Integration of contraception provision in emergency obstetric and neonatal care: A scoping review.
Koch MR., Kasliwal A., Elkholy N., Gizachew K., Ashan A., Makins A., Kallner H., Mosedale S., Sridhar A.
BACKGROUND: Emergency obstetric and neonatal care (EmONC) provides a framework to assess the capacity of health systems and mitigate maternal mortality. Given the high unmet need for contraception, integrating contraception provision and EmONC services could improve maternal and newborn health outcomes. OBJECTIVES: This scoping review aimed to examine the integration of contraceptive and EmONC services and identify opportunities for future work in this space. METHOD: A comprehensive search strategy was developed with sexual reproductive health and rights (SRHR) experts and librarians incorporating EmONC and contraceptive-specific terms. PubMed, EMBASE, CINAHL, Web of Science, and Cochrane Library were searched. Studies published before 2000 or those not in English were excluded. Nine reviewers conducted screening and full text reviews using Covidence with conflicts resolved through biweekly meetings. Data was analyzed descriptively. RESULTS: Of 7105 screened articles, 28 ultimately met inclusion criteria. Most were retrospective or cross-sectional in design and conducted in hospital settings. Fourteen studies explicitly referenced integration of contraception and EmONC services primarily at the time of emergency cesarean or incomplete abortions. Copper intrauterine devices and permanent sterilization were the most common methods provided. Barriers to integration included cultural stigma, routine deferral to outpatient settings, provider hesitation and gaps in training. Facilitators proposed included staff training, antenatal contraceptive counseling, and improved interprofessional communication. CONCLUSION: Given the dearth of literature on contraception in conjunction with EmONC services, there is a demonstrated need to standardize integration within EmONC indicators, metrics, and classifications. Strengthening provider training and institutional policies at national and international levels could enhance integration and improve outcomes.