Relationships between antenatal and postnatal care and post-partum modern contraceptive use: evidence from population surveys in Kenya and Zambia

Abstract

BackgroundIt is often assumed, with little supportive, empirical evidence, that women who use maternal health care are more likely than those who do not to use modern contraceptives. This study aims to add to the existing literature on associations between the use of antenatal (ANC) and post-natal care (PNC) and post-partum modern contraceptives.MethodsData come from the most recent Demographic and Health Surveys (DHS) in Kenya (2008–09) and Zambia (2007). Study samples include women who had a live birth within five years before the survey (3,667 in Kenya and 3,587 in Zambia). Multivariate proportional hazard models were used to examine the associations between the intensity of ANC and PNC service use and a woman’s adoption of modern contraceptives after a recent live birth.ResultsTests of exogeneity confirmed that the intensity of ANC and PNC service use and post-partum modern contraceptive practice were not influenced by common unobserved factors. Cox proportional hazard models showed significant associations between the service intensity of ANC and PNC and post-partum modern contraceptive use in both countries. This relationship is largely due to ANC services; no significant associations were observed between PNC service intensity and post-partum FP practice.ConclusionsWhile the lack of associations between PNC and post-partum FP use may be due to the limited measure of PNC service intensity, the study highlights a window of opportunity to promote the use of modern contraceptives after childbirth through ANC service delivery. Depending on the availability of data, further research should take into account community- and facility-level factors that may influence modern contraceptive use in examining associations between ANC and PNC use and post-partum FP practice.

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

“…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]. Thus, strengthening the integration of family planning into ANC services [23,26,52,53] would certainly go a long way in promoting modern contraceptive use, particularly during the postpartum period.…”

“…Recent studies provide insights into factors that determine contraceptive use among (i) women in the postpartum period [3,6,23,24], (ii) sexually active women in the reproductive age [20,25,26], and (iii) sexually active males [27]. However, studies are limited in providing an understanding of the factors among women particularly after resumption of sexual intercourse following a birth.…”

Use of maternal health care as a predictor of postpartum contraception in Nigeria

“…These findings are not novel, as research has consistently shown that better educated, wealthier women, women who live in urban areas, and women who were regularly exposed to the media are all more likely to use contraception in the postpartum period (Gebreselassie et al 2008, Do andHotchkiss 2011).…”

Uptake and correlates of contraception among postpartum women in Kenya: results from a national cross-sectional survey

“…[8–12, 24] Postpartum FP use in LMICs has also been associated with urban residence,[8] being married,[12] greater wealth and education,[10–12] achievement of desired family size and current fertility desire. [24] In contrast to our study, a study conducted in five LMICs found that younger postpartum women (<20 years old) were 24% more likely than women ≥30 years to have an unmet need for FP.…”

“…Previous studies report that women who attend more antenatal care (ANC) visits, deliver with a skilled birth attendant, or attend postnatal care (PNC) are more likely to use postpartum contraception. [8–12] However, other factors may also impact use of FP during the postpartum period.…”