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Background <p>Postpartum contraceptive counseling and access are challenging in Nepal’s remote, hilly areas, driving a disproportionately high unmet need for contraception. Community health workers (CHWs) play an important role in delivering healthcare in difficult to reach places, but there is limited evidence from professionalized CHW models and their impact over time in Nepal. We implemented a pilot program in two rural districts in Nepal where full-time, salaried, and supervised CHWs delivered a bundled reproductive, maternal, newborn, and child health (RMNCH) intervention. This included contraceptive counseling adapted from the <i>Balanced Counseling Strategy</i>. Here we describe postpartum contraceptive outcomes associated with the integrated RMNCH intervention over a five-year period.</p> Methods <p>Applying a type 2 hybrid effectiveness-implementation approach, we conducted a non-randomized pre-post study with repeated measurements and nested qualitative data collection to study the intervention’s reach, effectiveness, adoption, implementation, and maintenance.</p> Results <p>Compared to the pre-intervention period, we observed higher ward-level post-intervention postpartum contraceptive prevalence, stratified by early postpartum (RR: 2.20; 95% CI: 1.96, 2.48) and late postpartum (RR: 1.70; 95% CI: 1.50, 1.93), after adjusting for district and intervention site. Lactational amenorrhea method (LAM) was the most common method during early postpartum in most intervention sites. The proportion of women who switched to other effective methods after LAM was relatively low. Qualitative data indicated that CHWs’ longitudinal engagement with participants helped facilitate contraceptive counseling and uptake despite challenges such as participants’ fear of side effects, limited autonomy for women, and peer influence.</p> Conclusions <p>Our findings suggest the integrated RMNCH intervention’s potential to increase modern contraceptive uptake in low-resource community settings and underscore CHWs’ ability to help drive longer-term change in their communities, especially around sensitive topics. This study contributes to the implementation research literature on community-based interventions to improve postpartum contraception use and may inform other CHW programs in similar contexts.</p> Trial registration <p>ClinicalTrials.gov Identifier:&#xa0;NCT03371186, registered 04 December 2017, retrospectively registered.</p>

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“Now that they come to our doorsteps to teach us these things…” – Postpartum contraception outcomes from a pre-post effectiveness-implementation study of an integrated community health worker intervention in rural Nepal

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年12月22日

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  • Nandini Choudhury,
  • Wan-Ju Wu,
  • Rekha Khatri,
  • Aparna Tiwari,
  • Aradhana Thapa,
  • Samrachana 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 Devi Niraula,
  • Ramesh Shrestha,
  • Poshan Thapa,
  • Hari Jung Rayamazi,
  • Sheela Maru,
  • Sabitri Sapkota

摘要

Background

Postpartum contraceptive counseling and access are challenging in Nepal’s remote, hilly areas, driving a disproportionately high unmet need for contraception. Community health workers (CHWs) play an important role in delivering healthcare in difficult to reach places, but there is limited evidence from professionalized CHW models and their impact over time in Nepal. We implemented a pilot program in two rural districts in Nepal where full-time, salaried, and supervised CHWs delivered a bundled reproductive, maternal, newborn, and child health (RMNCH) intervention. This included contraceptive counseling adapted from the Balanced Counseling Strategy. Here we describe postpartum contraceptive outcomes associated with the integrated RMNCH intervention over a five-year period.

Methods

Applying a type 2 hybrid effectiveness-implementation approach, we conducted a non-randomized pre-post study with repeated measurements and nested qualitative data collection to study the intervention’s reach, effectiveness, adoption, implementation, and maintenance.

Results

Compared to the pre-intervention period, we observed higher ward-level post-intervention postpartum contraceptive prevalence, stratified by early postpartum (RR: 2.20; 95% CI: 1.96, 2.48) and late postpartum (RR: 1.70; 95% CI: 1.50, 1.93), after adjusting for district and intervention site. Lactational amenorrhea method (LAM) was the most common method during early postpartum in most intervention sites. The proportion of women who switched to other effective methods after LAM was relatively low. Qualitative data indicated that CHWs’ longitudinal engagement with participants helped facilitate contraceptive counseling and uptake despite challenges such as participants’ fear of side effects, limited autonomy for women, and peer influence.

Conclusions

Our findings suggest the integrated RMNCH intervention’s potential to increase modern contraceptive uptake in low-resource community settings and underscore CHWs’ ability to help drive longer-term change in their communities, especially around sensitive topics. This study contributes to the implementation research literature on community-based interventions to improve postpartum contraception use and may inform other CHW programs in similar contexts.

Trial registration

ClinicalTrials.gov Identifier: NCT03371186, registered 04 December 2017, retrospectively registered.