Effectiveness Of Targeted Antenatal Family Planning Information Provision on Early Postpartum Family Planning Uptake In Kisumu County, Kenya: Randomized Control Trial.

The need for early Postpartum Family Planning (PPFP) is often overlooked, resulting in missed opportunities to achieve inter-birth interval of at least three years to improve maternal, perinatal and neonatal outcomes. As such, the unmet need for early PPFP remains high, especially in West and Central Africa where it is estimated to be 75%. In Kenya, the unmet need for PPFP is 73%. The maternal and child health continuum presents an opportunity for PPFP interventions to be integrated, particularly through targeted information giving. Currently, there's no structured protocol for information delivery, and evidence on fertility intentions and optimal early PPFP strategies is insufficient or non-replicable. This study therefore examined the effectiveness of antenatal FP information provision on early PPFP uptake using a randomized control trial in Kisumu guided by Theory of Planned Behaviour (TPB) to guarantee replicability. The study compared early PPFP uptake between control and intervention groups, assessed the effect of the intervention on individual attitude towards early PPFP uptake, evaluated the effect of the intervention on of perceived social normative beliefs towards early PPFP uptake, measured the effect of the intervention on perceived individual control of early PPFP choice, analyzed the effect of the intervention on intentions for early PPFP and established the determinants of early PPFP uptake among the 246 study participants in Kisumu County after at least 6 months of intervention and 3 months of postpartum follow-up. Case Report Forms, client exit interview, and questionnaire were used to collect data which was analyzed using SPSS version 26. ANOVA with post hoc tests, Chi-square statistic, ordinal logistic regression analysis, and binary logistic regression analysis were the main statistical tests with α<0.05. There was a high PPFP uptake (85.8%), positive attitude (96.4%), positive normative beliefs (75.2%), perceived control (92.3%) and intention (96.3%) for early PPFP with a significantly higher early PPFP uptake within the intervention arm (90.9%) than the control arm (75.6%) (OR:3.2; 95% CI:1.5-6.7; P<0.0001). Nurses’ arm showed higher rates of early PPFP commencement (95.1%) as compared to control 75.6% OR=6.3 and community arms (86.6%) OR=3.0. Likewise, the intervention had a significant effect on; perceived social normative beliefs (P=0.015), perceived control of PPFP choice (P<0.0001) and intention for early PPFP (P<0.0001). The nurses’ arm had a superior influence on these constructs compared to the control and community arms. The determinant of early PPFP uptake were; being health educated in pregnancy (P=0.03, OR:4.6), good intimate partner relationship (P<0.0001, OR:2.3), setting a postnatal appointment for PPFP (P=0.021, OR:2.6), perceived normative belief about early PPFP (P<0.0001, OR:3.6), perceived behavioural control of PPFP choice (P<0.0001, OR:6.6), intention to use early PPFP (P<0.0001, OR:3.3), high FP counselling turnaround time (P=0.032, OR:0.94) and being counselled in group (P=0.002, OR:0.28). The study demonstrated effectiveness of nurse-led antenatal FP information provision on early PPFP uptake by enhancing; positive social normative beliefs on early PPFP, perceived individual control of early PPFP choice, and intention for early PPFP. The study recommends promotion of nurse-led targeted antenatal FP counselling for early PPFP uptake, streamlining counselling processes to enhance quality and client satisfaction by; tailoring interventions to address comorbidity-related attitudes and individual preferences, with future research focusing on inclusive participant recruitment. The study presents a practical model for targeted antenatal FP information provision to foster early PPFP uptake.