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Education for contraceptive use by women after childbirth.

Abstract

BACKGROUND

Providing contraceptive education is now considered a standard component of postpartum care. The effectiveness is seldom examined. Questions have been raised about the assumptions on which such programs are based, e.g., that postpartum women are motivated to use contraception and that they will not return to a health center for family planning advice. Surveys indicate that women may wish to discuss contraception prenatally and after hospital discharge. Nonetheless, two-thirds of postpartum women may have unmet needs for contraception. In particular, many adolescents become pregnant again within a year a giving birth.

OBJECTIVES

Assess the effects of educational interventions for postpartum mothers about contraceptive use

SEARCH STRATEGY

We searched the computerized databases of MEDLINE, CENTRAL, EMBASE, CINAHL, PsycINFO, and POPLINE. We also searched for current trials via ClinicalTrials.gov and ICTRP. In addition, we examined reference lists of relevant articles, and contacted subject experts to locate additional reports.

SELECTION CRITERIA

Randomized controlled trials were considered if they evaluated the effectiveness of postpartum education about contraceptive use. The intervention must have started postpartum and have occurred within one month of delivery.

DATA COLLECTION AND ANALYSIS

We assessed for inclusion all titles and abstracts identified during the literature searches with no language limitations. The data were abstracted and entered into RevMan. Studies were examined for methodological quality. For dichotomous outcomes, the Mantel-Haenszel odds ratio (OR) with 95% CI was calculated using a fixed-effect model.

MAIN RESULTS

Eight trials met the inclusion criteria. Of four trials with short-term interventions in the immediate postpartum period, one did not have sufficient data and one was statistically underpowered. The remaining two showed a positive effect on contraceptive use. However, most comparisons did not show an effect in one study and the other had short-term assessments. Of four multifaceted programs with multiple contacts, two showed fewer pregnancies or births among adolescents in the experimental group that had enhanced services, and a structured home-visiting program showed more contraceptive use. The effective interventions were conducted in Australia, Nepal, Pakistan, and the USA.

AUTHORS' CONCLUSIONS

Postpartum education about contraception led to more contraception use and fewer unplanned pregnancies. Both short-term and multiple-contact interventions had effects. The former were limited by self-reported outcomes or showing no effect for many comparisons. The longer-term interventions were promising and not necessarily more costly than usual care. Health care providers can determine if one of these interventions suits their setting and level of resources.

Authors+Show Affiliations

Behavioral and Biomedical Research, Family Health International, P.O. Box 13950, Research Triangle Park, North Carolina, USA, 27709.No affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Meta-Analysis
Review
Systematic Review

Language

eng

PubMed ID

20091524

Citation

Lopez, Laureen M., et al. "Education for Contraceptive Use By Women After Childbirth." The Cochrane Database of Systematic Reviews, 2010, p. CD001863.
Lopez LM, Hiller JE, Grimes DA. Education for contraceptive use by women after childbirth. Cochrane Database Syst Rev. 2010.
Lopez, L. M., Hiller, J. E., & Grimes, D. A. (2010). Education for contraceptive use by women after childbirth. The Cochrane Database of Systematic Reviews, (1), CD001863. https://doi.org/10.1002/14651858.CD001863.pub2
Lopez LM, Hiller JE, Grimes DA. Education for Contraceptive Use By Women After Childbirth. Cochrane Database Syst Rev. 2010 Jan 20;(1)CD001863. PubMed PMID: 20091524.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Education for contraceptive use by women after childbirth. AU - Lopez,Laureen M, AU - Hiller,Janet E, AU - Grimes,David A, Y1 - 2010/01/20/ PY - 2010/1/22/entrez PY - 2010/1/22/pubmed PY - 2010/4/17/medline SP - CD001863 EP - CD001863 JF - The Cochrane database of systematic reviews JO - Cochrane Database Syst Rev IS - 1 N2 - BACKGROUND: Providing contraceptive education is now considered a standard component of postpartum care. The effectiveness is seldom examined. Questions have been raised about the assumptions on which such programs are based, e.g., that postpartum women are motivated to use contraception and that they will not return to a health center for family planning advice. Surveys indicate that women may wish to discuss contraception prenatally and after hospital discharge. Nonetheless, two-thirds of postpartum women may have unmet needs for contraception. In particular, many adolescents become pregnant again within a year a giving birth. OBJECTIVES: Assess the effects of educational interventions for postpartum mothers about contraceptive use SEARCH STRATEGY: We searched the computerized databases of MEDLINE, CENTRAL, EMBASE, CINAHL, PsycINFO, and POPLINE. We also searched for current trials via ClinicalTrials.gov and ICTRP. In addition, we examined reference lists of relevant articles, and contacted subject experts to locate additional reports. SELECTION CRITERIA: Randomized controlled trials were considered if they evaluated the effectiveness of postpartum education about contraceptive use. The intervention must have started postpartum and have occurred within one month of delivery. DATA COLLECTION AND ANALYSIS: We assessed for inclusion all titles and abstracts identified during the literature searches with no language limitations. The data were abstracted and entered into RevMan. Studies were examined for methodological quality. For dichotomous outcomes, the Mantel-Haenszel odds ratio (OR) with 95% CI was calculated using a fixed-effect model. MAIN RESULTS: Eight trials met the inclusion criteria. Of four trials with short-term interventions in the immediate postpartum period, one did not have sufficient data and one was statistically underpowered. The remaining two showed a positive effect on contraceptive use. However, most comparisons did not show an effect in one study and the other had short-term assessments. Of four multifaceted programs with multiple contacts, two showed fewer pregnancies or births among adolescents in the experimental group that had enhanced services, and a structured home-visiting program showed more contraceptive use. The effective interventions were conducted in Australia, Nepal, Pakistan, and the USA. AUTHORS' CONCLUSIONS: Postpartum education about contraception led to more contraception use and fewer unplanned pregnancies. Both short-term and multiple-contact interventions had effects. The former were limited by self-reported outcomes or showing no effect for many comparisons. The longer-term interventions were promising and not necessarily more costly than usual care. Health care providers can determine if one of these interventions suits their setting and level of resources. SN - 1469-493X UR - https://www.unboundmedicine.com/medline/citation/20091524/Education_for_contraceptive_use_by_women_after_childbirth_ L2 - https://doi.org/10.1002/14651858.CD001863.pub2 DB - PRIME DP - Unbound Medicine ER -