Family Practice Physician, Mid-Atlantic Permanente Medical Group at Largo Medical Center, Largo, Maryland
Improving Contraception Access and Birth Spacing in Rural Honduras
Authors:
Rajwinder Kaur, DO; Tara Kedia, MD; Jessica Goddard, DO; Tania Castillo, MD; Veronica Guevara, RN; Carolina Hernandez, RN; Mark Meyer, MD; Randy Kolb, MD
Introduction:
In San José, del Negrito, Honduras a rural town in northwestern Honduras with a catchment area of 5,000+, the community identified lack of contraceptive access, limited reproductive health knowledge and high rates of teen pregnancy as key issues affecting the community. Unintended and short interval pregnancy is associated with unsafe abortions, preterm birth, low birth weight, maternal and infant mortality. 42% Honduran young women have an unmet need for contraception and 45% pregnancies are unintended. Effective contraception improves the social and economic role of women and enables them to fully participate in society.
Methods:
Progesterone intramuscular injections and oral contraceptive tablets were purchased for the clinic, initially using funds from US-Honduran nonprofit Shoulder to Shoulder and now with a mixed grant- and patient-funded model. Additionally, intra-uterine devices were obtained for placement through a grant. Data was collected through chart review using paper forms
Results:
178 patients received contraception as of March 2024. 96% received their first-choice method, 76% of patients receiving Depo-Provera. While Depo remains most popular, the percentage of IUDs placed has increased from 7% in 2023 to 11%. In 2024, 15% of multips had short inter- conception interval (<18 months), similar to 2020 but higher than 2023 when it was 12%. In 2020, primips used birth control prior to pregnancy about half as often as multips; this rate decreased 3-fold from 2020 to 2023, down to only 7% of primips in 2023 and 0% in 2024. While rates of teen pregnancy (age < 20) quadrupled from 2020 to 2023, in 2024 this rate decreased by 3%.
Conclusion:
Through this initiative, there has been improved contraception access for both prior/continuous users and for first time users. This project has reinforced the need for outreach and reproductive education to teens, nulliparious women, and education about safe interconception intervals.
