Training of healthcare providers and use of long-acting reversible contraception in low- and middle-income countries

Baekgaard, Rasmus Stokholm; Damhaugh, Eirik Gjaerevold; Mrema, Dorah; Rasch, Vibeke; Khan, Khalid Saeed; Linde, Ditte S
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Introduction: Unintended pregnancy, a major global health issue resulting in unsafe abortions and maternal deaths in low- and middle-income countries, could be significantly reduced through increased use of modern contraception, including long-acting reversible contraceptives (LARC). Training of healthcare providers to administer such contraceptives may improve uptake. We conducted a systematic review to collate the end-user uptake data following training of health care providers in low- and middle-income countries. Material and methods: We searched PubMed, Embase, the Global Health Library, and the Cochrane Library up to 23 May 2020. The review was restricted to low- and middle-income countries and focused on healthcare providers who had received training in LARC. Studies that reported contraceptive uptake among women, preference of LARC amongst health care workers and/or women, and unplanned pregnancies within 12 months of LARC initiation were included. All included studies underwent quality assessment using either the Cochrane‚Äôs risk of bias tool or the Newcastle-Ottawa Scale. PROSPERO registration number CRD42020185291.Results: A total of 28 studies (end-users n= 6.112.544) were included (27 cohort studies and one randomised trial). 19 studies were set in Africa, 5 in Asia, one in Central America and 4 were multi-country studies. 28 studies reported LARC use among women, and 25 studies found an increase in uptake of LARC either by women using short acting methods switching to longer acting methods or by recruiting new users of LARC. The randomised controlled trial was assessed as high quality and reported positive findings, however there was great heterogeneity in the type of intervention and of how outcomes were measured amongst the other included studies. Further, the quality of these studies varied, although it should be noted that the poor quality studies reflected the trends of those of higher quality. Conclusions: Despite heterogeneity, current evidence indicates that training of healthcare providers in LARC may increase the uptake amongst women in low- and middleincome countries. More robust studies are warranted to inform policy.