Effectiveness of Facility-Based Group Postpartum and Postabortion Counselling Among Adolescent Girls and Young Women in Southwestern Uganda: A Quasi-Experimental Study

Abstract

Purpose: Adolescent pregnancy rates have remained unacceptably high in Uganda, with a minimal decline over 20 years despite several interventions at the school and community levels. This study aimed at piloting and evaluating the effectiveness of facility-based group postpartum and postabortion counselling compared with routine care in increasing same-day uptake of modern contraception among adolescent girls and young women in selected health facilities in Southwestern Uganda. Methods: We conducted a quasi-experimental study among 393 participants in eight health facilities in four districts in Southwestern Uganda. Participants who were at least six weeks or more postpartum or two weeks postabortion were enrolled in the study between January and March 2024. A pre- and post-health facility visits questionnaire was conducted to assess whether a participant accepted a modern contraceptive method during routine care (control group) or following a group counselling session (intervention group). We conducted a Poisson regression to determine the prevalence ratio for uptake of modern contraception among participants. Results: A total of 393 participants (195 vs 198) were enrolled in the control (standard of care) and intervention group, respectively. Of these, 64 (16.3%) were younger than 18 years, 208 (52%) were single, 117 (29.8%) had sex younger than 15 years, and 51 (12%) had repeat pregnancies. A total of 108 (55.1%) vs 49 (25.1%) participants had same-day uptake of contraception within the intervention and control groups, respectively, with injectable contraception being the most common method used. Compared with those who received routine care, participants who received group counselling were more likely to accept a contraceptive method (PR= 2.24, 95% CI: 1.70– 3.00, P< 0.001). Conclusion: The rate of contraception uptake among participants in the intervention group was more than double that of those receiving routine counselling. This is a promising tailored intervention targeting adolescent girls and young women within healthcare settings that may be considered for scale-up in different contexts and further validation in cluster or individual randomized trials. Keywords: intervention, contraception uptake, adolescents, Uganda