An intervention aimed at institutionalizing postpartum intrauterine device (PPIUD) services was introduced in Nepal between 2015 and 2019. The intervention was evaluated using a cluster-randomized stepped-wedge trial, with data on women being collected immediately after delivery and at one- and two-year postpartum follow-ups. The sample consists of 19,155 women. We used intention-to-treat (ITT) analysis and structural equation model (SEM) to investigate how the intervention affected the occurrence of a new pregnancy (incident pregnancy). The ITT analysis showed that women in the intervention group had a reduced probability, –0.7 percentage points (95 percent CI: –3.0, 1.4), of having an incident pregnancy compared to women in the control group. The SEM analysis showed that the intervention increased the probability of receiving antenatal family planning counseling and PPIUD-specific counseling by 22.2 percentage points (95 percent CI: 20.0, 24.4) and 26.5 percentage points (95 percent CI: 24.8, 28.3), respectively. The intervention had an unintended spillover effect, increasing the probability of receiving postnatal family planning counseling by 11.4 percentage points (95 percent CI: 7.3, 15.5). In the SEM, we find the expected impact of the intervention on increased counseling and induced effects on contraceptive method initiation, lowering the probability of an incident pregnancy by 0.3 percentage points (95 percent CI: –0.5, –0.1).

中文翻译：

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计划生育咨询对尼泊尔意外怀孕的影响

2015 年至 2019 年期间，尼泊尔引入了一项旨在将产后宫内节育器 (PPIUD) 服务制度化的干预措施。该干预措施采用集群随机阶梯楔形试验进行评估，在分娩后立即收集女性数据，并在分娩后一岁和两岁时收集数据。年产后随访。样本包括 19,155 名女性。我们使用意向治疗 (ITT) 分析和结构方程模型 (SEM) 来研究干预如何影响新妊娠（意外妊娠）的发生。ITT 分析显示，与对照组女性相比，干预组女性意外怀孕的概率降低了 –0.7 个百分点（95% CI：–3.0, 1.4）。SEM 分析显示，干预措施使接受产前计划生育咨询和 PPIUD 特定咨询的概率分别提高了 22.2 个百分点（95% CI：20.0、24.4）和 26.5 个百分点（95% CI：24.8、28.3）。干预具有意想不到的溢出效应，将接受产后计划生育咨询的概率提高了 11.4 个百分点（95% CI：7.3，15.5）。在 SEM 中，我们发现干预对增加咨询的预期影响和对避孕方法启动的诱导影响，将意外怀孕的可能性降低 0.3 个百分点（95% CI：–0.5，–0.1）。分别。干预具有意想不到的溢出效应，将接受产后计划生育咨询的概率提高了 11.4 个百分点（95% CI：7.3，15.5）。在 SEM 中，我们发现干预对增加咨询的预期影响和对避孕方法启动的诱导影响，将意外怀孕的可能性降低 0.3 个百分点（95% CI：–0.5，–0.1）。分别。干预具有意想不到的溢出效应，将接受产后计划生育咨询的概率提高了 11.4 个百分点（95% CI：7.3，15.5）。在 SEM 中，我们发现干预对增加咨询的预期影响和对避孕方法启动的诱导影响，将意外怀孕的可能性降低 0.3 个百分点（95% CI：–0.5，–0.1）。