Authors: Nandini Choudhury, Wan-Ju Wu, Rekha Khatri, Aparna Tiwari, Aradhana Thapa, Samrachna Adhikari, Indira Basnett, Ved Bhandari, Aasha Bhatta, Bhawana Bogati, Laxman Datt Bhatt, David Citrin, Scott Halliday, Sonu Khadka, Yashoda Kumari Bhat Ksetri, Lal Bahadur Kunwar, Kshitiz Rana Magar, Nutan Marasini, Duncan Maru, Isha Nirola, Rashmi Paudel, Bala Rai, Ryan Schwarz, Sita Saud, Dikshya Sharma, Goma Niroula Shrestha, Ramesh Shrestha, Poshan Thapa, Hari Jung Rayamazi, Sheela Maru, Sabitri Sapkota
Postpartum contraceptive counseling and access are challenging in Nepal’s remote, hilly areas, leading to a high unmet need for contraception. Community health workers (CHWs) are crucial in these regions, but the best model for their use is unclear. A pilot program in two rural Nepalese districts employed full-time, salaried, and supervised CHWs to deliver a reproductive, maternal, newborn, and child health (RMNCH) intervention, including person-centered contraceptive counseling. Using a hybrid effectiveness-implementation study approach, it conducted a non-randomized pre-post study to assess the intervention’s impact over five years. It found a significant increase in postpartum contraceptive use after the intervention, particularly in early and late postpartum periods. CHWs’ long-term engagement built trust and likely boosted modern contraceptive uptake, although barriers like fear of side effects, limited autonomy, peer influence, and contraceptive unavailability persisted. Implementation was also hindered by distance, difficult terrain, and longer travel times during the rainy season. This study offers insights for improving postpartum contraception through community-based interventions in similar settings.
Resource Topic: Contraception
Resource Type: Evaluation
Year: 2024
Region:
Country: Nepal
Publisher May Restrict Access: No