We aimed to identify
effective behaviour change techniques to increase modern contraceptive use in
low and middle income countries (LMICs). Literature was identified in Global
Health, Web of Science, MEDLINE, PsycINFO and Popline, as well as peer reviewed
journals. Articles were included if they were written in English, had an
outcome evaluation of contraceptive use, modern contraceptive use,
contraceptive initiation/uptake, contraceptive adherence or continuation of
contraception, were a systematic review or randomised controlled trial, and
were conducted in a low or middle income country. We assessed the behaviour
change techniques used in each intervention and included a new category of male
partner involvement. We identified six studies meeting the inclusion criteria.
The most effective interventions were those that involve male partner
involvement in the decision to initiate contraceptive use. The findings also
suggest that providing access to contraceptives in the community promotes their
use. The interventions that had positive effects on contraceptive use used a
combination of behaviour change techniques. Performance techniques were not
used in any of the interventions. The use of social support techniques, which
are meant to improve wider social acceptability, did not appear except in two
of the interventions. Our findings suggest that when information and
contraceptives are provided, contraceptive use improves. Recommendations
include reporting of behaviour change studies to include more details of the
intervention and techniques employed. There is also a need for further research
to understand which techniques are especially effective...
The most effective interventions appear to be those that
involve male partner involvement in the decision to initiate contraceptive use [11]–[14]. This is shown
in Table 3. However, two of
these studies [11], [13] consisted of
self-reporting of contraceptive use either in the presence of the male partners
or by the male partners. As the methods included in the studies were female user
dependent (pills and injectables), this could affect the validity of the
results, as male partners may not have been present when their female partners
used the contraceptive.
The studies conducted among post-partum women suggest that
interventions targeting women only are not as effective as those that target
couples. In the Bashour et al. [15] study using
educative post-natal home visits by midwives in Syria, there was no significant
difference in contraceptive uptake between research arms for contraceptive use
(42 %, 37 % and 40.5 %). This low evidence of effectiveness is
congruent with a Cochrane review on post-natal education, which found low
evidence of effectiveness and suggested further research [8].
The findings also suggest that providing immediate
access to contraceptives in the community promotes their use. Trials of
interventions that included onsite provision, as opposed to referral to health
facilities, [12]–[14] showed better
uptake than the other studies that did not provide the contraceptives.
However, the uptake in all the studies were fairly modest. While the study by
Stephenson et al on serodiscordant couples appeared to be effective, it was
conducted among HIV positive serodiscordant and concordant couples. This could
affect how the intervention is used with other target groups, as the HIV status
of the couples could be a major determinant in whether they use family planning [14]...
Full article
at:
1Public Health Practitioner, Lusaka Trust
Hospital, 2191, Nsumbu road, Lusaka, Zambia
2Nuffield Centre for International Health
and Development, Leeds Institute of Health Sciences, Clarendon Road, Leeds LS2
9LJ, UK
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