Postpartum Contraception in Northern Tanzania: Patterns of Use, Relationship to Antenatal Intentions, and Impact of Antenatal Counseling

Abstract

In Tanzania, unmet need for contraception is high, particularly in the postpartum period. Contraceptive counseling during routine antenatal HIV testing could reach 97 percent of pregnant women with much-needed information, but requires an understanding of postpartum contraceptive use and its relationship to antenatal intentions. We conducted a baseline survey of reproductive behavior among 5,284 antenatal clients in Northern Tanzania, followed by an intervention offering contraceptive counseling to half the respondents. A follow-up survey at 6-15 months postpartum examined patterns and determinants of postpartum contraceptive use, assessed their correspondence with antenatal intentions, and evaluated the impact of the intervention. Despite high loss to follow-up, our findings indicate that condoms and hormonal methods had particular and distinct roles in the postpartum period, based on understandings of postpartum fertility. Antenatal intentions were poor predictors of postpartum reproductive behavior. Antenatal counseling had an effect on postpartum contraceptive intentions, but not on use. Different antenatal/contraceptive service integration models should be tested to determine how and when antenatal counseling can be most effective.

Predictors of Time-to-Contraceptive Use from Resumption of Sexual Intercourse after Birth among Women in Uganda

“…In Tanzania, findings that showed counseling had an influence on the intention to use contraception [50]. In our study, the longer time-to-contraceptive use observed among women who attended 1-3 ANC visits compared with those who attended the recommended four or more visits supports this finding as noted elsewhere [51].…”

Psychosocial correlates of patient–provider family planning discussions among HIV-infected pregnant women in South Africa

“…Given the reported limitations to health reproductive care access in Africa, 40 protocol elements aimed to ensure family planning, which includes postnatal contraceptive counseling, may be better provided during antenatal visits rather than only prior to conception, since antenatal counseling increases postnatal contraceptive intentions. 10 …”

“…Pregnancy rates within 1 year of pregnancy do not differ between women who intend to have children and those who do not, 9 and antenatal counseling has been found to increase postnatal contraceptive intentions. 10 As such, antenatal family planning appears necessary when attending clinical consultations during a current pregnancy, even when women do not express a desire to conceive.…”

Barriers to Uptake of Postpartum Long‐Acting Reversible Contraception: Qualitative Study of the Perspectives of Ugandan Health Workers and Potential Clients

“…; Dasgupta, Zaba, and Crampin ), only 25–34 percent report using any contraception in the 3–12 months postpartum (Keogh et al. ; Rutaremwa et al. ; Sileo et al.…”

“…They most commonly use relatively short‐acting methods such as injections, which have high discontinuation rates (Keogh et al. ; Dasgupta, Zaba, and Crampin ).…”