Postpartum family planning uptake in Uganda: findings from the lot quality assurance sampling survey

Abstract

Background The initiation and use of family planning (FP) services within the first 12 months following childbirth, postpartum family planning (PPFP), promotes safe motherhood by reducing unintended pregnancies and ensuring appropriate pregnancy spacing. However, there is a paucity of information on PPFP uptake from community surveys. This study aimed to quantify the reported use of PPFP and identify predictors and barriers to PPFP uptake from a large community survey. Methods We analysed data collected from the 2021 Lot Quality Assurance Sampling (LQAS) survey, a cross-sectional community and household survey that covered 68 districts in Uganda. The survey uses small sample sizes to designate health or administrative geographical areas which are assessed to determine whether they achieved the pre-determined target for defined indicators of interest. We abstracted and analysed data collected from mothers of children aged 12 months or younger on reproductive health and FP. PPFP use was defined as the reported use of modern FP by the mother or their partner. Associations were measured using Pearson’s chi-square test at 5% significance. Multivariate logistic regression was performed for variables that were significantly associated with PPFP use to identify the predictors of PPFP. Results Overall, 8103 mothers of children aged less than 12 years were included in the analysis; the majority of mothers, 55.8% (4521/8103) were above 24 years while 11.7% (950/8103) were 19 years and under. 98% (7942/8103) of the mothers attended at least one antenatal care (ANC) visit and 86.3% (6997/8103) delivered at a health facility. Only 10% (814/8103) of mothers who participated in the survey reported PPFP use at the time of the survey. Reporting of PPFP use was 5 times higher among mothers of children aged 7–12 months (AOR 4.9; 95%CI 4.1–5.8), 50% higher among mothers with secondary education (AOR 1.5; 95%CI 1.0-2.3), 80% higher among breastfeeding mothers (AOR 1.8; 95%CI 1.3–2.4) and 30% lower among those that didn’t receive a health worker visit within 3 months preceding the survey (AOR 0.7; 95% CI 0.5–0.8). Among 4.6% (372/8103) who stated a reason for non-use of PPFP, the most cited reasons for not using were breastfeeding 43% (161/372), fear of side effects 26.9% (100/372), respondent/partner opposition 17.6% (48/372) and infrequent sex 12.1% (48/372). Conclusion The analysis showed a low proportion of PPFP uptake among mothers of children under 12 years. Possible barriers included child age, education, a health worker visit, and side effects and perceived benefits of possibly improperly implementing lactation amenorrhea method. Integration of social, community and health services could provide a more holistic approach to improving PPFP uptake.

Level of minimum acceptable diet and its associated factors among children aged 12–23 months in Ugandan districts

“…One primary limitation lies in the self-reported nature of the LQAS survey data. This introduces the potential for bias, as respondents might not accurately portray their experiences [ 21 , 49 , 50 ]. Additionally, the survey only covers a limited number of districts in Uganda, which means that the findings may not be generalizable to the entire country.…”

“…Additionally, the survey only covers a limited number of districts in Uganda, which means that the findings may not be generalizable to the entire country. Nonetheless, within the surveyed regions, the data retain a level of generalizability, facilitated by the LQAS’s capacity for data aggregation to attain a representative scope [ 17 , 21 ]. However, the extent of this representativeness is confined by the study’s focus solely on biological mothers with children aged 12–23 months.…”

“…Each lot is classified as "acceptable" or "unacceptable" based on whether a specific criterion or threshold is met. Moreover, unlike other rapid assessment techniques, collating the results from the different lots can help estimate a reliable overall coverage [ 17 , 21 ]. The 2021 LQAS survey is a cross-sectional survey and was conducted during February and September 2021, encompassing 64 districts.…”

Knowledge, Attitudes, and Practices of Family Planning among Mothers attending Antenatal Care in Rural Uganda: Implications for Maternal Health and Population Growth

“…In Kyotera district, a cross-sectional study by Nakaggwa. et al in 2020 showed that family planning use preference varied from woman to woman; 52% of women were well aware of different types of contraceptives but didn't know when to start family planning after delivery, and regarding emergency contraception, only 7% were using family planning within their first 6 months after delivery [17]. In Africa, there is a low 44% indication of the uptake levels for FP methods across northern Africa [18].…”

“…Approximately 30,000 African women die each year from unsafe abortion, reflecting a huge need for effective family planning [20]. Uganda has a high total fertility rate (TFR), at 6.2 children per woman [21], with a young population (52% are below age 15, and 17% are aged [15][16][17][18][19][20][21][22][23][24], and as this large cohort of young people enters the childbearing years, their reproductive behaviour will determine the growth and size of Uganda's population for decades to come. Uganda still struggles with a low contraceptive prevalence rate (CPR) of 30%, which is lower than that of her neighbours, Kenya, Rwanda, and Tanzania, which had a CPR of 46%, 52%, and 34%, respectively, at the time of their last surveys [22].…”