Table 3.
Included studies by author, year, location, intervention description, and quality of the evidence
| (Author, year) (Country) | Intervention description | Assessment: quality of the evidence* | Effectiveness |
|---|---|---|---|
| (Hoke et al 2014)23 (South Africa) | Provider training on RH services for HIV+ women; IUD insertion and removal; supply management; referral system for female sterilization. | II-3, Poor | Knowledge: Mixed results |
| (Mullany et al 2010)20 (Nepal) | Education: Male involvement: two 35-minute counseling sessions in a private room at hospital during ANC and a second session 4–6 weeks later. Group A: husband + wife; Group B: wife alone; Group C: no education. | I, Good | Knowledge: Positive results |
| (Sarnquist et al 2014)21 (Zimbabwe) | Provider training in PMTCT–FP integration: three 90-minute sessions with 12 participants each. Intervention and controls received care with two 5-day FP trainings in counseling, and IUD and implant insertion and removal. | II-2, Fair | Knowledge: Positive results PPFP use: No effect PPFP use by method type: No effect Intention: No effect |
| (Varkey et al 2006)22 (India) | Education: Male involvement: individual or same-sex group counseling for women and husbands on: STIs, correct use of condoms, and use as dual protection at ANC visit and 6 months PP. | II-2, Fair | Knowledge: Positive results PPFP use: Positive results PPFP use by method type: No effect Intention: Positive results |
| (Lee et al 2011)39 (Taiwan) | Education: Group A received bedside health education in PP ward with pamphlets, and one pamphlet to take home and telephone reminders. Group B received the pamphlet only. Controls received routine PP education, a 10–15-minute talk by a nurse with a pamphlet, but without interactive design. | I, Fair | Knowledge: No effect PPFP use: No effect |
| (Vance et al 2014)38 (Ghana and Zambia) | Integration: FP–immunization; trained vaccinators to screen for pregnancy risk, provide individual counsel and referral for FP during immunization visit. | I, Fair | Knowledge: No effect PPFP use: No effect |
| (Tazhibayev et al 2004)24 (Kazakhstan) | Providers trained to counsel on the benefits of LAM as an FP method, lactation management, and breastfeeding using WHO/UNICEF 18-hour course and 20-hour course on LAM. Compared baby friendly hospitals (BFH), BFH with augmented training, ordinary hospitals (OH), and OH with augmented training. | II-3, Fair | Knowledge: Mixed results PPFP use: Mixed results |
| (Abdel-Tawab et al 2008)33 (Egypt) | Education: Group 1 (health services model) received birth spacing messages during pre- and postnatal visits. Group 2 (community awareness model) included health services model plus awareness for men through community activities. Both groups received home visits to PP women up to 12 months PP. Group 3 was control. | II-2, Poor | Knowledge: No effect PPFP use: Positive results Occurrence of pregnancy: No effect |
| (Sebastian et al 2012)25 (India) | Education: Campaigns by community workers educated pregnant women, mothers-in-law, and men about PPFP in intervention blocks. | II-2, Fair | Knowledge: Positive results PPFP use: Positive results PPFP use by method type: No effect |
| (Adanikin et al 2013)26 (Nigeria) | Women were randomized during the third trimester in ANC: receive either multiple individual counseling sessions or SOC (one individual session at the 6-week postnatal check). | I, Good | PPFP use: Positive results PPFP use by method type: No effect |
| (“Research Findings: Integration of Postpartum Family Planning with Child Immunization Services in Rwanda” 2013)27 (Rwanda) | Integration: FP–immunization; 14 facilities randomized messages provided in group sessions during immunization visits. Providers screen for pregnancy risk and provide counseling and services or referral for FP. | II-2, Fair | PPFP use: Positive results |
| (Saeed et al 2008)30 (Pakistan) | Education: Couples counseling intervention group received 20-minute counseling with husband or mother-in-law in the PP ward; Measurement at 8–12 week PP follow-up | I, Fair | PPFP use: Positive results PPFP use by method type: Positive results Intention: Positive results |
| (Shaaban et al 2013)28 (Egypt) | Education: PP contraceptive counseling. LAM-EC group got LAM + counseling on EC + one free pack of EC. Advised to use only once and then initiate regular FP. LAM group: no counseling on EC or EC packet. | I, Good | PPFP use: Positive results PPFP use by method type: Positive results Occurrence of pregnancy: Positive results |
| (Akman et al 2010)40 (Turkey) | Education: Individual 30-minute PP contraception counseling with visual aids. Controls received a leaflet during the third trimester visit with questions answered at time leaflet was given. | I, Fair | PPFP use: No effect PPFP use by method type: No effect |
| (Dhont et al 2009)34 (Rwanda) | Education: Contraception counsel at each visit ANC and PP. Women at Site A were referred to FP services where LARCs were occasionally available. Women at Site B were offered implants and IUD onsite and referred for short-acting methods. Women at both sites were referred for sterilization. Fees varied across methods and sites. | II-2, Fair | PPFP use: No effect PPFP use by method type: Positive results |
| (Huang et al 2014)31 (People’s Republic of China) | Education: Couple counseling on: fertility return, benefits/risks of long and short-acting contraception, resumption of sex, risks of unintended pregnancy, and pamphlet. Women could receive LARCs or condoms prior to discharge. Other modern methods available at follow-up visits. | II-2, Good | PPFP use: Positive results |
| (Sahip and Turan 2007)41 (Turkey) | Education: Male involvement study trained workplace doctors to provide six education sessions of 3–4 hours each for expectant fathers, covering maternal and child health and PPFP. | II-2, Fair | PPFP use: Mixed results |
| (Bashour et al 2008)42 (Syria) | Group A received four home visits at 1 day, 3 days, 7 days, and 4 weeks postpartum by registered midwives with 5 days training, including choices and plan for FP. Group B got one home visit on day 3. Group C got no visit. | I, Fair | PPFP use: No effect PPFP use by method type: No effect Occurrence of pregnancy: No effect |
| (Ahmed et al 2015)32 (Bangladesh) | Service delivery: Standard of care includes home visits at pregnancy, 6 days PP, and 29–35 days PP. Additional visits in intervention arm included home visits at 2–3 months and 4–5 months focused on PPFP. Intervention CHWs provided pills, condoms, and follow-up injectables. | II-2, Fair | PPFP use: Positive results PPFP use by method type: Positive results |
| (Kunene et al 2004)44 (South Africa) | Education: Male involvement study included three interactive counseling sessions (two ANC and one at 6 weeks PP) in groups, including an ANC booklet for women to read and share with partners. | I, Poor | PPFP use: No effect PPFP use by method type: No effect |
| (Warren et al 2008)45 (Lesotho) | Integration: PMTCT/FP trained nurses to provide three consultations with checklist for mother and baby at 48 hours, 1–2 weeks, and 6 weeks. | II-3, Poor | PPFP use by method type: Mixed results Intention: Negative results |
| (Mazia et al 2009)35 (Swaziland) | Integration: PMTCT/FP provider training, and increased number of consultations with mother and baby, and integrated health checks. | II-3, Fair | Intention: Positive results |
| (Warren et al 2010)36 (Kenya) | Integration: PMTCT/FP trained providers to conduct three consultations with checklist for mother and baby at 48 hours, 1–2 weeks, and 6 weeks PP. | II-3, Fair | Intention: Positive results |
| (Tawfik et al 2014)37 (Afghanistan) | Quality: Intervention includes QI processes and a PPFP change package, including private FP counseling space, and FP counseling training for staff, involving husbands and mother-in-laws. Women choosing FP referred to a private contractor for method. | II-2, Fair | Occurrence of pregnancy: Positive results |
| (Ayiasi et al 2015)46 (Uganda) | Service delivery: Women presenting at ANC at intervention clinics were followed with home visits by village health workers and offered counseling, but not products, related to PPFP during the prenatal period in their homes. Women presenting at ANC at control clinics were offered routine ANC offered in the clinics. | I, Fair | PPFP use: No effect Occurrence of pregnancy: No effect |
| (Topatan and Demirci 2015)29 (Turkey) | Education: The experimental group received a training of four sessions over 4 hours, including information on anatomy, FP, STDs, and cancers. The control group received routine discharge training over 30 minutes, including discussion of breastfeeding but not FP. | II-1, Fair | PPFP use: Positive results |
Notes:
*
We assessed the risk of bias according to the domains in the Newcastle–Ottawa Scale for nonrandomized studies and the Cochrane Handbook for randomized controlled trials. These domains included: study design (selection, assignment, and comparability of comparison and control groups), attrition, spillover and contamination, quality of intervention description and implementation, representativeness of the study groups, and sample size. We used the US Preventive Services Task Force to assign the strength of study design. Taken together, the US Preventive Services Task Force classification and risk of bias assessment were used to identify the quality of the evidence presented in each included study.
Abbreviations: ANC, antenatal care; EC, emergency contraception; FP, family planning; IUD, intrauterine device; LAM, lactational amenorrhea method; PMTCT, prevention of mother-to-child transmission; PP, postpartum; PPFP, postpartum family planning; UNICEF, United Nations International Children’s Emergency Fund; WHO, World Health Organization; RH, reproductive health; STI, sexually transmitted infection; SOC, standard of care; CHWs, community health workers; QI, quality improvement; STDs, sexually transmitted diseases.