title: The Impact of Balanced Counseling on Contraceptive Method Choice and Determinants of Long Acting and Reversible Contraceptive Continuation in Nepal.
abstract: Introduction Long-acting reversible contraceptives (LARCs) reduce rates of unintended pregnancies and repeat abortion. Uptake and continuation rates of LARCs are very low in Nepal, despite free provision from most health facilities. We sought to establish the effectiveness of a new approach to LARC promotion in Nepal. Methods We examined change in contraceptive method mix in Nepal using service data resulting from introduction of a balanced counseling (BC) approach to family planning (FP). All staff located at nine randomly selected FP sites were trained and began applying BC in April and May 2014. Women who accepted LARCs from a participating facility were re-contacted at 1, 3, 6 and 12 months. We estimated the LARC continuation rate and assessed determinants of continuation using descriptive analysis, Kaplan-Meier survival curves and univariate and multivariate Cox proportional hazard analysis. Results A total of 5744 women received BC between April and July 2014. 1580 women (27.5 %) took up LARCs, raising its contribution to contraceptive method mix at [organization] to 40 %, significantly higher than the 15 % recorded in 2013. 913 women were followed-up, and the LARC continuation rate at 12 months was 82 %. Women's reported satisfaction with LARC [AHR 0.23; 95 % CI 0.14-0.39, p = 0.000] was the single strongest determinant of LARC continuation after adjusting for all background characteristics. Discussion The findings suggest BC is an effective approach for increasing LARC uptake in Nepal. The rate of LARC continuation and its determinants are important inputs to strategies for improved delivery of FP services.
authors.affiliation: Marie Stopes International, 1 Conway Street, Fitzroy Square, London, W1T 6LP, UK. devkotasabitri@hotmail.com.
authors.forename: Sabitri
authors.initials: S
authors.lastname: Sapkota
authors.affiliation: Sunaulo Parivar Nepal, GPO Box 11254, Kathmandu, Nepal.
authors.forename: Ruchita
authors.initials: R
authors.lastname: Rajbhandary
authors.affiliation: Sunaulo Parivar Nepal, GPO Box 11254, Kathmandu, Nepal.
authors.forename: Shilpa
authors.initials: S
authors.lastname: Lohani
mesh_terms: D000293:Adolescent; D000328:Adult; D002755:Choice Behavior; D015331:Cohort Studies; D003267:Contraception / Q000379:methods*; D003271:Contraceptive Agents, Female / Q000627:therapeutic use; D003376:Counseling; D005193:Family Planning Services; D005260:Female; D006801:Humans; D000075523:Long-Acting Reversible Contraception; D009390:Nepal; D011247:Pregnancy; D049168:Pregnancy, Unplanned; D055815:Young Adult
chemical_list: D003271:Contraceptive Agents, Female
keywords: Balanced counselling; Continuation; LARC; Method mix; Nepal