Timely initiation of postpartum contraceptive utilization and associated factors among women of child bearing age in Aroressa District, Southern Ethiopia: a community based cross-sectional study

Effect of multiple counselling contacts along the continuum of care on use of postpartum family planning in a cohort of Ethiopian women: a dose-response analysis

OBJECTIVE

Dose-response analysis of the effect of each additional contact where family planning (FP) was discussed during antenatal, delivery, postnatal or immunisation visits on the uptake of postpartum family planning (PPFP) within 12 months.

DESIGN

A cohort where pregnant women were enrolled and reinterviewed approximately 12 months postpartum. Life table analyses examined differentials in probabilities of adopting contraception over 12 months postpartum by level of exposure to FP counselling. Competing risks regression analysis examined the dose effects in HRs by the number of maternal, newborn or child health (MNCH) contacts where FP was discussed, adjusted for confounding covariates.

SETTING

Two Arsi zone woredas: Oromia and Ethiopia.

PARTICIPANTS AND MEASURES

722 pregnant women enrolled, and 706 successfully reinterviewed 12 months postpartum about each MNCH contact during pregnancy, delivery and later visits, whether these included any PPFP counselling and PPFP use.

MAIN RESULTS

Two-thirds of the cohort delivered at home. The average number of MNCH contacts women received was 7.6, while the average number where FP was discussed was 2.8. The cumulative probability of PPFP uptake was higher for women who received FP information during at least one MNCH contact, regardless of place of delivery. Each additional MNCH contact where FP was discussed increased the likelihood of PPFP uptake by 14% (95% CI 8% to 20%) or 9% (95% CI 5% to 13%), depending on place of birth. PPFP did not increase with additional contacts without FP information.

CONCLUSIONS

While PPFP conversations immediately after a facility birth generated the greatest chance of affecting use, integrating at every visit in the continuum had more impact.

TRIAL REGISTRATION NUMBER

ClinicalTrials.gov, NCT03585361.

Family planning utilization among postpartum women in the Bule Hora District, southern Ethiopia

Background

Contraception use remains low in Ethiopia, particularly within the first year after childbirth. While some women might have medical conditions that limit their contraceptive options, the primary obstacle to wider family planning adoption is not a specific health problem. Instead, it is the lack of equitable access to high-quality family planning services. This barrier significantly hinders women's ability to make informed decisions about their reproductive health. This study examines postpartum family planning utilization and its associated factors among postpartum mothers in the Bule Hora District.

Methods

We conducted a community-based cross-sectional study. A multistage sampling technique was employed to recruit a total of 630 women who had given birth. To collect the data, structured, standardized, and pretested questionnaires were used, and the collected data were coded and entered into Epi-data version 4.6. The data were analyzed using SPSS version 25. Both bivariable and multivariable logistic regressions were used to identify factors associated with postpartum family planning utilization.

Results

The study found that 71.3% of women utilized postpartum family planning. Significant associations were found between postpartum family planning utilization and various factors, including counseling on family planning during pregnancy [adjusted odds ratio (AOR) = 1.79, 95% confidence interval (CI) 1.61-2.82], delivery (AOR = 2.62, 95% CI 1.56-4.38), and the postpartum period (AOR = 2.71, 95% CI 1.75-4.21). Women who resumed sexual activity after birth (AOR = 1.92, 95% CI 1.25-2.96), and who had at least four antenatal care visits (AOR = 3.09, 95% CI 1.61-5.92) were also more likely to use postpartum family planning. Women with grand multiparity were 69% less likely to use family planning methods than primiparous women (AOR = 0.31, 95% CI 0.13-0.73).

Conclusion

Postpartum family planning use in this study was higher than the national average. Factors such as parity; counseling during the pregnancy, delivery, and postpartum periods; and early resumption of sexual activity were linked to increased contraceptive use. These findings suggest that enhanced counseling during antenatal, delivery, and postnatal care could significantly increase contraceptive use.

Addressing a missed opportunity for contraceptive use during the extended postpartum period by integrating it with infant immunization services in Sidama Region, Ethiopia: A quasi-experimental study

Globally, unmet need for postpartum family planning is high. However, immunization services are among the most widely utilized health services. Establishing systematic screening, counseling, and referral systems from different contact points, particularly from EPI units may improve postpartum family planning uptake. Hence, this study aimed to assess the effect of counseling for family planning at EPI units on contraceptive uptake during the extended post-partum period. A before-and-after type of quasi-experimental study was conducted in 8 purposively selected primary health care units in Sidama region, Ethiopia. All mothers visiting the selected health facilities for infant immunization services from February 06 to August 30, 2020, were screened, counseled, and referred for family planning. A structured interviewer-administered questionnaire was used to collect data from 1421 randomly selected mothers (717 for pre-intervention and 704 post-intervention phases). EpiData version 3.1 and SPSS version 22 were used for data entry and analysis. The effect of the intervention was assessed using multivariable logistic regression analysis adjusting for the effects of potential confounders. P value < 0.05 was considered statistically significant. The contraceptive utilization rate before intervention was 72.7% with 95% CI (69.5, 75.9). It was 91.9%, 95% CI (89.8%, 93.9%) after the intervention. Utilization of contraceptive pills increased from 4.3% to 6.9%, injectables from 52.4% to 57.5%, implants from 12.8% to 22.9%, and IUCD from 3.2% to 5.0% after the intervention. After adjusting for the effect of possible confounding variables, screening, counseling, and referring mothers for family planning at infant immunization units significantly increases the contraceptive utilization rate among mothers presented for infant immunization services(AOR = 5.83, 95% CI: 4.02, 8.46). Screening, counseling, and referring mothers for family planning services at infant immunization units significantly increases postpartum contraceptive uptake. Integrating family planning messages with infant immunization services is recommended. Trial registration: ClinicalTrials.gov Identifier: NCT04767139 (Registered on 23/02/2021).

Modern contraceptive utilization and associated factors among postpartum women in Kena Woreda, Konso Zone, South Ethiopian Regional State, Ethiopia, 2023: mixed type community based cross-sectional study design

BACKGROUND

Even though family planning 2020 has made remarkable progress about solving the issue of unmet need for family planning, 70% of women in a developing countries who do not want to conceive are not using it. There are limited research that provided detail information regarding barriers of modern contraceptive utilization during postpartum period in the study area. In addition, previous study also recommended that to conduct using mixed quantitative and qualitative design for further investigations to answer these "why" questions and narrow these gaps.

OBJECTIVE

This study aimed to assess postpartum modern contraceptive utilization and associated factors among postpartum women in Kena woreda, Konso zone, South Ethiopian Regional State, Ethiopia, 2023.

METHODS

A mixed type community based cross-sectional study design was conducted among 605 women in Kena woreda, from September 1-30/2023 out of 628 sampled mothers. Multistage sampling technique was used to select study participant and data was collected using semi-structured pretested questionnaire and entered in to Epi data version 3.1 and then exported to STATA version 14 for analysis for quantitative. The association between variables was analyzed using bivariate and multivariable binary logistic regression and level of significant determined with adjusted odd ratio at 95% CI and P-value less than < 0.05. After translation and transcription, manual thematic analysis was applied to the qualitative data.

RESULTS

The prevalence of modern contraceptive use among women during postpartum period in Kena woreda was found to be 39.01% [95% CI: 35.18-42.96%]. Menses resumed (AOR = 1.63; 95% CI: 1.02, 2.59), linked to the family planning unit during their child`s immunization (AOR = 2.17; 95% CI: 1.45, 3.25), family planning counselling during antenatal care visit (AOR = 1.63; 95% CI: 1.10, 2.42) and good knowledge towards modern contraceptive (AOR = 1.53; 95% CI: 1.03, 2.26) were factors associated with postpartum contraceptive utilization. Partner oppose, myths and misconception, need for excess family size, religious prohibition, fear of side effect,menses not resumed, lack of counselling and privacy room, and lack of transportation to health facility were barriers to modern postpartum contraceptive utilization.   CONCLUSIONS AND RECOMMENDATIONS: The utilization of postpartum contraceptives was found to be lower than the target set by the 2020/21 national reproductive health strategy plan, which aimed to increase contraceptive method usage to 50%. Menses resumed, family planning counselling during antenatal care visit, linked to the family planning unit during child immunization and good knowledge were factors associated to modern postpartum contraceptive utilization. Strengthening service integration and family planning counseling during antenatal care visits and encourage mothers to start using modern family planning methods before menses resume are important. Overcoming barriers including partner opposition, myths, religious beliefs, fear of side effects, lack of counseling at health facilities, and transportation challenges is essential.

Time to initiation of modern contraceptive method use after childbirth and its predictors in Southern Ethiopia: a retrospective follow-up study

BACKGROUND

Timely initiation of modern contraceptive use is vital to prevent unintended pregnancy and its related morbidities and mortalities. However, there is a scarcity of evidence about the duration of time elapsing from childbirth to initiating modern contraceptive use following childbirth and its associated factors in the study area for evidence-based interventions. Therefore, we aimed to assess the time to initiation of modern contraceptive method use and its predictors in Hossana town, southern Ethiopia.

METHODS

A retrospective follow-up study was conducted at public health facilities in Hosanna town. A total of 503 study participants were included in the study using a systematic random sampling technique. The Box and Whisker plot was used to estimate the time to initiation of modern contraceptive use. A Weibull regression model was applied to identify predictors of time to initiation of modern contraceptive use. Adjusted Hazard Ratio (AHR) with a 95% confidence interval (CI) was used to interpret the strength of the association.

RESULTS

The median time to initiation of modern contraceptive use was 6 months, with an interquartile range of 3 months. Husband/partner attending higher education [AHR = 1.64, 95% CI: 1.04, 2.57], women who had parity of more than two [AHR = 1.93, 95% CI: 1.01, 3.67], and women who had communicated with their husband/partner about modern contraceptive methods [AHR = 3.03, 95% CI: 1.41, 6.67] were more likely to initiate modern contraceptive method use within six months after childbirth. In contrast, women with an older age of greater than or equal to 30 years [AHR = 0.32, 95% CI: 0.13, 0.82] and who did not resume sexual intercourse after childbirth [AHR = 0.02, 95% CI: 0.01, 0.03] were less likely to initiate modern contraceptive method use within six months after childbirth.

CONCLUSIONS

The median time to initiation of modern contraceptive method use after childbirth in the postpartum period was delayed from the World Health Organization recommendation of at most 6 weeks. Emphasis should be given to older women, women with lower parity, and men's participation in contraceptive communication to improve timing for initiation of modern contraceptive use after childbirth and to curb the five-month lag periods.

Socio-demographic and antenatal care-related factors associated with early post-partum family planning use in Ethiopia: evidence from Ethiopian Demographic and Health Survey 2016 data

Introduction

Initiation of family planning in the early post-partum period is a strategic move to reduce maternal, neonatal, and child mortality due to the negative consequences of short interbirth interval and the complications of unintended pregnancy. Antenatal care (ANC) is the noteworthy predictor of scaling up early initiation of post-partum family planning (PPFP) and preventing unintended pregnancy before menses resume. Despite the great role of ANC, information is scant about the effect of content, timing, and the number of ANC visits on the early initiation of PPFP in Ethiopia.

Objective

This study aimed to assess the association of ANC services with the early initiation of PPFP in Ethiopia.

Methods

The study was based on Ethiopian Demographic and Health Survey 2016 data, which was a cross-sectional survey from 18 January 2016 to 27 June 2016. A total weighted sample size of 2,920 post-partum women was included. A multilevel logistic regression model was used because of the hierarchical data, and variables with a p-value of ≤0.2 in the bivariable multilevel analysis were taken to multivariable multilevel analysis. An adjusted odds ratio with a 95% confidence interval (CI) was used to declare both the direction and strength of the association, and variables with a p-value of <0.05 were considered as statistically significant for the outcome variable.

Results

The early initiation of PPFP was 20.4%. Women with at least four ANC visits [adjusted odds ratio (AOR) = 1.31; CI 1.12-2.32], women who started ANC within the first trimester (AOR = 1.25; CI 1.10-2.23), complete routine ANC (AOR = 1.11; CI 1.01-2.03), post-natal care (AOR = 1.45; CI 1.19-1.87), resumption of menses (AOR = 1.67; CI 1.18-1.93), urban residency (AOR = 2.14; CI 1.18-2.51), and high community women's education (AOR = 1.71; CI 1.51-2.11) were variables significantly associated with the early initiation of PPFP.

Conclusion

The early initiation of PPFP in Ethiopia was very low. Attention needs to be given to the quality of ANC, post-natal care, resumption of menses, residency, and community-level education of women to increase the prevalence of the early initiation of PPFP in Ethiopia. Therefore, the government should design a program targeting the quality of ANC in rural communities, considering women without menses and scaling up the education of women at the community level to the culture of the early initiation of PPFP in order to achieve reduced maternal, neonatal, and child mortality.

Utilization of immediate post-partum long acting reversible contraceptives and its associated factors among mothers who gave birth in Addis Ababa public hospitals, Ethiopia: An institutional based cross-sectional study

BACKGROUND

An immediate postpartum period is a good opportunity to utilize immediate postpartum long-acting reversible contraceptives for women whom they want to delay pregnancy. Long-acting reversible contraceptive methods like intrauterine device, Jaddel and implants can improve maternal and newborn health by preventing unintended pregnancy. Despite on their advantage, evidence on its utilization and associated factors is limited in our study area.Ethiopia. This study assessed the utilization of immediate postpartum long acting reversible contraceptives and its associated factors among mothers who delivered in selected public hospitals of Addis Ababa, Ethiopia, 2022.

METHOD

An institutional-based cross-sectional study design was conducted among 420 study participants to assess the immediate postpartum long-acting reversible contraceptive utilization and its associated factors from August 30- September 25, 2022. Systematic sampling technique was used to select study participants. Data was entered into epi-data version 4.6 and analysis was performed by using SPSS version 25. Descriptive statistics and logistic regression were used. All statistical tests were significant at P-value < 0.05.

RESULT

A total of 417 postpartum women were participated in the study making a response rate of 99.3%. Of the total study participants, 30.7% [95% CI (26.1, 35.3)] utilized immediate postpartum family planning. Women at the age of 25-34 years (AOR = 3.228[95% CI: 1.140-9.136]), had discussion with their partners about family planning (AOR = 1.891[95% CI: 1.003, 3.565]), received counseling about immediate post-partum long acting reversible contraceptive (AOR = 3.146 [95% CI: 1.489, 6.647]), had positive attitude towards immediate post postpartum long acting reversible contraceptive (AOR = 3 [95% CI: 1.770-5.648]) were associated with utilization of immediate post-partum long acting reversible contraceptive.

CONCLUSION AND RECOMMENDATION

Almost one in three women delivering in health facilities of Addis Ababa Ethiopia started using immediate post-partum long acting reversible contraceptives. Discussion about contraception with partners, getting counseling about family planning on antenatal care, attitude toward contraception and the age of women were all factors that could increase IPPLARC uptake. Healthcare providers clarify any rumors about contraceptives to assure a positive and supportive attitude to increase its uptake.

Time to postpartum family planning initiation and its predictors among mothers coming for first measles vaccination at Family Guidance Association of Ethiopia, Dessie Model Clinic, Northeast Ethiopia: cox-regression model

BACKGROUND

Timing of initiation of family planning is an important determinant for the health status of the mother and her child. One-fourths of mothers in developing countries who wanted to space or limit their children were not using family planning methods at right time after delivery. Despite, the existence of many literatures about postpartum family planning, the timing of it is not yet studied. Thus, this study aimed to assess time to postpartum family planning and its predictors among mothers coming for first measles vaccination in Dessie city, Northeast Ethiopia.

METHODS

An institutional-based retrospective follow-up study was conducted among mothers coming for infant vaccination at Family Guidance Association of Ethiopia, Dessie Model Clinic in Dessie City. A systematic sampling technique was used. The data were entered and analyzed using Epi Data version 3.1 and STATA version 14.0, respectively. Kaplan-Meier and Cox regression model were used to test the time and predictors of postpartum family planning initiation. Adjusted hazard ratio with 95% CI was used to test the strength of association at a p-value of 0.05.

RESULTS

The rate of postpartum FP initiation was 0.6% with 95% CI  (0.0056, 0.0069). Keeping the effect of confounder constant, age of the women 20-24 [AHR = 2.63, 95% CI (1.65,4.19)], 25-29 [AHR = 3.66, 95% CI (2.35,5.73)], 30-34 [AHR = 2.79, 95% CI (1.75,4.46)], getting family planning counseling [AHR = 1.78, 95% CI (1.26, 2.52)], want more child [AHR = 0.47, 95% CI (0.34, 0.66)], having history of abortion [AHR = 0.54, 95% CI (0.36,0.81)] and wanted last pregnancy [AHR = 0.69, 95% CI (0.49, 0.97) were significantly associated with postpartum family planning initiation.

CONCLUSIONS

Age, history of abortion, counseling about family planning, the status of last pregnancy and want more child were significantly associated with postpartum family planning use. Continuous emphasis should be given for health care providers to encourage their counseling services for their customers at different age groups with special attention given for elders.

Modern Postpartum Family Planning and Associated Factors Among Postpartum Women in a Rural District of Ethiopia, 2021: A Cross-Sectional Study

The first year after a woman has given birth is critical for use of contraceptives although many women do not realize that they are at a risk for pregnancy. The main objective of this study was to assess the utilization of modern Postpartum Family Planning (PPFP) and associated factors among postpartum women in a rural district, Ethiopia. A cross-sectional study involving randomly selected 389 postpartum women was conducted in Ambo rural district from May 20, 2021 to June 10, 2021. Data were collected through face to- face interviews, entered into EPI Data version 3.1, and analyzed by SPSS version 25.0. In multivariable binary logistic regression, adjusted odds ratios (AOR) with 95% confidence interval (CI) were computed and statistical significance was declared at p < 0.05. The prevalence of modern PPFP was 72.5% (95% CI: 68%, 77%). Utilization of PPFP was significantly associated with women's self decision making (AOR = 6.43, 95% CI: 1.98, 20.90), counseling during antenatal care (AOR = 9.71, 95% CI: 3.83, 24.61), visit health facility after delivery (AOR = 5.24, 95% CI: 2.32, 11.84), ever heard of modern family planning (AOR = 5.17, 95% CI: 1.88, 14.23), perceived partner approval (AOR = 4.31, 95% CI: 1.62, 11.47), and the lowest income (AOR = 0.12, 95% CI: 0.02, 0.68). The use of modern PPFP in the study area was encouraging, which helps to prevent unplanned and unwanted pregnancies and spacing pregnancies. Therefore, family planning providers should focus on raising women's awareness and counseling their partners as part of a continuum of points of contact to encourage women to use the service.

Factors associated with modern contraceptives uptake during the first year after birth in Ethiopia: A systematic review and meta-analysis

Though postpartum family planning helps women to achieve the recommended birth interval before next pregnancy, its utilization in Ethiopia is low. Understanding drivers and barriers is key to improve postpartum family planning uptake. The aim of this systematic review and meta-analysis is to analyze and summarize predictors of postpartum family planning uptake, during the first year after birth, in Ethiopia. We conducted a systematic review and meta-analysis of observational studies published in English before April 16, 2021. We searched electronic sources like PubMed, MEDLINE, CINHAL Embase, Google and supplemented it with manual search. Two reviewers appraised independently the studies using the Joanna Briggs Institute Quality Assessment Tool for the observational studies. Data synthesis and analysis were conducted using Review Manager Version 5.3. The Cochrane Q test statistic and I2 tests were used to assess the heterogeneity among the included studies. A random-effects and fixed effect model were used to calculate pooled Odds Ratio and its 95% CI. A total of 22 studies were included in the review. Better educational status of women[OR = 2.60; 95% CI: 2.15, 3.14], women's marital status [OR = 4.70; 95% CI: 1.51, 14.60], resumption of sexual intercourse [OR = 6.22; 95% CI: 3.01, 12.86], menses return [OR = 3.72; 95% CI: 1.98, 6.99], PPFP discussion with partner [OR = 2.53; 95% CI: 2.00, 3.20], women's previous PPFP information [OR = 4.93; 95% CI: 2.26, 10.76], PPFP counseling during ANC [OR = 3.95; 95% CI: 2.50, 6.23], having PNC [OR = 4.22; 95% CI: 2.80, 6.34], having experience of modern contraceptive use [OR = 2.90; 95% CI: 1.62, 5.19], facility birth [OR = 6.70; 95% CI: 3.15, 14.25], and longer interval after last delivery [OR = 0.37; 95% CI: 0.32, 0.43] were significantly associated with modern contraceptive uptake during postpartum period. Our systematic review identified modifiable factors and estimated their association with PPFP uptake. Since most of these factors are related to reproductive health characteristics and MNCH services, integrating PPFP into MNCH services particularly at primary health care unit may improve contraceptive uptake during postpartum period. Systematic review registration: PROSPERO: 2020: CRD42020159470.

Timely initiation of postpartum contraceptive utilization in Sebata Hawas district, Ethiopia: A cross-sectional study

Lack of timely initiating of postpartum contraceptive utilization may lead to mistimed, unintended pregnancies and even become dying as a result of complications related to pregnancy and childbirth. To the best of our knowledge, we have not found enough evidence on the associated factors of timely initiation of postpartum contraceptive utilization in the rural setting of Ethiopia. Therefore, this study aimed to assess the prevalence of timely initiation of postpartum contraceptive utilization and associated factors among women of childbearing age in Sebat Hawas, Oromia, Ethiopia. A community-based cross-sectional study was conducted from March 30 to May 20, 2022. A multistage sampling technique was used to select the participants. Multivariable logistic regression was used to identify associated factors. An adjusted odds ratio with a 95% confidence interval was used to measure the strength of the association. A P-value <0.05 was declared as a statistically significant association. All analysis was performed using SPSS. A total of 804 participants were included in this study. Overall, the prevalence of timely initiation of postpartum contraceptive utilization was 38.6%. In the multivariable models, illiterate women (Adjusted Odd Ratio (AOR): 0.57; 95% CI: 0.35-0.94), with less than 3000 ETB monthly income (AOR: 0.41, 95% CI: 0.22-0.79), counseling on family planning (AOR: 3.75, 95% CI: 1.59-8.83), Menses returned time (AOR: 2.33, 95% CI: 1.15-4.72) and discussion with husband on family planning (AOR: 3.07, 95% CI: 1.61-5.84) were significantly associated with timely initiation of postpartum contraceptive utilization. The findings of this study suggested that the prevalence of timely initiation of postpartum contraceptive utilization was low. Illiterate women, with low monthly income, counseling on family planning, menses returned time, and discussion with their husbands on family planning was the main determinant factors for timely initiation of postpartum contraceptive utilization.

Mapping evidence on postpartum modern family planning service uptake among women in Ethiopia: A scoping review

Background

In Ethiopia, different fragmented studies have been conducted to assess the determinants and uptake of postpartum modern family planning services. There is discrepancy and inconsistency among reported studies on postpartum modern family planning service uptake. The scoping review aimed to collect evidence on postnatal birth control service use and supply a chance to spot key ideas and gaps to research, policy revision, and changes in strategies.

Methods

There were different process steps in this scoping review which included analysis questions, distinctive relevant studies, study choice, charting the information, and eventually collating, summarizing, and reporting the results. A search was conducted through scientific databases like PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Hinari, and Google Scholar. The first outcome of this scoping review was postpartum family planning service uptake after childbirth in Ethiopia. The Preferable Reporting Information in Systematic Review and Meta-Analysis (PRISMA) flow diagram was used to select and summarize the selection procedure of the articles. The information of the chosen studies was sorted using the subsequent categories: authors, year of publication, study location, main study objective, and method employed for information analyses.

Results

A total of 1,607 records were reclaimed from the database searches and reference list review. A total of 596 articles were identified in PubMed, 375 in CINAHL, 576 in Hinari, and 60 records in Google Scholar. A total of 1,607 literature studies were checked for replication, and 840 records were excluded. The bulk of articles (n = 420) were excluded because they did not focus on postpartum family planning service, and 322 articles were excluded due to study setting discrepancy. The remaining 28 full-text articles were read in full using the preidentified inclusion criteria and included in the scoping review for analysis.

Conclusion

Generally, this scoping review identified different fragmented and inconsistent research findings on the uptake of postpartum modern family planning in Ethiopia. Almost all studies were observational studies that lack interventional study designs to provide evidence-based interventions to improve postpartum family planning uptake. There is a definite need for further interventional and qualitative research to improve early postpartum family planning service uptake that improves maternal and child health.

Factors associated with utilization of modern postpartum family planing methods during the extended postpartum period among mothers who gave birth in the last 12 months at Injibara town, Northwest, Ethiopia: a cross-sectional study

BACKGROUND

The extended postpartum period is the first twelve months following childbirth and is an important entry point for family planning service providers to reduce unintended and too closely spaced pregnancies. A modern postpartum family planning service is one of the recommended public health interventions for reducing maternal and child morbidity and mortalities in sitting where maternal mortality is high, like in Ethiopia.

OBJECTIVE

This study was aimed to assess factors associated with the utilization of modern family planning methods during the extended postpartum period among mothers who gave birth in the last 12 months at Injibara town, Northwest, Ethiopia.

METHODS

A community-based cross-sectional study design was employed from March 1-15/2019 at Injibara town among 402 mothers. The data was collected by a simple random sampling technique and analyzed using the SPSS 23.0 version. Logistic regression analyses were employed to estimate the crude and adjusted odds ratio with a confidence interval of 95% and a P-value of < 0.05 in multivariable analysis considered statistically significant. Frequency tables and descriptive summaries were used to describe the study variables.

RESULTS

The total sample size of this study was 402 and among them, 400 postpartum mothers participated in the study with a response rate of 99.5%. The utilization of modern family planning methods during the extended postpartum period among postpartum mothers was 58.5% [95% CI: 53.5- 63%]. Of these, 38.9% and 32.9% of the mothers were using injectables and implants respectively. Secondary and above educational level, having ≥ 3 antenatal care visits, resumption of menstruation, discussing with the partner on utilization of family planning method, being counseled on family planning method utilization during antenatal care visits and immediately after delivery, linkage of the mothers to a family planning unit during child immunization, and having good knowledge of family planning methods were associated with utilization of modern family planning methods during the extended postpartum period.

CONCLUSION

The utilization of modern family planning methods during the extended postpartum period among postpartum women was low compared to the world health organization recommendation. Socio-demographic, health care service uptakes, and reproductive characteristics were associated with the utilization of modern family planning methods during the extended postpartum period. We suggest emphasizing the education and counseling of women on the utilization of family planning during maternal and child health care service utilization. Mothers should be encouraged to start using modern family planning methods before the resumption of menses.

Perinatal intimate partner violence and postpartum contraception timing among currently married women in Southern Ethiopia: A multilevel Weibull regression modeling

Background

Adopting contraception on time is a critical intervention for postpartum women, but violence exposure around pregnancy may interfere with postpartum contraceptive use behaviors. Hence, this study aimed to investigate the time duration of the first modern contraceptive adoption and its individual-and community-level predictors among postpartum women in the Wolaita zone, South Ethiopia.

Methods

A community-based prospective follow-up study was conducted among 1,292 postpartum women nested in 38 "Kebles" (clusters) using multistage-clustered sampling techniques. A multilevel Weibull regression model was employed to investigate predictors of time-to-method initiation after childbirth using STATA Version 14. Kaplan-Meier curve and Wilcoxon log-rank test were used to estimate time-to-modern contraceptive use across different variables. All variables with p-values <0.05 were considered for multivariate analysis. Adjusted time ratios (ATR) with 95 % CI were computed using Weibull accelerated failure time models.

Results

Of the respondents, 62% (95% CI: 59.1-64.5) had started the first modern contraception within a year after childbirth. The restricted mean survival time-to-postpartum modern contraceptive use was 6.28 months. Being a rural dweller (aTR: 1.44; 95% CI: 1.06-1.99) and living in the middle household wealth quintiles (aTR: 1.10; 95% CI: 1.02-1.19) predicted longer time duration to adopt first modern contraception by 44 and 10%, respectively. The women from the community with a high early marriage (aTR: 1.14; 95% CI: 1.01-1.28) took longer time to initiate modern postpartum methods. Furthermore, women who had no history of perinatal abuse took less time than those who had a history of abuse to start postpartum contraception (aTR: 0.71; 95% CI: 0.66-0.78).

Conclusion

Rural residence, poor household wealth status, history of perinatal abuse, and a high rate of early marriage in the community are predicted to lengthen the time duration to start modern postpartum contraception. Thus, community-level women's empowerment, particularly among rural women and integration of intimate partner violence screening into family planning counseling throughout the continuum of care will likely to improve postpartum contraception timing.

Time to initiate postpartum modern contraceptive use and predictors among women of reproductive age group in Dilla Town, Southern Ethiopia: a retrospective cohort study

Background

Globally 1 in 7 women aren’t using family planning as a result, larger numbers of women get pregnant within 7–9 months of childbirth. The aim of this study was to estimate the time to initiate postpartum modern contraceptive use and predictors among women of reproductive age group within the first 12 months of delivery in Della Town, Southern, Ethiopia.

Methods

A retrospective cohort study from March 25, 2019, to March 25, 2020, was conducted in Dilla town. A Systematic sampling technique was used to select 594 study participants. A Cox proportional hazards model was used to determine factors associated with time to initiate postpartum modern contraceptive use at 95% CI with a P-value of < 0.05.

Results

A total of 576 postpartum women were participated making a response rate of 96.9%. The median time to initiate postpartum modern contraceptive use was 7 months (IQR: 6, 8). Education [AHR = 3.01 (95% CI = 1.32, 6.83)], knowledge on family planning [AHR = 1.56(95% CI = 1.20, 2.02)], and family planning counseling during postnatal care [AHR = 2.22 (95% CI = 1.46, 3.38)] were predictors positively associated with time to initiate postpartum modern contraceptive.

Conclusions

The time to initiate postpartum modern contraceptive use was delayed longer than compared to the World Health Organization recommendation. Education level of women, knowledge of family planning, and family planning counseling during postnatal care were some predictors positively associated with time to initiate postpartum modern contraceptive use.

Utilisation of immediate postpartum family planning among postpartum women at public hospitals of North Shoa Zone, Ethiopia: a cross-sectional study

OBJECTIVE

This study aimed to assess the prevalence of immediate postpartum family planning utilisation and the associated factors among postpartum women at public hospitals of North Shoa Zone, Ethiopia.

DESIGN AND METHODS

A facility-based cross-sectional study was conducted in 1-30 May 2020. Systematic random sampling technique was used to select the participants. Data were collected through a face-to-face interview using a structured and pretested questionnaire. Univariate and multivariable logistic regression analyses were employed. In multivariable logistic regression analysis, p<0.05 and adjusted OR (AOR) with 95% CI were used to declare statistically significant factors.

SETTING AND PARTICIPANTS

The study was conducted at public hospitals of North Shoa Zone, Ethiopia. A total of 394 postpartum women within 48 hours after giving birth before discharge from the selected hospitals were enrolled in the study.

OUTCOME

Immediate postpartum family planning utilisation (used or not used).

RESULTS

Of the total 394 participants, 84 (21.3%) used immediate postpartum family planning. The factors associated with immediate postpartum family planning utilisation were women's age (30-34 years) (AOR: 0.118; 95% CI 0.023 to 0.616), planning status of pregnancy (AOR: 3.175; 95% CI 1.063 to 9.484), reproductive intention (AOR: 5.046; 95% CI 1.545 to 16.479), partner support (AOR: 4.293; 95% CI 1.181 to 15.61), attitude towards family planning (AOR: 2.908; 95% CI 1.081 to 7.824) and maternal satisfaction with intrapartum care (AOR: 6.243; 95% CI 2.166 to 17.994).

CONCLUSION

In the study area, only less than a quarter of postpartum women used immediate postpartum family planning. Therefore, enhancing immediate postpartum family planning utilisation, strengthening community awareness to develop a favourable attitude towards family planning, promoting partner involvement in family planning and ensuring maternal satisfaction during intrapartum care are essential.

Barriers and determinants of postpartum family planning uptake among postpartum women in Western Ethiopia: a facility-based cross-sectional study

Background

Despite Ethiopia’s efforts to avail postpartum family planning (PPFP) services, the unmet need for family planning among postpartum women remains high. Therefore, this study is aimed to assess barriers and determinants of postpartum family-planning uptake among women visiting Maternal, Neonatal, and Child Health (MNCH) services in public health facilities of western Ethiopia.

Methods

A facility-based cross-sectional study design with a quantitative method was conducted on 989 postpartum women in Western Ethiopia from September 1 to October 30, 2020. Data were collected through face-to-face interviews using pretested structured questionnaires, entered using EPI-INFO version 7.0, and analyzed by SPSS version 25. Descriptive analysis and logistic regressions were performed. The adjusted odds ratio with a 95% confidence interval was used and statistical significance was declared at P-value < 0.05.

Result

In this study, 56.1% of participants had used PPFP in the last year. The most commonly used method was injectable (51.7%). Family planning use before the index pregnancy (AOR = 2.09;95%CI:1.29,3,41),counselling on PPFP during antenatal care and delivery (AOR = 4.89;95%CI:2.31,10.37),health facility delivery (AOR = 7.61;95%CI:4.36,13.28), skilled birth attendance (AOR = 4.99;95%CI:2.88,8.64),COVID-19 restrictions (AOR = 0.59;95%CI:0.39,0.90) were factors associated with PPFP utilization. Being breastfeeding and amenorrhea were major reasons for not using postpartum family planning.

Conclusion

Post-partum family planning utilization among study participants was low. Given the associated factors, it is recommended that health facilities should make postpartum family planning one of their top priorities and focus on these factors to improve its utilization.

Uptake of postpartum modern family planning and its associated factors among postpartum women in Ethiopia: A systematic review and meta-analysis

OBJECTIVE

This study aimed to estimate the pooled prevalence and factors associated with postpartum modern contraceptive use in Ethiopia.

DESIGN

Systematic Reviews and Meta-Analysis.

METHOD

PubMed, MEDLINE, EMBASE, Hinari, Google Scholar, direct Google search, African Journal Online (AJOL), an online repository, and gray kinds of literature were used for searching. This meta-analysis included eighteen cross-sectional studies. The quality appraisal criterion of the Joanna Briggs Institute (JBI) was employed to critically appraise papers. The I2 statistics were used to test heterogeneity and subgroup analysis was computed with the evidence of heterogeneity. The Egger test with funnel plot was used to investigate publication bias. The "generate" command in STATA was used to calculate the logarithm and standard error of the odds ratio (OR) for each included study. Then odds ratio (OR) with a 95% confidence interval (CI) was presented.

RESULT

Eighteen studies were included in the systematic review and meta-analysis. The pooled prevalence of modern postpartum family planning utilization among postnatal women in Ethiopia was 45.44% (95%CI: 31.47, 59.42).Prenatal family planning counseling (AOR = 3.80; 95%CI: 2.70, 5.34), postnatal care utilization (AOR = 3.07; 95%CI: 1.39, 6.77), spouse communication on family planning (AOR = 1.86; 95%CI:1.36,2.54), resumption of menses (AOR = 4.20; 95%CI: 2.95, 5.99), and resumption of sexual activity (AOR = 3.98; 95%CI: 2.34, 6.79) were associated factors to uptake modern postpartum family planning among postnatal women.

CONCLUSION

The pooled prevalence of postpartum modern contraceptive use was low. The most common factors significantly associated with postpartum modern contraceptive use were prenatal family planning counseling, postnatal care utilization, spouse communication on family planning, resumption of menses, and resumption of sexual activity were the commonest factors significantly associated with postpartum modern contraceptive use.

Modern Contraceptive Use and Associated Factors During Extended Postpartum Period Among Women Who Gave Birth in the Last 12 Months at Northwest Ethiopia

BACKGROUND

The extended postpartum period is a one-year follow-up period after giving birth, and it is critical for women to prevent unintended pregnancy and reduce the risk of maternal and child mortality by ensuring safe birth intervals. Many women, however, are unaware that they are at risk for pregnancy throughout this period. Hence, the aim of this study was to assess the utilization and associated factors of modern contraceptives during extended postpartum family planning (EPPP) in northwest Ethiopia.

METHODS

A community-based cross-sectional study design was conducted using 630 samples from October 01 to October 30, 2020, in northwest Ethiopia. The study participants were drawn through a multistage sampling technique and data were collected using structured questionnaires via interview. The collected data were entered into EpiData version 4.2 and exported into SPSS version 25.0 for management and further analysis. A bivariable logistic regression model was used to identify variables having an association with the outcome variable. In bivariable analysis, variables having P ≤ 0.25 were selected and entered into multivariable logistic regression analysis. Finally, in multivariable analysis, variables having P ≤ 0.05 with a 95% CI were declared as significantly associated with the outcome variable.

RESULTS

About 60.6% of women were using modern contraceptive during extended postpartum period. Mothers to partner discussion (AOR= 7.6, 95% CI: 4.20-14.05), secondary educational status (AOR= 3.8, 95% CI: 1.36-10.93), college and above educational status (AOR= 7, 95% CI: 1.92-25.57), menstrual resumption (AOR= 9.2, 95% CI: 5.66-15.12), sex resumed (AOR=8.5, 95% CI: 2.19-33.58), fertility desire (AOR= 3.9, 95% CI: 1.99-6.15), linkage to FP during child immunization (AOR= 2.7, 95% CI: 1.67-4.50), and FP counseling during pregnancy (AOR=2, 95% CI: 1.25-3.34) were significantly associated with outcome variable.

CONCLUSION

Associating factors were identified as partner discussion, education, menstrual resumption, fertility desire, sexual resumption, FP counseling, and FP during child immunization. Improving mothers' education and informing couples about the dangers of becoming pregnant before menstruation are critical.

The influence of balanced counseling strategy on mother toward use of post partum family planning

OBJECTIVE

This study aimed to analyze influence of balanced counseling strategies on the use of immediate PPFP.

METHODS

This research is pre experiment with only posttest control group design. Samples were third trimester pregnant women, respectively 25 experimental and control group were selected purposively, analyzed by chi-square test.

RESULTS

There was an effect of BCS on the use of PPFP, there was an effect of using PPFP at age above 20 years, parity≥2, low secondary education, sufficient knowledge and husband's support (p-value<0.005). It was concluded that BCS in third trimester pregnant women and repeated post partum had an effect on the use of PPFP especially mothers with age, parity, sufficient knowledge and mothers who received support from their husbands.

CONCLUSION

It is expected that pregnant women will get BCS and continue post partum to increase coverage of PPFP use.

The unmet needs for modern family planning methods among postpartum women in Sub-Saharan Africa: a systematic review of the literature

BACKGROUND

Sub-Saharan Africa has the highest fertility rate in the world, with the highest unmet need for family planning (FP). Yet, there is a lack of knowledge about the determinants for non-utilisation of modern contraceptive methods among women of reproductive age. This systematic review of literature assessed factors affecting the unmet need and reasons for non-utilisation of modern contraceptive methods during the postpartum period in Sub-Saharan African women.

METHODS

An online literature search was conducted in several databases: MEDLINE, Cochrane Review, PubMed, Elsevier's Science Direct and Web of Science. The search was completed by hand searching. Data were extracted and summarised using the Arksey and O'Malley methodology.

RESULTS

In total, 19 studies were included; one qualitative study, seventeen quantitative, and one used a mixed-methods approach. Studies were conducted in Ethiopia (n = 11), Nigeria (n = 3), Kenya (n = 2), Malawi (n = 2) and Uganda (n = 1). Factors affecting the unmet need for modern contraceptive methods were described at three levels: (a) individual; (b) household; and (c) healthcare facility level. Reasons for non-use of FP included: fear of side effects; husband's disapproval; the absence of menses; abstinence; and low perception of risk of pregnancy.

CONCLUSION

Unmet needs in postpartum FP in women from Sub-Saharan Africa were associated with health-system and socio-demographic determinants. We suggest that there is a need to improve the awareness of modern contraceptive methods through effective interventions. Further research is needed for under-studied countries in this continent.

Family Planning Uptake in Kagera and Mara Regions in Tanzania: A Cross-Sectional Community Survey

In Tanzania, 27.1% of all women of reproductive age are currently using modern contraception and 16.8% have an unmet need for family planning. We therefore examined factors associated with family planning uptake after giving birth in two regions of Tanzania. The survey, which collected information beyond that collected in the Tanzania Demographic Health Survey, used a two-stage, stratified-cluster sampling design, conducted in April 2016 in Mara and Kagera regions in Tanzania. A total of 1184 women aged 15-49 years, who had given birth less than two years prior to the survey were included. Logistic regression mixed effect modelling was used to examine factors associated with family planning uptake. A total of 393 (33.2%) women used family planning methods and 929 (79%) required prior approval from their partners. Participation of men in utilization of maternal health care was low, where 680 (57.8%) women responded that their partners accompanied them to at least one antenatal care (ANC) counselling visit and 120 (10%) responded that their partners participated in family planning counselling. Women who did not want to disclose whether they had discussed family planning with their partners, strikingly had the highest percentage of using family planning methods after birth. Factors independently associated with family planning uptake included: having discussed family planning with the partner (aOR 3.22; 95% CI 1.99-5.21), having been counselled on family planning during antenatal care (aOR 2.68; 95% CI 1.78-4.05), having discussed family planning with a community health worker (CHW) (aOR 4.59; 95% CI 2.53-8.33) and with a facility health care worker (aOR 1.93; 95% CI 1.29-2.90), having primary or higher educational level (aOR 1.66; 95% CI 1.01-2.273), and being in union (aOR 1.86; 95% CI 1.02-3.42). Educational interaction with community and facility health workers, as well as having a supportive partner as facilitator increased uptake of family planning. This needs to be prioritized in regions with similar socio-cultural norms in Tanzania and beyond.

Determinants of Postpartum Contraception Use Among Teenage Mothers in Eastern Uganda: A Cross-Sectional Study

Introduction

In Uganda, the proportion of women having another live birth before age 20 years (repeat adolescent birth) has not declined in 30 years. More women want to delay the next birth. We determined the prevalence and factors associated with postpartum contraceptive use among teenage mothers in Mbale City.

Patients and Methods

We conducted a cross-sectional study in all the six government-supported health facilities within Mbale City. Over a period of 3 months, 511 teenage mothers in the postpartum period were consecutively enrolled by midwives/nurses. Data were collected using a pretested interviewer-administered questionnaire. We used logistic regression in STATA version 14, to determine the association between various sociodemographic characteristics and utilization of contraception. We set the level of significance at 5% and report odds ratios and the corresponding 95% confidence intervals.

Results

Most of the respondents - 314/511 [61.5%, 95% CI= 57.1-65.6%] - were using contraceptives. More than three-fourth (238/314) of the respondents opted for short-term methods of contraception. In the adjusted analyses, intention to resume school [AOR 1.79 (1.16-2.74)], and utilization of maternal Child Heath services such as postnatal care services [AOR 0.40 (0.25-0.63)] were significantly associated with utilisation of postpartum contraception.

Conclusion

We found a high prevalence of postpartum contraceptives use - over 6 in 10 women - although they were using mainly short-term methods. Those with intentions of resuming schooling and utilised postnatal care services were most likely to use contraceptives. This is encouraging and calls for inquiry into why their use is higher than the national averages. Further, the results call for renewed efforts to maintain adolescent mothers in school.

Postpartum modern contraception utilization and its determinants in Ethiopia: A systematic review and meta-analysis

BACKGROUND

Contraceptive use is the best and most cost-effective strategy to reduce feto-maternal adverse effects of short birth intervals. More than two-thirds of women in developing countries who do not want to conceive are not using contraception methods. Although there were various primary studies in different parts of the country, there is no nationally representative evidence on postpartum modern contraception utilization and its determinants in Ethiopia.

OBJECTIVE

This review was aimed to determine the best available pieces of evidence to pool the magnitude of postpartum modern contraception utilization and find out its determinants.

METHODS

Published studies were extensively searched by using electronic databases and unpublished studies were identified from the digital library. All observational studies conducted on the magnitude of postpartum modern contraception utilization and its determinants in Ethiopia were included. Data were extracted on the Microsoft Excel spreadsheet and analyzed using STATA 14.1 version. A random-effects model was used to estimate the pooled magnitude of postpartum modern contraception utilization with a 95% confidence interval (CI). Inverse variance (I2) was used to identify the presence of heterogeneity and forest plot was used to estimate the pooled magnitude of postpartum contraception utilization. The presence of publication bias was assessed by funnel plots and Egger's statistical tests. Sub-group analysis was computed to minimize underlying heterogeneity.

FINDINGS

In this review, 19 primary studies were included. The pooled magnitude of postpartum modern contraception utilization in Ethiopia was 45.79% (95%CI 36.45%, 55.13%). The review found that having more than four Antenatal care visits(ANC), having postnatal care visit (PNC), having a formal education, history of family planning use, history of counseling on family planning, and having greater than four alive children as significant determinants of postpartum modern contraception utilization.

CONCLUSION

The magnitude of postpartum modern contraception utilization in Ethiopia was low. ANC visit, PNC visit, maternal educational status, history of previous family planning use, counseling on family planning, and number of alive children were found to be significant determinants of postpartum modern contraception utilization. Therefore, strengthening focused ANC and PNC services to encourage women in utilizing modern contraception during the postnatal period is needed.

Knowledge, Utilization and Associated Factors of Postpartum Family Planning Among Women Who Had Delivered a Baby in the Past Year in Oromia Regional State, Ethiopia

BACKGROUND

Globally, 95% of women wants to avoid pregnancy for at least two years after giving birth, but 70% of them are not using contraception; majority of them were from developing countries. Postpartum family planning (PPFP) enables families to avoid unplanned pregnancies following 12 months after childbirth. Different studies in Ethiopia showed that the majority of postpartum women do not use PPFP. Moreover, the level of PPFP knowledge and utilization in West Shewa, Oromia region of Ethiopia is unclear.

PURPOSE

This study aimed to assess the knowledge, utilization and associated factors of postpartum family planning (PPFP) Oromia regional state, Ethiopia.

METHODS

A community-based cross-sectional study was conducted in Ambo town, West Shewa Zone of Oromia regional state from April 01 to July 30, 2019. A sample of 367 postnatal women participated in the study. An interview administered questionnaire was used to collect the data and the collected data were entered into Epi Info version 7.1 and analyzed with SPSS version 23. Study participants' characteristics were described using frequency and percentage. Bivariate and multivariate logistic regression was carried out to identify the associated factors with the outcome variables.

RESULTS

A total of 354 women were participated in the study making a response rate of 96.4%. About 249 (70.3%) of the respondents had good knowledge about PPFP and 144 (40.7%) had utilized PPFP services. Higher education level [AOR= 3.4, 95% CI: 1.3-6.9], history of family planning utilization [AOR= 2.8, 95% CI: 2.1-4.4] and having ANC follow-up [AOR=2.1, 95% CI: 1.1-4.0] had showed a positive association with knowledge of PPFP. Meanwhile, knowledge of PPFP [AOR=2.1, 95% CI: 1.6-3.1], a grand multi-para women [AOR=1.7, 95% CI (1.3-3.6)] and received routine PNC service [AOR=2.5, 95% CI: 1.3-5.9] were associated with the utilization of PPFP.

CONCLUSION AND RECOMMENDATION

Although the majority of the women knew about PPFP, more than half of them did not utilize PPFP. Due emphasis should be given to improve the utilization of PPFP.

Associations of spousal communication with contraceptive method use among adolescent wives and their husbands in Niger

OBJECTIVES

This study aims to examine associations between spousal communication about contraception and ever use of modern contraception, overt modern contraceptive use (with husband's knowledge), and covert modern contraceptive use (without husband's knowledge) among adolescent wives and their husbands in Niger.

STUDY DESIGN

Cross-sectional data, from the Reaching Married Adolescents Study, were collected from randomly selected adolescent wives (ages 13-19 years) and their husbands from 48 randomly selected villages in rural Niger (N = 1,020 couples). Logistic regression models assessed associations of couples' reports of spousal communication about contraception with wives' reports of contraception (overall, overt, and covert).

RESULTS

About one-fourth of adolescent wives and one-fifth of husbands reported spousal communication about contraception. Results showed couples' reports of spousal communication about contraception were positively associated with ever use of modern contraception. Couples' reports of spousal communication about contraception were negatively associated with covert modern contraceptive use compared to overt use. Wives' reports of spousal communication were marginally associated with covert use compared to no use but husbands' reports were not.

CONCLUSION

Among a sample of couples in Niger, spousal communication about contraception was positively associated with modern contraceptive use (compared to no use) and negatively with covert use (compared to overt use) but wives' and husbands' reports showed differential associations with covert use compared to no use. Since there is little understanding of couple communication surrounding covert contraceptive use decisions, research should focus on characterizing content and context of couple communication particularly in cases of disagreement over fertility decisions.

Utilization of Family Planning Methods Among Postpartum Mothers in Kailali District, Nepal

Background

Postpartum contraceptives use offers a distinctive opportunity to maintain appropriate birth spacing for health benefits to both mother and child. However, the concept of postpartum family planning (PPFP) is poorly understood and contraceptives use during the postpartum period remains low in Nepal. Therefore, this study aimed to assess the factors affecting the utilization of family planning (FP) methods among postpartum mothers in the Kailali district, Nepal.

Methods

A community-based cross-sectional study was conducted between September and October 2013 among postpartum mothers in Kailali district. Simple random sampling was applied to select a total of 427 study participants. A pre-tested standard semi-structured questionnaire was used for gathering data. Data were analyzed using Statistical Package for Social Sciences (SPSS) version 20.0.

Results

Overall, 32.8% of the postpartum women used different types of contraceptives. Condoms (37.1%) followed by Depo-Provera 29.3% were the most used postpartum contraceptives. Half (50%) of the postpartum women had an unmet need for family planning. Multiple logistic regression model revealed that the occupation of husband [AOR=3.2 (95% CI: 2.0–6.00], past use of family planning methods [AOR=4.0 (95% CI:2.4–6.5)] and resumption of menstruation [AOR=2.5 (95% CI:1.6–4.1)] were significantly associated with the use of modern contraceptives during the first year of the postpartum period.

Conclusion

Contraceptive uptake within the first year of postpartum was found to be low among women in the Kailali district, Nepal. Previous experience with the use of family planning methods, occupation of the husbands, and resumption of menstruation are important factors in the PPFP decisions of women in this population. Therefore, the family planning program should work on improving couples’ knowledge of the risk of pregnancy, fertility returning time and modern contraceptives use during the postpartum period targeting women whose husbands are in migrant occupations, who are not menstruating and who have not used FP before.

The role of maternal health care services as predictors of time to modern contraceptive use after childbirth in Northwest Ethiopia: Application of the shared frailty survival analysis

Introduction

The first year after birth is an ideal time to offer contraception services, as many women have many opportunities to be in contact with the health care system. Nevertheless, a large number of postpartum women in developing countries do not use the service owing to the interplay of factors operating at various stages. Therefore, this study aimed to assess predictors of modern contraceptive use in the extended postpartum period.

Methods

A community based retrospective cross-sectional study was done among 1281 women who gave birth within 12 months preceding the survey. Kaplan-Meier plots and log rank tests were used to explore the rate of modern contraceptive use. The Weibull regression survival model with multivariate frailty was employed to identify the predictors of time to contraception.

Results

Of the respondents, 59.1% (95% CI: 56.8%–62.2%) had started using modern contraceptive methods within 12 months after birth. By the second month after birth, only 11.1 percent of the women surveyed started to use a contraceptive method, which increased steadily to 25.9%, 37.7%, and 59.5% at 6, 9, and 12 months, respectively. The most preferred contraceptive method was injectable (71.5%), followed by implants (21.5%). Women’s education (aHR = 1.29; 95%CI: 1.02, 1.66), four or more antenatal care (aHR  =  1.59; 95% CI: 1.22, 2.06), early initiation of antenatal care (aHR = 2.03; 95% CI: 1.28, 3.21), and early postnatal checkup (aHR  =  1.39; 95% CI: 1.12, 1.73) were statistically significant predictors of earlier initiation of modern contraceptive methods.

Conclusions

A substantial proportion of women did not use modern contraceptive methods in the first year after birth. Maternal services were found to be the sole predictors in postpartum contraceptive use. Findings suggest the importance of linking postpartum family planning along the continuum of care. The observed heterogeneity at cluster level also urges the need of disaggregating data for decision-making.

Postpartum Contraceptive Use and Its Determinants in Ethiopia: A Systematic Review and Meta-analysis

Background

Postpartum contraceptive use is defined as the avoidance of short spaced pregnancies and unintended pregnancy through the first 12 months after delivery. In Ethiopia, different studies have been conducted to assess the prevalence of postpartum contraceptive use and associated factors. The findings of these studies were inconsistent and characterized by great variability. Therefore, the aim of this systematic review and meta-analysis was to estimate the pooled prevalence of postpartum contraceptive use and determinants in Ethiopia using the accessible studies.

Methods

The articles were identified through electronic search of reputable databases (MEDLINE through PubMed, EMBASE, HINARI, Science Direct, and Cochrane Library) and the hand search of reference listed in previous prevalence studies to retrieve more. 18 articles are included based on a comprehensive list of inclusion and exclusion criteria. Two authors independently extracted all necessary data using a standardized data extraction format. STATA 14 statistical software was used to analyze the data. The Cochrane Q and I² test were used to assess the heterogeneity between the studies. A random effects model was calculated to estimate the pooled prevalence of postpartum contraceptive use. Moreover, the determinants for family planning use were reviewed.

Results

The pooled prevalence of family planning use among mothers during the postpartum period in Ethiopia was 48.11% (95% CI: 36.96, 59.27). Besides, subgroup analysis revealed that the highest family planning use prevalence among postpartum mothers was observed in Addis Ababa, 65.41 (95% CI: 48.71, 82.11). Resumed sexual activity: 7.91 (95% CI: 4.62, 13.55), antenatal care: 4.98 (95% CI: 2.34, 10.21), secondary school and above level of maternal education: 3.53 (95% CI: 1.67, 7.45), postnatal care: 3.16 (95% CI: 1.7, 5.88), menses resumption: 3.12 (95% CI: 1.52, 6.39), and ≥6 months of postpartum period: 2.78 (95% CI: 1.97, 3.93) have shown a positive association with the use of family planning among mothers in the postpartum epoch.

Conclusions

In this study, family planning use among mothers of the postpartum period in Ethiopia was significantly low compared to the existing global commendation on postpartum contraceptive use. Resumed sexual activity, antenatal care, secondary and above level of maternal education, postnatal care, menses resumption, and postpartum period ≥ 6 months were found to be significantly associated with postpartum contraceptive use.