Task Shifting/Sharing on Contraceptive Counselling Services between Midwives and Physicians A Randomized Control Trial in Kisumu County, Kenya

Abstract

Introduction: Unsafe abortion, led to 120,000 Kenyan women receiving Post Abortion Care (PAC) in 2012. 70% of those women, had not used  contraceptives before pregnancy. The aim of the study was to determine if post abortion contraceptive counselling could be shared between  physicians and midwives in Kisumu County, Kenya.

Methodology: A total of 128 women were included in this cohort study that was nested in a larger randomized controlled trial, whereby women  sought PAC at Jaramogi Oginga Odinga Teaching and Referral Hospital (JOOTRH) and Kisumu County Hospital (KCH) from October 2015 to September 2017. The 128 women were randomly assigned to a midwife or a physician for contraceptive counselling. Then a follow up after 7–10 days or three months. Associated factors for contraceptive uptake, contraceptive method choice, adherence, and satisfaction level, were analyzed using chi square, Fishers exact test , IBM SPSS Statistics for Windows, Version 22.0.

Results: In the study, there was no difference between midwives (98.5%) and physicians (93.5%) in providing contraceptive counselling to post abortion women. 95.3% of the participants accepted while 4.7% did not accept use of contraceptives. The most commonly used contraceptive  method after counselling was hormonal injection at 39%. After 3-months follow-up 79.7% retained the chosen contraceptive method while 20.3% had changed the usual type of contraception and 3.9% had stopped using contraceptives. Among the respondents who still used a method, 96.1% were satisfied with the chosen methods, with no difference between midwifes and physicians (p=0.799). Parity had significant influence on contraceptive uptake and adherence (p= 0.000.).

Conclusion: Post abortion seeking women were satisfied with contraceptive counselling they received regardless of whether the provider was a  midwife or a physician. The result emphasizes that physicians task sharing of contraceptive counselling with midwives is conceivable, with possibility
for physicians focusing on more complicated cases.

Keywords: Contraceptive counselling, Contraceptive uptake, Post Abortion Women, Midwives, Physicians, Kenya.