Multilevel analysis of early resumption of sexual intercourse among postpartum women in sub-Saharan Africa: evidence from Demographic and Health Survey Data

(2023) 23:733 Asmamaw et al. BMC Public Health https://doi.org/10.1186/s12889-023-15687-8 BMC Public Health Open Access RESEARCH Multilevel analysis of early resumption of sexual intercourse among postpartum women in sub‑Saharan Africa: evidence from Demographic and Health Survey Data Desale Bihonegn Asmamaw1*, Tadele Biresaw Belachew2 and Wubshet Debebe Negash2 Abstract Background Resuming sexual activity early after childbirth can cause reproductive health problems such as unwanted pregnancy, unsafe abortion, and short birth intervals, especially if contraception is not used. However, it is uncommon for healthcare providers to discuss postpartum sexual practices during prenatal and postnatal care. Therefore, this study aimed to assess early resumption of sexual intercourse and associated factors among postpartum women in sub-Saharan Africa. Methods Secondary data analysis from the most recent Demographic and Health Surveys data from the period of 2014 to 2019/2020 of 23 countries in sub-Saharan Africa were used. A total weighted sample of 118,371 women who gave birth in the three years before the surveys were used. We analyzed the data using Stata version 14. A multilevel mixed-effect logistic regression model was fitted to identify factors associated with early resumption of sexual intercourse. Variables with a p-value < 0.05 in the multilevel mixed-effect logistic regression model were declared significant factors associated with the outcome variables. Results The magnitude of early resumption of sexual intercourse among postpartum women was 67.97% (95% CI: 67.60, 68.34). Urban resident (AOR = 1.91; 95% CI: 1.83, 2.06), women with primary education 1.11 (AOR = 1.11; 95% CI: 1.07 to 1.31) and secondary education and above level 1.17 (AOR = 1.17; 95% CI: 1.09 to 1.29), husbands with primary education 1.32 (AOR = 1.32; 95% CI: 1.27, 1.38) and secondary education and above level 1.15 (AOR = 1.15; 95% CI: 1.11 to 1.25), family planning use (AOR = 95%; CI: 1.77, 1.91), fertility intention wanted then 1.24 (AOR = 1.24; 95%; CI: 1.19, 1.32) and wanted later 1.27 (AOR = 1.27; 95%; CI: 1.22, 1.46), religion (AOR = 2.08; 95%CI: 1.97, 2.17), and place of delivery (AOR = 1.51; 95%CI = 1.36, 1.65) were significantly associated with early resumption of sexual intercourse. Conclusion The study revealed that more than two-thirds of the women had resumed sexual intercourse early after childbirth. Hence, the concerned bodies should strengthen the integration of postpartum education on sexual resumption with maternal, neonatal, and child health care services to reduce the early resumption of sexual intercourse. In addition, healthcare providers providing counseling on the resumption of postpartum sexual intercourse should focus on these factors to ensure a more effective outcome. Keywords Early resumption of sexual intercourse, Postpartum women, Sub-Saharan Africa *Correspondence: Desale Bihonegn Asmamaw Full list of author information is available at the end of the article © The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativeco mmons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Asmamaw et al. BMC Public Health (2023) 23:733 Introduction The postpartum period begins immediately after the delivery of the child and is an ideal time for interventions aimed at improving the health and survival of both mother and infant [1, 2]. During the postpartum period, women face emotional /psychological changes such as anticipation, excitement, happiness, and fulfillment, as well as anxiety, frustration, confusion, or sadness [3]. And physical changes like involution occur, lochia starts to appear, after pain, and so as well as changes in sexual function [4, 5]. Despite the many changes that childbirth brings to the sexual health and well-being of mothers, the period following childbirth has great expectations for the parents to have healthy babies [4]. Early resumption of sexual activities during the postpartum period is usually associated with reproductive tract infections and unintended pregnancies [6]. Scholars revealed that women who had initiated sexual practices early after childbirth were highly affected by puerperal infection, complications of unwanted pregnancy, unsafe abortion, and genital trauma [6, 7]. The other consequences of early resumption of sexual intercourse is short birth interval [6, 8]. Short birth intervals are associated with poor maternal health outcomes such as maternal haemorrhage, uterine rupture, low birth weight, stillbirth, early neonatal loss, and child undernutrition [6, 8]. Reduction of maternal, neonatal, and child morbidity and mortality is the primary aim of sustainable development goals. To achieve this goal, attention needs to be given to prevent unintended pregnancy, unsafe abortion, and short birth intervals as well as postpartum infection by reducing early resumption of sexual intercourse after childbirth [9, 10]. In spite of the fact that more than 90% of women worldwide want to delay or avoid future pregnancies, they usually resume sexual activity without using family planning [11]. A study conducted in Ethiopia which found that 60.41% of women resumed sexual intercourse after childbirth by 6 weeks [9], similarly, a study done in Uganda showed that 21.6% of women resumed sexual intercourse before 6 weeks after childbirth [7]. Multiple factors like socio cultural norms and beliefs, education, place of delivery, status of breast feeding, mode of delivery, and residence were some of the identified factors that can affect early resumption of sexual intercourse [4, 7, 9, 10, 12]. There has been little attention given to the issue of the resumption of sexual intercourse by researchers, policymakers, and healthcare providers even though the WHO recommends that all women be assessed 2–6 weeks after childbirth as part of a general assessment. In addition, in sub-Saharan African countries, most studies done on women’s health during the postpartum period focused Page 2 of 10 primarily on contr (...truncated)