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Scholarly Works (3 results)

  • Thesis
  • Peer Reviewed
UC Berkeley Electronic Theses and Dissertations (2016)

The benefits of family planning are well documented and unequivocal. Allowing women to space or limit pregnancies through access to modern contraceptive methods can empower women to achieve their desired fertility, prevent deaths and disability that result from pregnancy and unsafe abortion, and may lead to broader benefits, such as increased education and economic opportunities for women and their children. Postpartum family planning is defined as the prevention of pregnancy during the 12 months after childbirth, and it has the potential to improve the health of women, infants, and children in less developed countries. Research has shown that short birth-to-conception intervals are associated with adverse infant, child, and maternal outcomes. The World Health Organization recommends postpartum family planning as a critical component of health care that has the potential to meet women’s desire for contraception, and save millions of lives.

Despite the importance of postpartum family planning, some countries continue to face challenges related to improving contraceptive use. Mozambique has had particular difficulty meeting its family planning goals. The fertility rate in Mozambique increased from 5.5 in 2003 to 5.9 in 2011, with the highest levels of fertility found in rural areas (TFR 6.6) and among the poorest (TFR 7.2) and least educated women (TFR 6.8). Estimates from 2011 show that only 13.2% of married Mozambican women age 15-49 years used modern methods of contraception, and the unmet need for family planning is relatively high at 12.8%.

This dissertation establishes the factors associated with postpartum family planning use in Mozambique. The research then aims to describe the contraceptive decision-making processes of postpartum women participating in a community-based injectables project in rural Mozambique. Finally, this dissertation presents a policy analysis of the strategic financing options for the community-based health services delivery program in Mozambique, which is integrally tied to expanding access to postpartum family planning.

    Cover page: Postpartum family planning in Mozambique: Factors for use, decision-making, and the promise of community-based distribution
    • Article
    • Peer Reviewed
    UC Berkeley Previously Published Works (2016)
    We reviewed existing evidence of the efficacy of postpartum family planning interventions targeting women in the 12 months postpartum period in low- and middle-income countries. We searched for studies from January 1, 2004 to September 19, 2015, using the US Preventive Services Task Force recommendations to assess evidence quality. Our search resulted in 26 studies: 11 based in sub-Saharan Africa, six in the Middle East and North Africa, and nine in Asia. Twenty of the included studies assessed health facility-based interventions. Three were focused on community interventions, two had community and facility components, and one was a workplace program. Overall quality of the evidence was moderate, including evidence for counseling interventions. Male partner involvement, integration with other service delivery platforms, such as prevention of mother-to-child transmission of HIV and immunization, and innovative product delivery programs may increase knowledge and use during the postpartum period. Community-based and workplace strategies need a much stronger base of evidence to prompt recommendations.
      Cover page: Postpartum family planning: current evidence on successful interventions.
      • Article
      • Peer Reviewed
      UC Berkeley Previously Published Works (2016)
      Mozambique has witnessed a climbing total fertility rate in the last 20 years. Nearly one-third of married women have an unmet need for family planning, but the supply of family planning services is not meeting the demand. This study aimed to explore the safety and effectiveness of training 2 cadres of community health workers-traditional birth attendants (TBAs) and agentes polivalentes elementares (APEs) (polyvalent elementary health workers)-to administer the injectable contraceptive depot-medroxyprogesterone acetate (DMPA), and to provide evidence to policy makers on the feasibility of expanding community-based distribution of DMPA in areas where TBAs and APEs are present. A total of 1,432 women enrolled in the study between February 2014 and April 2015. The majority (63% to 66%) of women in the study started using contraception for the first time during the study period, and most women (over 66%) did not report side effects at the 3-month and 6-month follow-up visits. Very few (less than 0.5%) experienced morbidities at the injection site on the arm. Satisfaction with the performance of TBAs and APEs was high and improved over the study period. Overall, the project showed a high continuation rate (81.1%) after 3 injections, with TBA clients having significantly higher continuation rates than APE clients after 3 months and after 6 months. Clients' reported willingness to pay for DMPA (64%) highlights the latent demand for modern contraceptives. Given Mozambique's largely rural population and critical health care workforce shortage, community-based provision of family planning in general and of injectable contraceptives in particular, which has been shown to be safe, effective, and acceptable, is of crucial importance. This study demonstrates that community-based distribution of injectable contraceptives can provide access to family planning to a large group of women that previously had little or no access.
        Cover page: Safety and Acceptability of Community-Based Distribution of Injectable Contraceptives: A Pilot Project in Mozambique
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