How do changes in motivation to prevent pregnancy influence contraceptive continuation? Results from a longitudinal study with women who receive family planning services from Community Pharmacists and Patent and Proprietary Medicine Vendors in Nigeria

The IntegratE project is a proof-of-concept that Community Pharmacists (CPs) and Patent and Proprietary Medicine Vendors (PPMVs) have the capacity to provide a wider range of family planning (FP) and primary health care (PHC) services than they are currently authorized by law to provide. The project seeks to improve the quality of FP and PHC services provided by CPs and PPMVs and support the creation of an enabling environment that will sustain these services. The dataset includes data from a larger evaluation of the IntegratE project which seeks to expand access to family planning (FP) in Nigeria through community pharmacies and drug shops. 491 women were interviewed within 10 days after receiving a FP service (counseling, referral or FP method) from these sources and again nine months later. We then used logistic regression models to assess whether changes in motivation to avoid pregnancy between receiving a FP service to 9 months later is associated with continued use of FP. We found that many women (89%) continued using contraception approximately 9 months after the enrollment interview. Women who remained highly motivated (reported it was very important to avoid pregnancy at both interviews) were more likely to continue using contraception compared to women who became more motivated between the two interviews. Women who became less motivated were 65% less likely to continue using contraception compared to who became more motivated. Our results suggest that FP providers, including private sector pharmacists and drug shop owners, should continuously check in with women about their motivations around pregnancy to support continuation contraceptive use among those who wish to avoid pregnancy.

IntegratE项目是一项概念验证研究，旨在证实社区药师（Community Pharmacists, CPs）与专利及专有药品供应商（Patent and Proprietary Medicine Vendors, PPMVs）具备提供超出当前法律授权范围的更多计划生育（family planning, FP）与基层医疗（primary health care, PHC）服务的能力。本项目旨在提升CPs与PPMVs所提供的FP及PHC服务质量，并助力构建可持续支撑此类服务的有利环境。本数据集源自针对IntegratE项目的大规模评估，该项目旨在通过社区药房与药品零售店拓展尼日利亚的计划生育服务可及性。研究共招募491名女性，在其从上述机构获得FP服务（包括避孕咨询、转诊或避孕方法提供）后的10天内完成首次访谈，并于9个月后开展二次随访。随后我们采用逻辑回归模型（logistic regression models），评估从首次接受FP服务至随访的9个月期间，女性避免妊娠的动机变化是否与避孕措施持续使用存在关联。研究结果显示，约89%的女性在首次访谈后的9个月左右仍持续使用避孕措施。相较于两次访谈间避孕动机增强的女性，始终保持高度避孕动机（两次访谈均认为避免妊娠极为重要）的女性更有可能持续使用避孕措施。而避孕动机减弱的女性，其持续使用避孕措施的概率相较于动机增强者低65%。本研究结果表明，包括私营部门药师与药品零售店店主在内的FP服务提供者，应定期跟进女性的妊娠相关避孕动机，以助力有避孕需求的女性持续坚持避孕措施。