Effect of structured counselling on postpartum contraceptive acceptance: A cluster randomized controlled trial, Puducherry

Background & objectives As per District Level Household Survey-III, there are 44 million people with unmet contraceptive needs in India. Contraception uptake in postpartum is around 17 per cent within six months and 33 per cent within six to 12 months post-delivery. Through our study, we aimed to access the effectiveness of a structured counselling session on acceptance of postpartum contraception within six wk after delivery among third-trimester pregnant women in Puducherry. Methods A randomised controlled trial was conducted among 236 third-trimester antenatal women receiving care from four selected primary health centres in Puducherry between March 2023 and February 2024. Antenatal women undergoing intervention received a structured counselling session with audio-visual aid along with a health education booklet & controls received standard care. They were followed up six wk postpartum. The chi-square test was used to compare the effectiveness of intervention, and P<0.05 was considered significant. Relative risk with a 95 per cent confidence interval was calculated to measure the strength of association. Results Among 221 (93.6%) participants who completed the study, 78 (66.7%) out of 117 in the intervention arm and 25 (21%) out of 119 in the control arm accepted any contraceptive method at six wk postpartum. The contraceptive acceptance was significantly higher in the intervention arm, with a three-fold increase compared to the control arm [RR: 3.21 95% confidence interval (CI): 2.22-4.61; P<0.001]. Additionally, there was a significant improvement in knowledge levels among mothers in the intervention group. Interpretation & conclusions The findings demonstrate that the structured counselling sessions with audiovisual aids and educational materials enhanced postpartum contraceptive uptake and improved knowledge levels among mothers. Our intervention has the potential for broader implementation in routine maternal health services and would improve postpartum contraceptive acceptance at the national level.