Implementing postpartum family planning services in rural Rwanda: A mixed-methods study.

Area of Science:

• Public Health
• Reproductive Health
• Global Health

Background:

• Postpartum family planning (PPFP) is vital for reducing adverse maternal and child health outcomes associated with short interpregnancy intervals and unintended pregnancies.
• This study addresses the need to assess PPFP requirements in rural Rwandan health facilities and understand client perspectives on uptake barriers.

Purpose of the Study:

• To evaluate the current state of postpartum family planning (PPFP) services in rural Rwandan government health facilities.
• To identify clients' knowledge, perceptions, and barriers concerning PPFP uptake.

Main Methods:

• A mixed-method approach combining cross-sectional needs assessments in 12 rural facilities and focus group discussions (FGDs) with couples attending antenatal clinics.
• Quantitative data analyzed descriptively; qualitative data analyzed thematically using a deductive approach.

Main Results:

• Limited provider training in implant and postpartum intrauterine device (PPIUD) insertion was observed, particularly at health centers and health posts.
• While counseling is available, clients reported insufficient information on contraceptive mechanisms and side effects, with specific knowledge gaps regarding IUD/PPIUD.
• Service provision data indicated low uptake of postpartum implants and very low PPIUD utilization.

Conclusions:

• There is a clear need for enhanced PPFP training for rural healthcare providers, with a specific focus on PPIUD insertion and management.
• Addressing knowledge gaps and client concerns about contraceptive side effects through tailored demand creation strategies is essential.
• Improving PPFP access and uptake in rural Rwandan clinics requires a dual approach of provider capacity building and community-level education.