Abstract
INTRODUCTION: Postpartum family planning (PPFP) reduces adverse maternal-child outcomes related to short interpregnancy intervals and unintended pregnancies. This mixed-method study assessed PPFP needs in rural government health facilities as well as clients' knowledge and barriers to PPFP uptake in Rwanda. METHODS: From May-July 2023, we conducted cross-sectional PPFP needs assessments in rural government health facilities and focus group discussions (FGDs) among couples attending antenatal clinics to understand women's and men's perceptions and barriers to PPFP uptake. Quantitative data were collected from twelve rural government health facilities (two hospitals, four health centers, six health posts). Qualitative data were collected during six FGD with 6-12 participants per session. Quantitative data were analyzed descriptively, and qualitative data were analyzed thematically with a deductive approach. RESULTS: Seventeen (65%) hospital nurses and 11 (23%) health center nurses were trained in implant insertion, and six (23%) hospital nurses and four (9%) health center nurses were trained in postpartum intrauterine device (PPIUD) insertion. Hospitals provided an average of 204 postpartum implants (29% of deliveries) and seven PPIUDs per month (1% of deliveries), while health centers provided 25 postpartum implants and no PPIUDs per month. At health posts, there was no equipment for implant or intrauterine device (IUD) provision. FGD findings revealed that couples have access to family planning counseling at the health center, but they were concerned about limited information on contraceptive method mechanisms of action and side effects; knowledge about and access to IUD/PPIUD was especially limited. CONCLUSIONS: Enhanced PPFP training and provision is needed in rural areas, especially for PPIUD. Knowledge gaps and concerns about side effects were emphasized in FGDs. PPFP demand creation strategies tailored for the rural populace as well as rural provider training could improve PPFP access and uptake in rural government clinics of Rwanda.