{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,23]],"date-time":"2026-06-23T04:02:55Z","timestamp":1782187375686,"version":"3.54.5"},"reference-count":25,"publisher":"BMJ","issue":"3","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Sex Reprod Health"],"accepted":{"date-parts":[[2020,8,25]]},"published-print":{"date-parts":[[2021,7]]},"abstract":"<jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>Postpartum family planning (PPFP) is critical to reduce maternal\u2013child mortality, abortion and unintended pregnancy. As in most countries, the majority of PP women in Rwanda have an unmet need for PPFP. In particular, increasing use of the highly effective PP long-acting reversible contraceptive (LARC) methods (the intrauterine device (IUD) and implant) is a national priority. We developed a multilevel intervention to increase supply and demand for PPFP services in Kigali, Rwanda.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We implemented our intervention (which included PPFP promotional counselling for clients, training for providers, and Ministry of Health stakeholder involvement) in six government health facilities from August 2017 to October 2018. While increasing knowledge and uptake of the IUD was a primary objective, all contraceptive method options were discussed and made available. Here, we report a secondary analysis of PP implant uptake and present already published data on PPIUD uptake for reference.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Over a 15-month implementation period, 12\u2009068 women received PPFP educational counselling and delivered at a study facility. Of these women, 1252 chose a PP implant (10.4% uptake) and 3372 chose a PPIUD (27.9% uptake). On average providers at our intervention facilities inserted 83.5 PP implants\/month and 224.8 PPIUDs\/month. Prior to our intervention, 30 PP implants\/month and 8 PPIUDs\/month were inserted at our selected facilities. Providers reported high ease of LARC insertion, and clients reported minimal insertion anxiety and pain.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>PP implant and PPIUD uptake significantly increased after implementation of our multilevel intervention. PPFP methods were well received by clients and providers.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjsrh-2020-200741","type":"journal-article","created":{"date-parts":[[2020,9,16]],"date-time":"2020-09-16T17:27:17Z","timestamp":1600277237000},"page":"173-178","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":11,"title":["Postpartum long-acting contraception uptake and service delivery outcomes after a multilevel intervention in Kigali, Rwanda"],"prefix":"10.1136","volume":"47","author":[{"given":"Julie","family":"Espey","sequence":"first","affiliation":[{"name":"Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosine","family":"Ingabire","sequence":"additional","affiliation":[{"name":"Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA"},{"name":"Projet San Francisco, Kigali, Rwanda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julien","family":"Nyombayire","sequence":"additional","affiliation":[{"name":"Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA"},{"name":"Projet San Francisco, Kigali, Rwanda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra","family":"Hoagland","sequence":"additional","affiliation":[{"name":"Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA"},{"name":"Projet San Francisco, Kigali, Rwanda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vanessa","family":"Da Costa","sequence":"additional","affiliation":[{"name":"Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amelia","family":"Mazzei","sequence":"additional","affiliation":[{"name":"Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA"},{"name":"Projet San Francisco, Kigali, Rwanda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa B","family":"Haddad","sequence":"additional","affiliation":[{"name":"Department of Gynecology and Obstetrics, School of Medicine, Emory University, Atlanta, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel","family":"Parker","sequence":"additional","affiliation":[{"name":"Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeannine","family":"Mukamuyango","sequence":"additional","affiliation":[{"name":"Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA"},{"name":"Projet San Francisco, Kigali, Rwanda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Victoria","family":"Umutoni","sequence":"additional","affiliation":[{"name":"Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan","family":"Allen","sequence":"additional","affiliation":[{"name":"Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Etienne","family":"Karita","sequence":"additional","affiliation":[{"name":"Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA"},{"name":"Projet San Francisco, Kigali, Rwanda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amanda","family":"Tichacek","sequence":"additional","affiliation":[{"name":"Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8547-2004","authenticated-orcid":false,"given":"Kristin M","family":"Wall","sequence":"additional","affiliation":[{"name":"Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA"},{"name":"Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2020,9,16]]},"reference":[{"key":"2025090221243409000_47.3.173.1","unstructured":"Muthal-Rathore A . Immediate postpartum insertion for intrauterine devices: RHL commentary Geneva: the WHO Reproductive Health Library, 2010. Available: http:\/\/cms.kcn.unima.mw:8002\/moodle\/downloads\/Department%20of%20Maternal%20&%20Child%20Health\/who%20videos\/apps.who.int\/rhl\/fertility\/contraception\/cd003036_muthalrathorea_com\/en\/index.html [Accessed 3 Aug 2018]."},{"key":"2025090221243409000_47.3.173.2","unstructured":"World Health Organization (WHO) . Medical eligibility criteria for contraceptive use. Geneva: WHO Press, 2015. Available: http:\/\/www.who.int\/reproductivehealth\/publications\/family_planning\/Ex-Summ-MEC-5\/en\/ [Accessed 3 Aug 2018]."},{"key":"2025090221243409000_47.3.173.3","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1016\/j.contraception.2015.03.007","article-title":"Missed opportunities for family planning: an analysis of pregnancy risk and contraceptive method use among postpartum women in 21 low- and middle-income countries","volume":"92","author":"Moore","year":"2015","journal-title":"Contraception"},{"key":"2025090221243409000_47.3.173.4","unstructured":"Government of Rwanda Ministry of Health . Family planning 2020 commitment 2017. Available: http:\/\/ec2-54-210-230-186.compute-1.amazonaws.com\/wp-content\/uploads\/2018\/02\/Govt.-of-Rwanda-FP2020-Commitment-2018-Update.pdf [Accessed 15 Jun 2018]."},{"key":"2025090221243409000_47.3.173.5","unstructured":"Family Planning . Rwanda 2018, 2020. Available: http:\/\/www.familyplanning2020.org\/entities\/81 [Accessed 11 Jun 2018]."},{"key":"2025090221243409000_47.3.173.6","doi-asserted-by":"crossref","first-page":"38","DOI":"10.12688\/gatesopenres.12854.2","article-title":"Evaluation of a multi-level intervention to improve postpartum intrauterine device services in Rwanda","volume":"2","author":"Ingabire","year":"2018","journal-title":"Gates Open Res"},{"key":"2025090221243409000_47.3.173.7","doi-asserted-by":"crossref","first-page":"117955811988684","DOI":"10.1177\/1179558119886843","article-title":"An exploratory analysis of factors associated with interest in postpartum intrauterine device uptake among pregnant women and couples in Kigali, Rwanda","volume":"13","author":"Da Costa","year":"2019","journal-title":"Clin Med Insights Reprod Health"},{"key":"2025090221243409000_47.3.173.8","doi-asserted-by":"crossref","first-page":"1640","DOI":"10.1089\/jwh.2018.7423","article-title":"Development and uptake of long-acting 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