The Effects of a PPIUD Intervention on Family Planning Counseling Quality: Results from Stepped-Wedge Randomized Controlled Trial

Leigh G. Senderowicz, University of Wisconsin at Madison
Erin Pearson, Ipas
Joel Francis, University of the Witwatersrand

Postpartum family planning (FP) has been resurgent in recent years, with antenatal care seen as an opportune time to reduce unmet need for contraception. In Tanzania (where unmet need is 22%), an intervention to promote postpartum IUD(PPIUD) was implemented in 2015 and included training nurses on high-quality postpartum FP counseling for integration into routine antenatal care. We conducted a step-wedged cluster randomized trial at five tertiary hospitals, surveying women at delivery(n=23,408). We use mixed-effects multilevel linear regression models to examine the impact of the intervention on counseling quality and satisfaction. The intervention reduced overall patient satisfaction with the counseling they received by 19%(p=.004), with women exposed to the PPIUD intervention counseled, on average, on 0.87 fewer methods than women in the control(p<.001). We hypothesize that providers may have focused on PPIUD counseling to the exclusion of other methods, paradoxically reducing overall FP quality with the intervention's single-method focus.