TY - JOUR T1 - ‘I haven’t heard much about other methods’: quality of care and person-centredness in a programme to promote the postpartum intrauterine device in Tanzania JF - BMJ Global Health JO - BMJ Global Health DO - 10.1136/bmjgh-2021-005775 VL - 6 IS - 6 SP - e005775 AU - Leigh Senderowicz AU - Erin Pearson AU - Kristy Hackett AU - Sarah Huber-Krum AU - Joel Msafiri Francis AU - Nzovu Ulenga AU - Till Bärnighausen Y1 - 2021/06/01 UR - http://gh.bmj.com/content/6/6/e005775.abstract N2 - Background Programmes promoting the postpartum intrauterine device (PPIUD) have proliferated throughout South Asia and sub-Saharan Africa in recent years, with proponents touting this long-acting reversible contraceptive (LARC) method’s high efficacy and potential to meet contraceptive unmet need. While critiques of LARC-first programming abound in the Global North, there have been few studies of the impact of LARC-centric programmes on patient-centred outcomes in the Global South.Methods Here, we explore the impact of a PPIUD intervention at five Tanzanian hospitals and their surrounding satellite clinics on quality of contraceptive counselling and person-centred care using 20 qualitative in-depth interviews with pregnant women seeking antenatal care at one of those clinics. Using a modified version of the contraceptive counselling quality framework elaborated by Holt and colleagues, we blend deductive analysis with an inductive approach based on open coding and thematic analysis.Results Interpersonal aspects of relationship building during counselling were strong, but a mix of PPIUD intervention-related factors and structural issues rendered most other aspects of counselling quality low. The intervention led providers to emphasise the advantages of the IUD through biased counselling, and to de-emphasise the suitability of other contraceptive methods. Respondents reported being counselled only about the IUD and no other methods, while other respondents reported that other methods were mentioned but disparaged by providers in relation to the IUD. A lack of trained providers meant that most counselling took place in large groups, resulting in providers’ inability to conduct needs assessments or tailor information to women’s individual situations.Discussion As implemented, LARC-centric programmes like this PPIUD intervention may decrease access to person-centred contraceptive counselling and to accurate information about a broad range of contraceptive methods. A shift away from emphasising LARC methods to more comprehensive, person-centred contraceptive counselling is critical to promote contraceptive autonomy.No data are available. To protect respondent privacy and adhere to our IRB commitments, these qualitative data are not currently available to the public. ER -