<i>“Even things they won’t share with their sisters-in-law”</i> – Assessing an integrated Community Health Worker intervention on person-centered postpartum contraception in rural Nepal
Bibliographic record
Abstract
Abstract Postpartum contraceptive counseling and access are challenging in Nepal’s remote, hilly areas, driving a disproportionately higher unmet need for contraception. Community health workers (CHWs) play an important role in delivering healthcare in difficult to reach places in Nepal, but there is limited evidence on the ideal CHW model and its impact over time. 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 a person-centered contraceptive counseling component adapted from the Balanced Counseling Strategy. Applying a type 2 hybrid effectiveness-implementation study approach, we conducted a non-randomized pre-post study with repeated measurements and nested qualitative data collection to assess the intervention’s reach, effectiveness, adoption, implementation, and maintenance. This paper describes the postpartum contraceptive outcomes associated with the integrated RMNCH intervention over a five-year period. Compared to the pre-intervention period, we observed a 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) periods, after adjusting for district and intervention site. Although we observed high rates of lactational amenorrhea method (LAM) in most intervention sites, the proportion of women who switched from LAM to another effective method was relatively low. Qualitative data indicate that CHWs’ longitudinal engagement enabled them to build trust with participants in their community, which likely contributed to their uptake of modern contraceptive methods. Barriers to modern contraceptive use included fear of side effects, limited autonomy for women, peer influence, and contraceptive unavailability. Implementation barriers included distance, challenging physical terrain, and increased travel times during the rainy season. 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.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.007 | 0.010 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.008 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".