Community mobilization and service strengthening to increase awareness and use of postabortion care and family planning in Kenya

Objective To evaluate whether a community engagement and service-strengthening intervention raised awareness of family planning (FP) and early pregnancy bleeding (EPB), and increased FP and postabortion care (PAC) use. Methods The intervention was carried out in 3 communities in Kenya over 18 months; 3 additional communities served as the comparison group. A pre-post, contemporaneously controlled, quasi-experimental evaluation was conducted independently from the intervention. Results Baseline characteristics were similar. Awareness of FP methods increased (P ≤ 0.001) in the intervention group. The incidence of reported EPB (before 5 months of pregnancy) in the comparison group was 13.3% at baseline and 6.0% at endline (P = 0.02); 79% at baseline and 100% at endline sought care (P > 0.05). In the intervention group, recognition and reporting of EPB increased from 9.8% to 13.1% (P > 0.05); 65% sought PAC at baseline and 80% at endline (P = 0.11). The relative increase in EPB reports after the intervention was over 3 times greater in the intervention group (P ≤ 0.01). Conclusion The intervention raised FP and EPB awareness but not FP and PAC services use. As fewer comparison group respondents reported experiencing EPB, the PAC impact of the intervention is unclear. Mechanisms to improve EPB reporting are needed to avoid this reporting bias. © 2014 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.