Dynamics of Long-Acting and Reversible Contraceptive Adoption During the First Year Postpartum: A Secondary Analysis of the Yam Daabo Cluster Randomized-Controlled Trial in Burkina Faso and DR Congo
Authors: Coulibaly Abou , Millogo Tiéba , Baguiya Adama , Tran Nguyen Toan , Thiéba Blandine , Seuc Armando , Cuzin-Kihl Asa , Landoulsi Sihem , Kiarie James , Yodi Rachel , Mashinda Désiré , Kouanda Séni 
Published: May 2020

Abstract
Background: an earlier adoption of contraceptive methods during the postpartum period could help women to extend the inter-pregnancy interval. This article aimed to determine and compare the timing and dynamics of long-acting and reversible contraceptives (LARC) use (i.e., intra-uterine device and implant) in Burkina Faso (BF) and the DR Congo (DRC).Methods: Study participants were followed up to 12 months postpartum. We used Royston-Parmar's semi-parametric model to estimate the effect of the interventions. All multivariate results were adjusted for covariates found to be imbalanced between the intervention and control groups. We used a Mantel-Haenszel-type method to compare adjusted hazard ratios (aHR) between the two countries. We computed the median time of contraceptive adoption in each group by country.Results: Our analysis included 567 postpartum women in BF (284 in the intervention group and 283 in the control group) and 553 in the DRC (274 in the intervention group and 279 in the control group). Interventions had an effect in LARC use in BF (aHR 1.85; p=0.001) as well as DRC (aHR 2.78; p<0.001), but no difference between the two countries adjusted rate ratios (p=0.344). In both countries, median time to LARC adoption was shorter in the intervention group than control (in BF, difference=39 days; in DRC, difference=86 days).Conclusion: The Yam Daabo intervention package resulted in an increased and earlier adoption of LARC in both rural settings in Burkina Faso and urban settings in DR Congo. Such an intervention could be relevant in similar contexts in Sub-Saharan Africa.Plain English summary: Many studies showed that postpartum family planning use is low and unmet need for contraception following pregnancy is high in low- and middle-income countries. The Yam Daabo cluster-randomised controlled trial showed that a package of six low-technology interventions, designed in a participatory manner and aimed at strengthening routine antenatal and postnatal services in primary health clinics, doubled the proportion of women using short-acting and long-acting reversible modern contraceptives up to 12 months post partum when compared with women using routine care. This paper, which is a secondary analysis of the Yam Daabo trial, focuses on long-acting and reversible contraceptive (LARC) because of their multiples advantages and few disadvantages by reporting the dynamics of LARCs adoption during the first year postpartum. Such an analysis is very relevant because an earlier adoption of LARC in poor countries such as Burkina Faso and the DR Congo, with a high fertility rate, is effective in spacing pregnancies.Yam Daabo’s interventions showed a reduction of the median time of LARCs adoption in the intervention group compared to the control group in both countries (just under 2 months for the median time for LARC adoption in intervention group, difference of 39 days in Burkina Faso; 75 days postpartum for the median time for LARC adoption in intervention group, difference of 86 days in the DR Congo). This is an important point for the decision makers. According to our results, if the women are checked in the six postpartum weeks, as recommended by the WHO about postnatal care in 2013, and exposed to Yam Daabo’s interventions, this might increase an earlier PPFP use and specifically LARC use. Considering the high effectiveness of LARC, this may contribute to prevent unintended pregnancies and extend the inter-pregnancy interval. This is all the more important since most of these countries have very high fertility rates with high unmet needs for contraception. These results have important programmatic implications for countries with similar context.