Couples-based interventions and postpartum contraceptive uptake: A systematic review

Objective: Systematically review the existing evidence about couples-based interventions and postpartum contraceptive uptake and generate recommendations for future research.

Data sources: PubMed, Web of Science, PsycINFO, Embase, and CINAHL through June 7, 2021.

Study selection and data extraction: Studies with a couples-based intervention assessing postpartum contraceptive uptake. Two independent reviewers screened studies, extracted data, and assessed risk of bias with RoB-2 (Cochrane Risk of Bias 2) for randomized and ROBINS-I (Risk of Bias in Non-Randomized Studies - Interventions) for observational studies. Data were synthesized in tables, figures, and a narrative review.

Results: A total of 925 papers were identified, 66 underwent full text review, and 17 articles, which included 18 studies - 16 randomized, 2 observational - were included. The lack of intervention and outcome homogeneity precluded meta-analysis and isolating the effect of partner involvement. Four studies were partner-required, where partner involvement was a required component of the intervention, and 14 were partner-optional. Unadjusted risk differences ranged from 0.01 to 0.51 in favor of couples-based interventions increasing postpartum contraceptive uptake versus standard of care. Bias assessment of the 16 randomized studies classified 8, 3, and 5 studies as at a high, some concern, and low risk of bias. Common sources of bias included intervention non-adherence and missing outcome data. One observational study was at a high and the other at a low risk of bias.

Conclusions: Future studies that assess couples-based interventions must clearly define and measure how partners are involved in the intervention and assess how intervention adherence impacts postpartum contraceptive uptake.