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

项目概要/摘要： 计划生育（FP），包括提供避孕药具，是支持个人实现其 期望的孩子数量，时间和间隔。扩大产后FP的获得可以预防孕产妇和 通过减少意外怀孕和缩短两次怀孕之间的间隔，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，以及农村产后妇女 是那些需求最大的群体。印度农村地区以社区为基础的婴儿疫苗接种计划 提供产后FP护理的理想环境，因为他们得到了很好的照顾， 提供多种机会提供FP护理，包括对产后妇女的外展和随访， 夫妻。我们先前在该地区的工作表明，性别变革方案，即，这些地址 限制性的性别规范（社会对人们行为的期望基于他们的性别感知）-是 与避孕药具使用率的增加和避孕决策的机构有关。我们的中央 假设是，将基于社区的、改变性别的计划生育护理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，并提高产后避孕的使用率。 本研究的目的是初步测试PIVoT（产后疫苗和避孕的整合）， 通过性别转型方案），由护士提供30分钟的咨询会议， 如果需要，在一个月内进行三次婴儿疫苗接种时提供避孕措施（包括宫内节育器） 8-在印度农村的一周。我们对该地区的定性研究表明，这种护理模式是 我们的目标人群和供应商都可以接受。 使用混合有效性设计、普罗克特实施成果框架和混合方法 方法，包括一个两组随机对照试验，这项研究的目的是评估的效果， PIVoT干预： 1.实施成果-干预措施的可行性、可接受性、适当性、可接受性和忠实性， 2.初步有效性-避孕药具使用、护理质量和避孕决策机构。 印度农村的村庄（N=12）将被随机分配，以提供PIVoT干预或标准护理（转诊 向产后妇女提供计划生育咨询和避孕药具） 接种疫苗访问。将通过对PIVoT参与者（N=294）的调查评估实施成果， 对一部分女性参与者、她们的丈夫和PIVoT提供者（N=40）进行深入访谈， 会议的意见。我们的初步有效性评估将包括基线和6个月的随访 对试验参与者进行调查，评估避孕药具的使用和避孕决策的机构， 他们对护理质量的看法。这项研究有可能指导实施一项创新的性别- 变革性计划生育干预措施，增加了需求未得到满足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.