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Assessing the Impact of a Postpartum Intrauterine Device Intervention on Contraceptive Decision-Making in Tanzania, Sri Lanka, and Nepal
Assessing the Impact of a Postpartum Intrauterine Device Intervention on Contraceptive Decision-Making in Tanzania, Sri Lanka, and Nepal
상세정보
- 자료유형
- 학위논문 서양
- 최종처리일시
- 20260202103020
- ISBN
- 9798315714798
- DDC
- 614.4
- 서명/저자
- Assessing the Impact of a Postpartum Intrauterine Device Intervention on Contraceptive Decision-Making in Tanzania, Sri Lanka, and Nepal
- 발행사항
- [Sl] : The University of North Carolina at Chapel Hill, 2025
- 발행사항
- Ann Arbor : ProQuest Dissertations & Theses, 2025
- 형태사항
- 128 p
- 주기사항
- Source: Dissertations Abstracts International, Volume: 86-11, Section: B.
- 주기사항
- Advisor: Pettifor, Audrey.
- 학위논문주기
- Thesis (Ph.D.)--The University of North Carolina at Chapel Hill, 2025.
- 초록/해제
- 요약Historically, the global family planning field has evaluated programs and defined success based on increases in contraceptive use, thereby relying on the assumption that contraceptive use is a positive outcome for all people with the capacity to get pregnant. Scholars have warned that this approach de-centers individual contraceptive preferences and desires, and called for new rights-based, person-centered outcomes. Still, few family planning programs have been evaluated based on measures of reproductive autonomy. Further, programs that promote long-acting reversible contraception (LARC) may be particularly vulnerable to violations of autonomy, given that users of these methods conventionally rely on a trained provider for method discontinuation.This dissertation uses data collected from the Postpartum Intrauterine Device (PPIUD) Study, a step-wedged cluster randomized trial of a provider-focused PPIUD intervention conducted in Nepal, Sri Lanka, and Tanzania from 2015-2018. Using data from Sri Lanka, we assess whether the PPIUD intervention was associated with perceived pressure to adopt contraception 18-months after delivery. Using data from all three countries but restricting to only those who adopted PPIUDs immediately after delivery, we describe PPIUD removal and access to removal in the 18-months following insertion. About 5% of participants in the PPIUD Study in Sri Lanka reported perceived pressure to adopt contraception 18 months following delivery. The PPIUD intervention in Sri Lanka was associated with increased perceived pressure to adopt contraception. Among the sample of participants who adopted PPIUDs immediately following delivery in Nepal, Sri Lanka, and Tanzania, about three quarters had their PPIUD in use at the end of the study period. Just under a quarter of participants (22%) had sought PPIUD removal in the 18 months following insertion. Of those who sought removal, a quarter faced a barrier to removal; most reported barriers were provider-imposed.In conjunction with existing literature, this work supports the idea that barriers to autonomous contraceptive decision-making are structural, rooted in larger public health and demographic goals that aim to promote contraceptive use. Our findings also highlight the importance of measuring and evaluating family planning programs using rights-based, person-centered outcomes that capture quality of contraceptive care and autonomy in contraceptive decision-making.
- 일반주제명
- Epidemiology
- 일반주제명
- Public health
- 일반주제명
- Medicine
- 키워드
- Autonomy
- 키워드
- Contraception
- 키워드
- Postpartum
- 기타저자
- The University of North Carolina at Chapel Hill Epidemiology
- 기본자료저록
- Dissertations Abstracts International. 86-11B.
- 전자적 위치 및 접속
- 로그인 후 원문을 볼 수 있습니다.
MARC
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■1001 ▼aBullington, Brooke Whitney.
■24510▼aAssessing the Impact of a Postpartum Intrauterine Device Intervention on Contraceptive Decision-Making in Tanzania, Sri Lanka, and Nepal
■260 ▼a[Sl]▼bThe University of North Carolina at Chapel Hill▼c2025
■260 1▼aAnn Arbor▼bProQuest Dissertations & Theses▼c2025
■300 ▼a128 p
■500 ▼aSource: Dissertations Abstracts International, Volume: 86-11, Section: B.
■500 ▼aAdvisor: Pettifor, Audrey.
■5021 ▼aThesis (Ph.D.)--The University of North Carolina at Chapel Hill, 2025.
■520 ▼aHistorically, the global family planning field has evaluated programs and defined success based on increases in contraceptive use, thereby relying on the assumption that contraceptive use is a positive outcome for all people with the capacity to get pregnant. Scholars have warned that this approach de-centers individual contraceptive preferences and desires, and called for new rights-based, person-centered outcomes. Still, few family planning programs have been evaluated based on measures of reproductive autonomy. Further, programs that promote long-acting reversible contraception (LARC) may be particularly vulnerable to violations of autonomy, given that users of these methods conventionally rely on a trained provider for method discontinuation.This dissertation uses data collected from the Postpartum Intrauterine Device (PPIUD) Study, a step-wedged cluster randomized trial of a provider-focused PPIUD intervention conducted in Nepal, Sri Lanka, and Tanzania from 2015-2018. Using data from Sri Lanka, we assess whether the PPIUD intervention was associated with perceived pressure to adopt contraception 18-months after delivery. Using data from all three countries but restricting to only those who adopted PPIUDs immediately after delivery, we describe PPIUD removal and access to removal in the 18-months following insertion. About 5% of participants in the PPIUD Study in Sri Lanka reported perceived pressure to adopt contraception 18 months following delivery. The PPIUD intervention in Sri Lanka was associated with increased perceived pressure to adopt contraception. Among the sample of participants who adopted PPIUDs immediately following delivery in Nepal, Sri Lanka, and Tanzania, about three quarters had their PPIUD in use at the end of the study period. Just under a quarter of participants (22%) had sought PPIUD removal in the 18 months following insertion. Of those who sought removal, a quarter faced a barrier to removal; most reported barriers were provider-imposed.In conjunction with existing literature, this work supports the idea that barriers to autonomous contraceptive decision-making are structural, rooted in larger public health and demographic goals that aim to promote contraceptive use. Our findings also highlight the importance of measuring and evaluating family planning programs using rights-based, person-centered outcomes that capture quality of contraceptive care and autonomy in contraceptive decision-making.
■590 ▼aSchool code: 0153.
■650 4▼aEpidemiology
■650 4▼aPublic health
■650 4▼aMedicine
■653 ▼aAutonomy
■653 ▼aContraception
■653 ▼aIntrauterine device
■653 ▼aLong-acting reversible contraception
■653 ▼aPostpartum
■690 ▼a0766
■690 ▼a0564
■690 ▼a0769
■690 ▼a0573
■71020▼aThe University of North Carolina at Chapel Hill▼bEpidemiology.
■7730 ▼tDissertations Abstracts International▼g86-11B.
■790 ▼a0153
■791 ▼aPh.D.
■792 ▼a2025
■793 ▼aEnglish
■85640▼uhttp://www.riss.kr/pdu/ddodLink.do?id=T17356701▼nKERIS▼z이 자료의 원문은 한국교육학술정보원에서 제공합니다.
