包括对产后妇女的外展和随访，以及 情侣。我们之前在该地区的工作表明，性别变革性方案--即那些解决 限制性性别规范(基于人们感知的性别对人们行为的社会期望)-- 与更多的避孕用具使用和避孕决策机构有关。我们的中央 假设是将以社区为基础的、改变性别的计划生育保健与现有的公共婴儿疫苗接种联系起来 这些方案将覆盖更多的农村产后妇女和夫妇，并提高产后避孕的接受度。 这项研究的目的是试行Pivot(产后疫苗和避孕的整合 通过改变性别的规划)，由护士作为30分钟的咨询会议外加 如果需要，在三次婴儿疫苗接种期间提供避孕措施(包括宫内节育器) 印度农村地区为期8周。我们在该地区的定性研究表明，这种护理模式是 对我们的目标人群和供应商来说都是可行和可接受的。 使用混合有效性设计、Proctor实施成果框架和混合方法 方法，包括一项双臂整群随机对照试验，本研究旨在评估 将干预重点放在： 1.执行结果--干预的可行性、可接受性、适当性、接受性和保真度 2.初步效果--避孕使用、护理质量和避孕决策机构。 印度农村地区的村庄(N=12)将被随机抽样，以提供支点干预或护理标准(转诊 向公共卫生中心提供计划生育咨询和提供避孕)给婴儿的产后妇女 疫苗接种访问。将通过对枢轴参与者(N=294)的调查来评估执行成果-- 对一部分女性参与者、她们的丈夫和Pivot提供者(N=40)和Pivot进行深入访谈 会议观察。我们的初步效果评估将包括基线和6个月的随访 与试验参与者一起进行的调查，评估避孕措施的使用和机构在避孕决策中的作用 他们对护理质量的看法。这项研究有可能指导实施创新的性别-- 变革性计划生育干预，增加未满足需求的产后妇女获得避孕药具的机会。

Project Summary/Abstract: Family planning (FP), including provision of contraception, is care that supports individuals to achieve their desired number, timing, and spacing of children. Expanding access to postpartum FP can prevent maternal and infant morbidity and mortality by decreasing unintended pregnancy and short inter-pregnancy intervals. India is the country with the largest number of women with an unmet need for contraception, and rural postpartum women are among those with the highest unmet need. Community-based infant vaccination programs in rural India are an ideal setting to provide postpartum FP care because they are well-attended, and the infant vaccine schedule provides multiple opportunities to offer FP care including outreach and follow-up to postpartum women and couples. Our prior work in the region shows that gender-transformative programs – i.e., those that address restrictive gender norms (social expectations of people’s behavior based on their perceived gender) – are associated with increased contraceptive use and agency in contraceptive decision-making. Our central hypothesis is that linking community-based, gender-transformative FP care with existing public infant vaccination programs will reach more rural postpartum women and couples and improve uptake of postpartum contraception. The objective of this study is to pilot test PIVoT (Postpartum Integration of Vaccines and contraception through gender-Transformative programming), delivered by a nurse as a 30-minute counseling session plus contraception provision if desired (including intrauterine devices) at three infant vaccine visits that occur over an 8-week period in rural India. Our qualitative research from the region demonstrate that this model of care is feasible and acceptable to both our target population and providers. Using a hybrid-effectiveness design, the Proctor Implementation Outcomes Framework, and a mixed-methods approach, including a two-arm cluster randomized controlled trial, this study aims to assess the effect of the PIVoT intervention on: 1. Implementation outcomes -- intervention feasibility, acceptability, appropriateness, uptake, and fidelity and 2. Preliminary effectiveness -- contraceptive use, quality of care, and contraceptive decision-making agency. Villages (N=12) in rural India will be randomized to deliver the PIVoT intervention or the standard of care (referral to public health centers for FP counseling and provision of contraception) to postpartum women at infant vaccination visits. Implementation outcomes will be assessed via surveys from PIVoT participants (N=294), in- depth interviews with a subset of women participants, their husbands, and PIVoT providers (N=40), and PIVoT session observations. Our preliminary effectiveness evaluation will involve baseline and 6-month follow-up surveys with trial participants assessing contraceptive use and agency in contraceptive decision-making and their perceptions of quality of care. This study has the potential to guide implementation of an innovative gender- transformative FP intervention which increases access to contraception for postpartum women with unmet need.