IMPROVE-it

Postpartum care represents a key opportunity to improve women’s sexual and reproductive health and rights (SRHR), as it facilitates women’s choice of effective contraceptive methods. This, in turn, supports birth spacing and indirectly prevents unintended pregnancies and abortions. In European studies, immigrant women report lower use of effective contraception, higher fertility rates, unintended pregnancies and abortions compared to native-born women.

Among women who did not intend to have more children, 32% chose to use less effective or no contraception, reflecting the need for improved contraceptive counseling. In Sweden, the rate of repeat abortions is increasing among women of childbearing age. Almost 1/3 of women giving birth in Sweden are immigrants. Furthermore, immigrant groups are frequently excluded from research initiatives on SRHR for a variety of reasons, including language and knowledge barriers.

Purpose

To promote equity in SRHR through the improvement of contraceptive services and, thus, immigrant women’s choice of effective postpartum contraception.

The project is a collaboration between Global Public Health and Women´s and Children´s Health at Karolinska Intitutet. The project is funded by grants from The Swedish Research Council, FORTE, and Karolinska Institutet (SFO-V and Research School in Health Science)

Research questions

• What are immigrant women’s and men’s views on reproductive decisions, contraception, partner’s involvement, and opportunities to improve contraceptive services? (Study 1)
• Can a Quality Improvement Collaborative increase the proportion of immigrant women who choose an effective postpartum contraceptive method? (Study 2A)
• How and by what mechanisms are contraceptive services influenced by a Quality Improvement Collaborative, and how does context affect the implementation and outcomes? (Study 2B)
• How and by what mechanisms does a Quality Improvement Collaborative, influence contraceptive services, and how does context affect the practices changes, and outcomes? (Study 2B)

By combining qualitative studies, and a cluster randomized controlled trail with process-evaluation, we will gain an in-depth understanding of how to improve contraceptive services with and for immigrant women, and how to best involve partners when seeking to support immigrant women’s choice of effective postpartum contraceptive methods.

Methods

The project will involve cooperation between immigrant women and men and health care professionals. Immigrant women and men from the largest immigrant groups in Sweden will be included in focus group discussions on reproductive decision making, contraception, how to involve partners and how to improve postpartum contraceptive services (Study 1).

Using a cluster randomized trial with a process-evaluation, informed by the results from Study 1, we aim to enhance contraceptive services for immigrant women by evaluating a Quality Improvement Collaborative through registration of contraception in the Swedish Pregnancy Register (Study 2A and 2B).