# Implementation and evaluation of a large-scale postpartum family planning program in Rwanda

> **NIH NIH R01** · EMORY UNIVERSITY · 2024 · $472,962

## Abstract

PROJECT SUMMARY
In 2017-2018, we worked closely with the Rwanda Ministry of Health (MOH) to develop and pilot test a theory-
based, multi-level intervention targeting postpartum family planning (PPFP) supply and demand in 5
government health facilities in Kigali, the capital. This innovative PPFP intervention is known as `C4' because it
is informed by Clients, Clinic providers, Champions, and Community Health Workers. Long-acting reversible
contraceptives (LARC), the intrauterine device (PPIUD) and implant, are fundamental to PPFP programs.
LARCs are highly effective and are the only reversible methods that may be safely used in early postpartum
period by breastfeeding women. During our pilot, LARC uptake among postpartum women increased
significantly (172% for PP implant, 2,687% for PPIUD), PPFP feasibility and acceptability were high among
providers and clients, and side-effects were rare. We now propose to use an implementation science framework
to evaluate the effectiveness of different PPFP demand creation strategies and test the hypothesis that C4 is
adaptable to large-scale implementation, cost-effective, and sustainable. In a Type 2 effectiveness-
implementation hybrid study, we will evaluate facility organizational readiness prior to implementing C4 in a
clinic randomized trial in 12 high-volume health facilities in Kigali, Rwanda (Aim 1). Adaptability and
sustainability within government facilities is a critical aspect of our proposal, and the MOH and other local
stakeholders will be engaged from the outset. We expect to deliver C4 PPFP counseling to over 21,000
women/couples during the project period. We will then evaluate C4 effectiveness and implementation
processes using RE-AIM (Aim 2). We hypothesize that C4 will significantly increase the number of
stakeholders engaged, PPFP providers and promoters, couples/clients receiving information about PPFP
(reach), and LARC uptake (effectiveness) comparing intervention versus standard of care. We expect PPFP
client satisfaction will be high and side-effects will be rare. The independent effectiveness of each demand
creation strategy on LARC uptake will be estimated. We assess measures of C4 adoption, implementation, and
maintenance at the patient-, provider- and stakeholder-level to assess C4 sustainability. Finally, we will
evaluate C4 cost-effectiveness and develop a national costed implementation plan to guide Rwandan MOH
decision-making for nationwide roll-out of PPFP services (Aim 3). We hypothesize that C4 will be cost-saving
relative to standard of care. C4 represents an important contribution to the Rwanda Family Planning 2020
goals and the MOH are enthusiastic to see our successful pilot efforts expanded to a larger number of facilities
for greater and sustained impact. Our PPFP implementation model is designed to be replicable and expandable
to other countries in the region which similarly have high unmet need for PPFP.

## Key facts

- **NIH application ID:** 10828895
- **Project number:** 5R01HD101600-04
- **Recipient organization:** EMORY UNIVERSITY
- **Principal Investigator:** Kristin Marie Wall
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $472,962
- **Award type:** 5
- **Project period:** 2021-07-01 → 2026-03-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10828895

## Citation

> US National Institutes of Health, RePORTER application 10828895, Implementation and evaluation of a large-scale postpartum family planning program in Rwanda (5R01HD101600-04). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/10828895. Licensed CC0.

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