TABLE 2.
Summary of Main Effect Sizes, by Outcome Typea
| Study | Postpartum Contraceptive Use Within 1 Year of Birth | Use of Specific Methods of Contraception | Other Outcomes |
|---|---|---|---|
| Counseling interventions | |||
| Ndegwa, 201432 | Post-placental IUD insertion: 63.3% intensive vs. 64.3% routine P=.23 | ||
| Adanikin, 201339 | 6 months: intervention group reported higher modern contraceptive use (57.4% vs. 35.4%; P=.002) and less use of traditional methods (19.8% vs. 32.3%; P=.044) |
Precise method used postpartum (P=.061):Condom: 30.7% vs. 18.2%IUD: 12.9% vs. 11.1%POP/COC: 6.9% vs. 4.0%Injectables: 5.0% vs. 2.0%Implants: 0 vs. 0Sterilization: 2.0% vs. 0LAM: 13.9% vs. 21.2%Calendar: 4.0% vs. 2.0%Withdrawal: 2.0% vs. 9.1% |
|
| Camara, 201843 |
6 months: no difference in use of any FP method (4.8% vs. 5.7 in intervention; P=.708);No difference in use of modern FP method (3.2% vs. 4.6% in intervention; P=.473)9 months: no difference in use of any FP method (2.7% vs. 6.7% in intervention; P=.064);Higher uptake of modern FP methods in intervention group (1.1% vs. 5.7% in intervention; P=.024) |
6 months: no difference in choice of FP method (P=.282): condoms (2.1% vs. 2.1%), pills (0.0% vs. 2.1%), IUD (0.0% vs. 0.0%), injectable (0.0% vs. 0.0%), traditional methods (1.6% vs. 1.0%)At 9 months: no difference in choice of FP method (P=.058): pills (0.0% vs. 0.5%), injectable (0.5% vs. 5.2%), implant (0.5% vs. 0.0%), traditional methods (1.6% vs. 1.0%).The authors intended to group LAM with modern methods but could not verify its accurate measurement. |
At 9 months, women cited more FP methods in intervention group.More women with postpartum FP intention in the intervention group at 6 months (88% vs. 69%, P<.01), as well as at 9 m months (78% vs. 54%, P<.001). However, these proportions were similar at time of inclusion just after counseling session.Also asked for reasons for not using FP methods; common ones: preference to abstain from sexual intercourse till child walks, unavailability of desired FP method, husband does not want it. |
| Ayiasi, 201546 | 12 months: Only 28.2% (control) and 31.6% (intervention) of mothers were current users of modern contraceptives. Although there was slightly higher proportion of current users in the intervention arm, this difference was not statistically significant (aRR: 1.10; 95% CI=0.51, 1.82; P=.810). |
About half of postpartum women, 47.1% (control) and 49% (intervention) arm had considered delaying the next pregnancy among the current noncontraceptive users, signifying unmet needs for contraceptive use. Of these, 71.4% in control and 87% in intervention had considered using a modern FP method. In preliminary analysis, risk of being willing to use was 1.5 times higher among intervention group, but this difference was not statistically significant after adjustment (aRR: 0.98; 95% CI=0.53, 1.82; P=.955).Pregnancy: Intervention arm (3.3% vs. 5.7%; P=.302)No difference in breastfeeding practices. |
|
| Keogh, 201540 | At 6–15 months (median 10.5 months): No evidence of an association between antenatal counseling and starting FP |
At 6–15 months (median 10.5 months):No evidence of an association between antenatal counseling and stopping FP, unmet need, and repeat pregnancy. |
|
| Abdulkadir, 202038 | 12–20 weeks (2.8–4.6 months): intervention group reported higher contraceptive use (48.5% vs. 31.0%, P=.0001 based on Mc Nemar’s X2) | Significant predictors of uptake: occupation, education, husbands’ participation | |
| Daniele, 201836 |
3 months: Positive effect on use of any contraceptive method (57.0% vs. 49.3% in control, RD=7.7 [1.2 to 13.6], RR=1.16 95% CI=1.04, 1.30)8 months: Positive effect on use of any contraceptive method (70.6% vs. 64.4% in control, RD=6.5 95% CI=1.0, 12.1; RR=1.10 95% CI=1.02, 1.20)Positive effect on use of effective modern contraceptive methods (59.6% vs. 53.1% in control, RD=6.4, RR=1.12 95% CI=1.01, 1.24). |
8 months: positive effect on use of long-acting or permanent contraception (30.7% vs. 22.9% in control, RD=8.1, RR=1.33 95% CI=1.09, 1.62) |
Intervention was associated with reduction of unmet need for contraception 8 months postpartum (14.2% vs. 18.7% in control, RD= −4.8, RR=0.75; 95% CI=0.57, 0.98Also looked at timely initiation of effective modern contraception, Unmet need for contraception 8 months postpartum. |
| Digital interventions | |||
| Unger, 201831 |
16 weeks (3.7 months): Contraceptive use was significantly higher in both intervention arms (1-way SMS: 72% and 2-way SMS: 73%; P=.03 and 0.02 versus 57% control, respectively). However, this difference was not significant when correcting for multiple comparisons.At 10 and 24 weeks (2.3 months and 5.5 months): No difference in contraceptive uptake between groups. |
LARCs use similar across arms:One-way versus control, RR 1.16, 95% CI=0.44, 3.03; P=0.772-way versus control, RR 1.41 95% CI=0.57, 3.51; P=0.46) with only 25 (11%) of all contraceptive users using long-acting, reversible contraception methods (intrauterine devices and implants), the majority implants.Women in both intervention arms were significantly more likely to EBF at 10 weeks and 16 weeks than women in the control arm. The probability of EBF to 24 weeks postpartum was higher in both intervention groups than in the control, but only statistically significant in the 2-way messaging group [0.49 in 1-way, 0.62 in 2-way, and 0.41 in control, (P=.30 and .005 for 1-way and 2-way vs. control, respectively)] |
Contraceptive continuation high among women starting contraception at 10 weeks; however, 44 (30%) of contraceptive users across all arms switched methods between 10 and 24 weeks. |
| Harrington, 201933 | 6 months: use of any contraceptive method higher among women in the SMS group (aRR=1.19; 95% CI=1.01, 1.41) |
6 months: use of highly effective methods higher among women in the SMS group (aRR=1.26; 95% CI=1.04, 1.52). No difference observed in use of LARC/permanent contraception (aRR=0.96; 95% CI=0.91, 1.02).At 6 months, 31.7% of all attendees were using injection. Implant users made up 25.4% of participants at 6 months. No participants reported LAM as their method of contraception at the 6 months visit. |
Contraceptive discontinuation at 6 months was comparable in the SMS and control groups at 1.6% (P=.96). |
| Educational interventions | |||
| Sebastian, 201254 | 9 months: higher proportion of women in the intervention group than of those in the comparison group reported modern contraceptive use (57.0% vs. 30.1%, P≤.01) |
9 months – choice of methods:Pill: 13.8% (intervention) vs. 7.1% (control)Condoms: 40.9% (intervention) vs. 22.6% (control)IUD: 1.9% (intervention) vs. 0.2% (control)Sterilization: 0.4% (intervention) vs. 0.2% (control)Traditional method: 18.9% (intervention) vs. 25.3 (control); P≤.014 months – LAM:23% (intervention) vs. 13% (control) |
Knowledge of the various contraceptive methods (including LAM) was significantly higher in the intervention group compared with the comparison group at 4 months postpartum; these differences were even greater at the 9-month postpartum survey. |
| Maldonado, 202035 | 12 months: increased contraceptive adoption in intervention clusters (RD 7.2%, 95% CI=2.6, 12.9, P=.034) |
12 months: increased EBF in intervention clusters (11.9% 95% CI=7.2%, 16.9%; P=.14).No statistically significant effect on adoption of LARCs (RD=7.1% 95% CI=0.9%, 13.3%; P=.099). |
|
| Bang, 201841 | 18-19 months after the baseline survey: In intervention group, contraceptive prevalence increased from 31.3% to 61.8% (in comparison group: from 33% to 35.5%) (P=.065) | The intervention group showed significantly greater increases in knowledge about FP compared to the comparison group (P<.038). | |
| Lori, 201842 | 12 months: Women who participated in group ANC had higher odds of using a modern or non-modern method of contraception (aOR= 6.690, 95% CI=2.724, 16.420) |
12 months: Women who participated in group ANC had higher odds of using a modern FP method than those in individual care (aOR=8.063, 95% CI=2.887, 22.524).Women enrolled in group ANC had nearly three-fold odds of EBF for more than 6 months compared with women in individual care (aOR=2.84, 95% CI= 1.298, 6.216). |
Women who participated in group ANC were more likely to demonstrate intention to use FP immediately postpartum than those who were in individual care (63.0% vs. 31.6%, X2=16.49, P<.001) |
| Sarnquist, 201448 | 3 months: uptake of LARCs in intervention (87.1%) and standard of care (81.8%) group (P=.34). Uptake of other modern FP methods in intervention (9.7%) and standard of care (9.1%) group (P=.12). |
Use at 3 months PP (Intervention v control)IUD: 1.6% v 9.1%, P=.12Implant: 85.5% v 72.7%, P=.11 |
Identified IUD as effective at preventing pregnancy, 3 months PP (Intervention vs. control)85.5% v 56.3%, .002 |
| Financial interventions | |||
| McConnell, 201834 | 22 weeks (after estimated date of delivery; 5.1 months): increased probability of using modern contraception among those with standard voucher + SMS (RD=25% [6%, 44%]). None of the other treatment arms were estimated to statistically significantly increase the likelihood of modern contraceptive use | 22 weeks (after estimated date of delivery): increased probability of using LARCs among those with standard voucher + SMS (RD=20% [0%, 41%]). None of the other treatment arms were estimated to statistically significantly increase the likelihood of LARC use. | |
| Engineer, 201652 | 23-25 months after P4P rollout- current use of modern FP methods: 10.7% vs 11.2% (P-value: 0.90) | ||
| Package of interventions | |||
| Jiusitthipraphai, 201555 | 12 weeks (2.8 months): mean scores on oral contraceptive self-efficacy (OCSE) and oral contraceptive used behavior (OCUB) of study group were higher than control group with a statistical significance (P<.001) | ||
| 12 months: use of modern contraception (0.04; 95% CI=0.00, 0.10)(Huber-Krum) |
IUD insertion in immediate postpartum period:Intervention increased PPIUD uptake by 4.4% (95% CI=2.8%, 6.4%]). The adherence-adjusted estimate implies that receiving counseling due to the intervention increases uptake of PPIUD by around 17% (95% CI=4%, 40%).(Pradhan)At 1 year:Short-acting contraception: Y1 (0.02, 95% CI=−0.02, 0.07, P>.05)Long-acting contraception: Y1 (0.03, 95% CI=0.01, 0.05, P<.05)PPIUD: Y1 (0.03, 95% CI=0.02, 0.04, P<.05)Non-postpartum IUD LARC: Y1 (−0.00, 95% CI=−0.01, 0.01, P>.05)Sterilization: Y1 (−0.01, 95% CI=−0.02, −0.00, P<.05)24 months:Short-acting contraception: Y2 (−0.01, 95% CI=−0.04,0.02), P>.05)Long-acting contraception: Y2 (0.02, 95% CI=−0.00, 0.04), P>.05)PPUID: Y2 (0.02, 95% CI=0.01, 0.03,P<.05)Non-PPIUD LARC: Y2 (−0.01, 95 %CI=−0.02, 0.01, P>.05)Sterilization: Y2 (−0.01, 95% CI=−0.02, 0.00, P>.05)(Huber-Krum) |
At 24 months: use of modern contraception (0.00; 95% CI=−0.04, 0.4) (Huber-Krum)Women counseled in either the pre-discharge period (aOR 0.86; 95% CI=0.80, 0.93) or in the post-discharge period (aOR 0.86; 95% CI=0.79, 0.93) were less likely to have an unmet need in the postpartum period compared to women with no counselinga; women who received counseling in both the pre- and post-discharge period were 27% less likely than women who had not received counseling to have unmet need (aOR 0.73; 95% CI=0.67, 0.80). (Puri)The adjusted probability of having incident pregnancy was 0.7 percentage points (95% CI=−3.0, 1.4) lower among women in the intervention group than among women in the control group. (Guo) |
|
| Karra, 201927 |
Assessed choice not insertion: 4.1% of women choosing PPIUD prior to the intervention compared to 9.8% of women choosing PPIUD after the rollout of the intervention (0.027; 95% CI=0.000, 0.054).The adherence-adjusted estimate implies that receiving counseling due to the intervention increases uptake of PPIUD by around 8.9% [95% CI=2.7%, 15%]. |
||
| Pearson, 202028 |
Assessed choice not insertion: Increased choice of PPIUD by 6.3% (95% CI=2.3%, 8.0%).The adherence-adjusted estimate implies that receiving counseling due to the intervention increases uptake of PPIUD by around 31.6% (95% CI=24.3%, 35.8%). |
||
| Tran, 201929 | 12 months: prevalence of modern contraceptive methods in the intervention arm was about twice that of the control arm (55% vs 29%, aPR: 1.79, 95% CI=1.30, 2.47). Also, significant changes in modern contraceptive use were observed at 6 weeks and 6 months. |
At 12 months: In the intervention group, increased use of LARCs (aPR: 1.66; 95% CI=1.17, 2.35) and short-acting methods (aPR: 2.01; 95% CI=1.18, 3.43) was observed.Also, significant changes were observed in LARC use at 6 months and in use of short-acting methods at 6 weeks and 6 months. |
|
| Tran, 202030 |
12 months: prevalence of modern contraceptive methods in the intervention arm was not significantly different from the control group (aPR: 1.58; 95% CI=0.74, 3.38).No difference was observed also at 48 hours, 1 week, 6 weeks, 6 months. |
Significant change was observed in use of implants (long-acting) at 6 weeks, 6 months, 12 months. | |
| Jarvis, 201837 |
Within 12 months (timing unclear): FP use among all nonpregnant womenModern FP Use OR (95% CI)/aOR(95% CI)Arm 1 (quality): 0.4(0.2,0.8)/0.4(0.2,0.9) P<.05 for bothArm 2 (free): 1.2(0.7,2.0)/0.9(0.5,1.8)Arm 3 (free/quality): 2.3(1.4,3.9) P<.005/2.3(1.2,4.3) P<.05Control=reference |
Among all nonpregnant women:Modern FP use, excluding condomsArm 1: 0.8(0.4,1.7)/1.4(0.6,3.2)Arm 2: 3.2(1.8,5.8) P<.001/3.2(1.4,7.2) P<.005Arm 3: 6(3.4,10.7)/8.6(3.9,19.0) P<.001 for bothLARC UseArm 1: 2.1(0.8,5.4)/2.9(1.1,7.9)Arm 2: 6.3(2.8,14.2)/5.6(2.3,13.7) P<.001 for bothArm 3: 8.2(3.7,18.4)/8.4(3.4,20.6) P<.001 for bothImplant useArm 1: 1.7(0.6,4.8)/2.3(0.8,6.9)Arm 2: 7.0(3.0,16.4)/5.7(2.2,14.4) P<.001 for bothArm 3: 6.8(2.9,16.0)/5.6(2.2/14.4) P<.001 for both |
|
| Karra, 202244 | At 24 months: Use of long-acting methods increased by 5.4% (95% CI=0.020, 0.089). Use of implants increased by 4.3% (95% CI=0.011, 0.075). No change in use of injectables (0.00088 (95% CI=−0.039, 0.040). |
At 24 months: contraceptive use increased in intervention group by 5.9% (95% CI=0.024, 0.094).Intervention group’s hazard of pregnancy was 43.5% lower 24 months after the index birth (based on a hazard rate of 0.565 (95% CI=0.387, 0.824). |
|
| Espey, 202145 | Over the 15-month intervention period, providers at our intervention facilities inserted 83.5 PP implants per month (SD=51.9) and 224.8 PPIUDs per month (SD=75.3). Notably, prior to our intervention, only 30 PP implant insertions per month and 8 PPIUD insertions per month occurred in our selected facilities. | Receiving more promotions was associated with client uptake for PP implants (test for trend, X2=65.8, P<.0001) and PPIUDs (test for trend, X2=26.9, P<.0001). Of the 12,068 women who received our intervention and delivered at a study facility, 1252 chose a PP implant (10.4% uptake), 3372 chose a PPIUD (27.9% uptake), and 7444 declined a postpartum LARC method (61.7% non-uptake) | |
| Wu, 202051 |
Within 12 months: Use of any modern contraceptive method increased from 29% pre-intervention to 46% post-intervention (P<.0001).The adjusted OR for any modern contraceptive use of women in the post-intervention group as compared to pre-intervention group was 2.3 (95% CI=1.7, 3.1; P<.0001). |
With respect to method mix, use of LAM, injectables, and implant increased significantly. Condom use decreased significantly from 4.5% to 1.6% (P=.01). | |
| Ahmed, 201553 |
12 months: cumulative probability of adopting any modern contraceptive method=65.9% in intervention and 39.1% in comparison arm.CPR=42% in intervention and 27% in comparison (P<.001). |
In intervention arm, higher acceptance of oral contraceptives (aHR=1.33, P<.001), condoms (aHR=3.39, P<.001), and reduced acceptance of traditional methods (aHR=0.59, P=.001).No difference in adoption of injectables and female sterilization. Low acceptance of IUDs in both groups (0.6% in intervention vs. 1.3% in control)Higher use of LAM in intervention arm: 3 months – 23% vs. 0%; 6 months – 12% vs. 0%; no use in either arm at 12 months or 24 months (not reported in article table). |
24 months:Cumulative probability of adopting any modern contraceptive method=76.6% in intervention and 54.5% in comparison armThe hazard of all-method adoption was higher in the intervention arm than in the comparison arm (adjusted hazard ratio=2.57, P<.001; excluding LAM: aHR=1.51, P<.001).CPR=46% in intervention and 35% in comparison (P<.001).Continuation rates for first 12 months after adoption show that continuation of oral contraceptives was not significantly (in multivariate analysis) higher in intervention arm [aHR=0.81]; continuation rate of IUDs/implants was higher in intervention arm (85.3%) than in the control arm (59.0%) but was not significantly different in the multivariable model [aHR:0.32). Continuation rates of other methods were not statistically significant.After discontinuation (n=745), 34% of LAM users switched to oral contraceptives, 21% to condoms, 12% to injectables, 1% to IUDs/implants, and 2% to sterilization; 26% remained nonusers at 24 months |
| Cooper, 201656 |
Up to 11 months: Effect statistically insignificant for mothers with children 11 months or younger.Up to 24 months: overall, there was a decline in modern contraceptive use over the study period. However, intervention might still have positive effect (In Upper Egypt: OR=1.45, P<.001; in Lower Egypt: OR=1.29, P<.05). |
Use of LARCs generally decreased in intervention and comparison sites over the study period. Measured LAM incorrectly as a breastfeeding method, limiting the ability to interpret this indicator. |
When stratifying by children’s age, effect only statistically significant in women with children 12-24m (these are the women that were hardly exposed to antenatal visits)Positive effect on (lower) risk of pregnancy in both Lower (OR=0.40, P<.001) and Upper Egypt (OR=0.67, P<.001)The intervention appears to have had a positive effect on knowledge of optimal birth spacing in Upper Egypt (OR=1.68, P<.001); negative effect on same outcome in Lower Egypt (OR=0.55, P<.001)Positive effect on joint contraceptive decision making in both Lower and Upper Egypt |
| Buser, 202147 | Women who gave birth in the last 13 months: aOR contraceptive use (also referred to as avoiding pregnancy/actively avoiding pregnancy) among those who used the Core MWH Model compared to those who did not: 1.33 (1.08–1.63, P<.05) | ||
| Maru, 201749 | 12 months: postpartum contraceptive prevalence increased from 19.0% to 46.5% (difference=27.5%, 95% CI=20.8% to 34.2%, P<.001). | ||
| Training intervention | |||
| Dhital, 202150 | In the adjusted model, a 25-fold increase in FCHV knowledge had been observed at the post-test [aOR=25.4 (CI=12.6, 50.2), P<.001], and at 1-year post-intervention, it remained approximately 11-fold higher [aOR=10.7(CI=6.3, 18.1), P<.001] as compared to the pre-intervention phase. | ||
Abbreviations: aHR, adjusted hazard ratio; ANC, antenatal care; aOR, adjusted odds ratio; aPR, adjusted prevalence ratio; aRR, adjusted relative risk; CI, confidence interval; CPR, contraceptive prevalence rate; FCHV, female community health volunteer; FP, family planning; IUD, intrauterine device; LAM, lactational amenorrhea method; LARC, long-acting reversible contraceptive; MWH, maternity waiting home; OR, odds ratio; PP, postpartum; PPIUD, postpartum intrauterine device; RD, risk difference; RR, relative risk; SD, standard deviation; SMS, short message service.
Information regarding outcomes largely taken verbatim from the text.