The Effect of Antenatal Contraceptive Counseling and IUD Insertion Services on Modern Contraceptive Use and Method Mix in Nepal: Results From a Stepped-Wedge Randomized Controlled Trial

Sarah Huber-Krum , Harvard University
Aayush Khadka, Harvard University
Julia Rohr, Harvard School of Public Health
Elina Pradhan, Harvard University
Mahesh Puri, Center for Research on Environment Health and Population Activities (CREHPA)
Dev Maharjan, Center for Research on Environment Health and Population Activities (CREHPA)
Saugat Joshi, Center for Research on Environment Health and Population Activities (CREHPA)
Iqbal H. Shah, World Health Organization (WHO)
David Canning, Harvard University

Unmet need for modern contraception in the postpartum period is common. We examined the effects of an antenatal contraceptive counseling and postpartum IUD services intervention in six Nepalese hospitals on modern contraceptive use and long-acting method use at two follow-up points (approximately 12 and 21 months post-delivery). An Intent-to-Treat analysis was used to assess the relationship between the intervention and use of modern contraception and long-acting contraception (i.e., sterilization, IUD, implant) at follow-up. At the first follow-up, women in the intervention group reported a significant increase in modern contraceptive use and long-acting method use, compared to the control group. However, at the second follow-up, differences in modern contraceptive use were negligible, but the intervention group continued to report significantly higher rates of long-acting method use. Institutionalizing antenatal contraceptive counseling and postpartum IUD services at hospitals in Nepal may produce positive, lasting effects on long-acting method use among postpartum women.

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 Presented in Session 1. Fertility, Family Planning, Sexual Behavior, & Reproductive Health 1