Evaluation of a community-based counseling and longitudinal follow-up intervention on uptake of postpartum contraception in rural Nepal: A prospective mixed methods study
Awarded 2017
Complex Family Planning Fellowship Research
Wan-Ju Wu, MD, MPH
Planned Parenthood League of Massachusetts

Unmet need for postpartum contraception in rural Nepal remains high. Strategies that integrate contraceptive counseling along the continuum of reproductive health care are more effective than single isolated counseling sessions. Through a public-private partnership, Possible, an NGO, is utilizing a system of intensive Community Health Worker (CHW) outreach to deliver antenatal, postnatal, and infant care. The CHWs integrate structured contraceptive counseling at multiple visits during antenatal and postnatal care. CHW services are bolstered by strong referral linkages to health care facilities. 
To evaluate the effect of a longitudinal CHW contraceptive counseling intervention on postpartum modern contraceptive uptake and method mix.
This is a quasi-experimental repeated cross-sectional study nested within a larger prospective, longitudinal cohort study conducted in seven village clusters in rural Nepal. Data were collected by CHWs using mobile phones The primary outcome was modern contraceptive use among recently postpartum women pre-intervention as compared to a similar group one year into implementation of the intervention. Bivariate analyses were performed for baseline characteristics including age, caste, monthly household expenses, postpartum time, and sex of child in index pregnancy to determine significant differences between the two groups. For our primary outcome we used multivariate logistic regression with covariates selected based on content knowledge.
There were 445 women are in the pre-intervention group and 510 in the intervention group. Modern contraceptive use increased from 29.4% pre-intervention to 46.1% in the intervention group. Adjusting for age, caste, household expenses, postpartum time, and sex of child in index delivery women in our intervention group had twice the odds of using a modern contraceptive method as compared to the pre-intervention group.
A community-based structured contraceptive counseling intervention integrated into longitudinal care delivered by professionalized CHWs in the home is feasible in rural Nepal and effective in increasing use of modern contraceptive methods.