The role of family planning counselling during maternal and child health services in postpartum modern contraceptive uptake in Ethiopia: A national longitudinal study

Abstract

Family planning counselling can help improve the postpartum modern contraceptive uptake. However, studies in Ethiopia indicate inconsistent effects of integrated family planning counselling on postpartum modern contraceptive uptake. This study aimed to determine the extent of family planning counselling and its role in improving postpartum contraceptive uptake among women in Ethiopia. We used the Performance Monitoring for Action (PMA) Ethiopia panel survey data, a community-based prospective cohort study. Randomly selected pregnant women were recruited at the baseline interview and followed by six weeks and six months postpartum. A weighted generalised linear model fitted with a Poisson distribution and a log link function was used to estimate the adjusted relative risk (aRR) and 95% Confidence Interval (CI) of modern contraceptive uptake. The coverages of family planning counselling provision during ANC, prior to discharge and child immunisation were 20%, 27% and 23%, respectively. The modern contraceptive uptakes by six weeks and six months postpartum were 18% and 36%, respectively. Family planning counselling prior to discharge from the facility was associated with increased modern contraceptive uptake by six weeks (aRR 1.25; 95% CI 0.94, 1.65) and six months postpartum periods (aRR 1.07; 95% CI 0.90, 1.27). Moreover, women who received family planning counselling during child immunisation were 35% more likely to use modern contraceptives by six months postpartum (aRR 1.35;95% CI 1.12, 1.62). However, counselling during ANC visits was not associated with modern contraceptive uptake by either six weeks or six months postpartum. A significant proportion of women had missed the opportunity, and the postpartum modern contraceptive uptake was low. Despite these, family planning counselling prior to discharge from the facility and during child immunisation improved the postpartum modern contraceptive uptake. However, our finding revealed insufficient evidence that family planning counselling during ANC is associated with postpartum modern contraceptive uptake.

Family Planning Integration in Ethiopia’s Primary Health Care System: A qualitative study on opportunities, challenges and best practices

“…Expanding service integration, including FP integration could be one of the e cient strategies to achieve these agenda. Existing evidence consistently support the effectiveness of FP integration with other services in increasing use of FP and reducing unmet need for FP (8,15).…”

“…Studies on the effect of FP integration with HIV care services reported improvement in FP uptake and declines in unmet need for FP among women of reproductive age group with HIV infection (13,14). A longitudinal study also demonstrated that FP counselling during postpartum and during child immunization period were associated with increased modern contraceptive uptake (15). However, integration of FP with other PHC services is still not strong (16).…”

Family planning integration in Ethiopia’s primary health care system: a qualitative study on opportunities, challenges and best practices

“…Expanding service integration, including FP integration could be one of the efficient strategies to achieve these agenda. Existing evidence consistently support the effectiveness of FP integration with other services in increasing use of FP and reducing unmet need for FP [ 15 , 22 ].…”

“…Studies on the effect of FP integration with HIV care services reported improvement in FP uptake and declines in unmet need for FP among women of reproductive age group with HIV infection [ 20 , 21 ]. A longitudinal study also demonstrated that FP counselling during postpartum and during child immunization period were associated with increased modern contraceptive uptake [ 22 ]. However, integration of FP with other PHC services is still not strong [ 23 ].…”

Who Actualizes Postpartum Contraceptive Intentions? A Trajectory Cluster Analysis

“…Women in Ethiopia who state an intent to use contraception during the postpartum period are likely to have previous knowledge and/or experience of contraception (Abraha, Teferra, and Gelagay 2017; The Ethiopian Ministry of Health (MOH) has thus recommended that postpartum family planning be fully integrated into maternal health services, so that "every new mother will leave the clinic having made an informed choice about family planning," (Ministry of Health 2020:28). An important component of the guidelines to integrate PPFP into maternal health services is quality counseling, which does seem to impact contraceptive uptake, even though rates of counseling remain low in Ethiopia (Mruts et al 2022). The MOH advises healthcare providers to engage in discussions with expectant mothers during antenatal care visits on PPFP, including contraceptive counseling.…”