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

Abstract

Objectives To characterize uptake and correlates of effective contraceptive use postpartum. Study Design We analyzed data from a national, cross-sectional evaluation of prevention of mother-to-child HIV transmission programs that enrolled women attending 6-week or 9-month infant immunization visits at 120 Kenyan maternal and child health clinics. We classified women who resumed sexual activity postpartum and did not desire a child within 2 years as having a need for family planning (FP). Results We included 955 (94%) of 1012 women 8–10 months postpartum in the analysis. Mean age was 25.8 years and 36% were primigravidas. By 9-months postpartum 62% of all women used contraception and 59% used effective contraception (injectables, implants, intrauterine devices [IUDs], oral contraceptives [OCs], and tubal ligations). Most contraceptive users (61%) used injectables, followed by implants (10%), OCs (6%), IUDs (4%), and condoms alone (2%). The majority (n=733, 77%) had a need for FP and 67% of 733 women with FP need used effective contraception. Among women with a need for FP, effective contraception use was higher among those who discussed FP in postnatal care (PNC) than who did not discuss FP in PNC (Prevalence Ratio (PR) for PNC alone: 1.35 (95% Confidence Interval [CI]:1.16-1.58; PR for PNC and antenatal care [ANC]:1.42, 95% CI: 1.21-1.67; p=0.001 for both). Conclusions Two-thirds of postpartum women with a need for FP used effective contraception at 9-months postpartum, and use was associated with discussing FP during PNC. Implications Integrating FP counseling in ANC/PNC could be an effective strategy to increase effective contraception use.

Utilization and associated factors of modern contraceptives during postpartum period among women who gave birth in the last 12 months in injibara town Awi Zone, North-West Ethiopia 2019

“…The major reasons for not currently using contraceptives were feeling of not exposed to the risk of pregnancy due to amenorrhea after birth 48(29 %), followed by were feeling of not exposed to the risk of pregnancy due to breastfeeding 36(22%) and partner opposed to use family planning 28(17%) (Figure2). This finding is in line with a study conducted in Kenya (59%) [16]. This similarity might be due to similar socio-demographic characteristics.…”

“…This might be due to women who were proper counseled about available methods of family planning and the consequences of frequent birth during ANC by providers. However, a study done in Kenya shows that discussing FP in ANC alone was not associated with effective contraceptive use [16].…”

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

“…Lastly, in this meta-analysis, we observed that those mothers who had ANC and PNC follow-up were more likely to use contraceptive as compared to their counterparts, respectively. This finding is supported by previous studies conducted in Kenya [55], Uganda [48], Rwanda [52], and America [64]. These studies reported that having antenatal as well as postnatal care services were positively associated with contraceptive uses.…”

“…Similarly, those mothers whose postpartum epoch was six months and above after childbirth were more likely to use family planning as compared to those mothers whose postpartum epoch was less than six months after childbirth. This finding is supported by previous studies conducted in Kenya [55] and Ethiopia [28]. This might be due to the fact that as the duration of the postpartum period increases, mothers engage in sexual activity, and moreover, their menses will resume.…”

“…Additionally, 12 primary articles were excluded because of the study population and outcome of interest. Among these, eight of the studies were conducted in Uganda [48,49], Ghana [50,51], Burundi and Rwanda [52], Thailand [53], International Journal of Reproductive Medicine India [54], and Kenya [55]. From the remaining four studies, one was conducted in Addis Ababa, Ethiopia [56] and excluded because of the unreported outcome of interest.…”