Dr. Kirsten Black (University of Sydney): Post-Partum Contraceptive Choice Research in PNG
Overview
In Papua New Guinea (PNG), maternal and neonatal health remains a significant challenge, with high rates of maternal mortality and unintended pregnancies. The availability and use of effective contraception are crucial in addressing these issues. With the support of the Women’s Plans Foundation, Dr. Kirsten Black led a pioneering project aimed at improving access to postpartum contraceptive implants at Port Moresby General Hospital (PMGH). This case study explores the project’s journey, objectives, and impactful findings.
The Problem
PNG has one of the highest maternal mortality rates in the world, with many women facing significant risks during pregnancy and childbirth. Contraceptive use in the country is low, particularly in rural areas, leading to a high incidence of unintended pregnancies. These pregnancies often result in unsafe abortions and severe maternal health complications. Long-acting reversible contraceptives (LARCs), such as contraceptive implants, offer a promising solution by providing effective, long-term protection against pregnancy. However, awareness and acceptance of these methods remain limited.
Project Overview
Official Project Name
Post-partum contraceptive choice: A survey of mothers at Port Moresby General Hospital.
Project Location
Port Moresby, Papua New Guinea
Project Description
In response to the pressing need for better contraceptive options, Port Moresby General Hospital (PMGH) introduced a midwife-led service in 2016 to educate women about postpartum contraceptive implants and provide these implants immediately after childbirth. Funded by the Women’s Plans Foundation, this project, led by Dr. Kirsten Black, aimed to understand the factors influencing the uptake of contraceptive implants and to identify barriers to their acceptance.
Project Goals
The primary goals of the project were:
Assess Impact of Education: Evaluate the effect of antenatal education on the uptake of contraceptive implants.
Identify Barriers: Understand the barriers to the acceptance of postpartum contraceptive implants.
Provide Insights: Offer actionable insights to improve family planning services in low-resource settings.
The Study
Methodology
The study surveyed 2082 women at PMGH who had given birth to a single, live baby. Among these women, 531 (25.5%) chose to receive the contraceptive implant. The study involved detailed interviews with both groups – those who accepted the implant and those who did not – to identify influencing factors and barriers.
Findings
The research revealed several critical insights:
No Prior Contraception Use: Women without prior contraception use were more likely to choose the implant.
Unplanned Pregnancies: Women with unplanned pregnancies showed a higher likelihood of opting for the implant.
Antenatal Education: Antenatal education about contraceptive implants significantly increased the likelihood of their uptake.
Interviews highlighted a clear understanding of the benefits of family planning and a preference for the implant due to its convenience. Conversely, those who declined the implant often cited a lack of knowledge and misconceptions about side effects as major barriers.
Supporting Research Context
Additional research conducted in rural PNG further supports the effectiveness of LARCs in reducing maternal and neonatal morbidity and mortality. For instance, a study on Karkar Island found significant reductions in adverse birth outcomes following the introduction of contraceptive implants. These findings align with Dr. Black’s study, underscoring the broader potential of LARCs in improving maternal health in low-resource settings.
Impact and Outcomes
The project demonstrated the significant impact of targeted education and the provision of contraceptive implants on improving postpartum contraceptive choices among women in PNG. Key outcomes include:
Increased Likelihood of Choosing the Implant: Women were 1.3 times more likely to choose the implant if they had no prior contraception use.
Influence of Unplanned Pregnancy: Women were 1.3 times more likely to choose the implant if they had an unplanned pregnancy.
Antenatal Education: Women were 1.6 times more likely to choose the implant if they received antenatal education about it.
Conclusion
The project led by Dr. Kirsten Black, with the support of the Women’s Plans Foundation, has made significant strides in enhancing postpartum contraceptive choices in Papua New Guinea. By addressing knowledge gaps and misconceptions, the initiative has empowered women with the information and tools needed to make informed decisions about their reproductive health. This case study highlights the critical role of education and support in advancing women's health in low-resource settings.
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