Linking provision of postpartum contraception to infant vaccination care is feasible and acceptable in rural India, conditional on addressing resource-related barriers to family planning provision in this setting, finds this study.
Authors
Sarah Averbach, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, 9300 Campus Point Drive #7433, San Diego, La Jolla, 92037, CA 92037-7433, 92037, United States of America; Center on Gender Equity and Health, University of California San Diego School of Medicine, San Diego, La Jolla, CA, USA.
Edwin Elizabeth Thomas, Center of Gender Equity and Health, University of California San Diego, Delhi, India.
Gennifer Kully, Center on Gender Equity and Health, University of California San Diego School of Medicine, La Jolla, San Diego, CA, United States of America.
Melody Nazarbegian, University of California San Diego School of Medicine, La Jolla, CA, United States of America.
Mohan Ghule, Center of Gender Equity and Health, University of California San Diego, Delhi, India.
Borsika A. Rabin, Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, United States of America; UC San Diego Altman Clinical and Translational Research Institute Dissemination and Implementation Science Center, University of California San Diego, La Jolla, CA, USA.
Anita Raj, Center on Gender Equity and Health, University of California San Diego School of Medicine, La Jolla, San Diego, CA, United States of America.
Nandita Bhan, Center on Gender Equity and Health, University of California San Diego, Delhi, India; Professor, Jindal School of Public Health and Human Development, O.P. Jindal Global University, Sonipat, Haryana, India.
Summary
Linking family planning with infant vaccination care has the potential to increase contraceptive use among postpartum women in rural settings. We explored the multilevel factors that can facilitate or impede uptake of contraception at the time of infant vaccination among postpartum women and couples in rural Maharashtra, India.
Methods
We conducted 60 semi-structured interviews with key stakeholders including: postpartum married women (n = 20), husbands (n = 10), and mothers-in-law (n = 10) of postpartum women, frontline healthcare workers (auxiliary nurse midwives (ANMs) and Accredited Social Health Activists (ASHAs), (n = 10), and community leaders (physician medical officers and village panchayat leaders) (n = 10). We sought to assess the feasibility and acceptability of delivering community-based postpartum family planning care in rural India at the time of infant vaccination. The Consolidated Framework for Implementation Research (CFIR) was used to design a structured interview guide and codebook. Data were analyzed via directed content analysis.
Results
Three major themes emerged: (1) Social fertility and gender norms including son preference and male control over contraceptive decision-making influence postpartum contraceptive access and choice. (2) Linking contraceptive care and infant vaccination is perceived as potentially feasible and acceptable to implement by families, health workers, and community leaders. The intervention provides care to women and families in a convenient way where they are in their community. (3) Barriers and facilitators to linked infant postpartum contraception and infant vaccination were identified across the five CFIR domains.
Key barriers included limited staff and space (inner setting), and contraceptive method targets for clinics and financial incentives for clinicians who provide specific methods (outer setting). Key facilitators included convenience of timing and location for families (intervention characteristics), the opportunity to engage husbands in decision-making when they attend infant vaccination visits (participant characteristics), and programmatic support from governmental and community leaders (process of implementation).
Conclusions
Linked provision of family planning and infant vaccination care may be feasible and accessible in rural India utilizing strategies identified to reduce barriers and facilitate provision of care. A gender-transformative intervention that addresses gender and social norms has greater potential to impact reproductive autonomy and couples’ contraceptive decision-making.
Published in: BMC Pregnancy and Childbirth
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