Assessing the impact of a postpartum intrauterine device intervention on contraceptive decision-making - PROJECT SUMMARY/ABSTRACT Significance: Long-acting reversible contraceptives (LARCs) are recommended first-line as they are safe and highly effective. Yet LARCs are not widely adopted in low- and middle-income countries (LMICs). Over the last decade, family planning programs have increasingly promoted LARCs in LMICs. While ensuring LARC access is imperative, overzealous promotion of LARC initiation or limited access to LARC removal services may inhibit reproductive autonomy. Women without reproductive autonomy face adverse health outcomes, have increased medical mistrust, and are less likely to utilize contraception. Yet, no quantitative studies have examined the impact of LARC promotional programs on reproductive autonomy in LARC initiation and discontinuation. Specific Aims: The proposed project will (1) assess whether a postpartum intrauterine device (IUD) intervention was associated with perceived pressure to adopt contraception that influenced contraceptive decision-making, (2) examine longitudinal patterns of IUD removal and access to removal by marital status, parity, and pressure to adopt contraception, and (3) qualitatively understand women’s experiences with autonomy when seeking IUD removal. Approach: The proposed analyses will utilize data collected by the Postpartum Intrauterine Device (PPIUD) Study, a step-wedged cluster randomized trial of a postpartum IUD intervention that was conducted in Tanzania and Nepal. The intervention involved provider training in contraceptive counseling and PPIUD insertions. Aim 1 will utilize multinomial logistic regression to estimate the association between the intervention and a novel, person-centered measure of reproductive autonomy, whether perceived pressure to adopt contraception influenced contraceptive decision-making. Aim 2 will apply robust survival analysis techniques to examine whether sociodemographic factors are associated with access to IUD removal over time. Aim 3 will use an explanatory mixed-methods approach to contextualize findings by qualitatively exploring women’s experiences with autonomy when seeking IUD removal services. Fellowship Information: The applicant is a PhD student in epidemiology at the University of North Carolina at Chapel Hill (UNC), a predoctoral trainee in an NICHD-funded T32 training program in reproductive epidemiology, and a predoctoral trainee in population sciences at the Carolina Population Center. Through interdisciplinary training and mentorship that spans public health, social science, medicine, and bioethics and integrates causal inference and mixed-methods approaches and UNC’s rigorous and collaborative research environment, the proposed training plan will provide the applicant with the resources she needs to successfully complete her doctoral dissertation and pursue her long-term goal of becoming an independent investigator focused on reproductive epidemiology and family planning.
