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Task Sharing of Injectable Contraception Services in Pakistan: A Randomized Controlled Trial
Author(s) -
ChinQuee Dawn S.,
Abrejo Farina,
Chen Mario,
Lashari Talib,
Olsen Patrick,
Habib Zaheer,
Gao Xiaoming,
Assad Fauzia,
Midhet Farid,
Chandio Shabir,
Stankevitz Kayla,
Saleem Sarah
Publication year - 2021
Publication title -
studies in family planning
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.529
H-Index - 68
eISSN - 1728-4465
pISSN - 0039-3665
DOI - 10.1111/sifp.12149
Subject(s) - medroxyprogesterone acetate , medicine , family planning , developing country , context (archaeology) , randomized controlled trial , family medicine , population , service delivery framework , gynecology , service provider , nursing , environmental health , service (business) , business , surgery , economic growth , research methodology , geography , archaeology , marketing , hormone , economics
Abstract Provision of injectable contraceptive services by lay health workers is endorsed by normative bodies, but support for this practice is not universal. We assessed whether lay providers (lady health workers, LHWs) could perform as well as clinically trained providers (family welfare workers, FWWs) on appropriate screening, counseling, and injection of intramuscular and subcutaneous depot medroxyprogesterone acetate (DMPA) using a randomized controlled trial. In the urban sample ( n = 355), 88 percent of FWW DMPA clients were appropriately screened versus 77 percent of LHW clients (noninferiority test p = 0.88). In rural facilities ( n = 105), over 90 percent of both providers’ clients were screened appropriately. Appropriate counseling was low overall, but LHWs were significantly noninferior to FWWs ( p = 0.003). Notably, LHWs demonstrated better injection technique than FWWs. We could not conclude that LHWs screened new DMPA users as well as FWWs from an urban sample of providers but results from the rural sample suggests that service delivery context played an important role.