Predictors of modern contraceptive use during the postpartum period among women in Uganda: a population-based cross sectional study

Rutaremwa et al. BMC Public Health (2015) 15:262 DOI 10.1186/s12889-015-1611-y RESEARCH ARTICLE Open Access Predictors of modern contraceptive use during the postpartum period among women in Uganda: a population-based cross sectional study Gideon Rutaremwa1*, Allen Kabagenyi1, Stephen Ojiambo Wandera1, Tapiwa Jhamba2, Edith Akiror2 and Hellen Laetitia Nviiri3 Abstract Background: The rationale for promotion of family planning (FP) to delay conception after a recent birth is a best practice that can lead to optimal maternal and child health outcomes. Uptake of postpartum family planning (PPFP) remains low in sub-Saharan Africa. However, little is known about how pregnant women arrive at their decisions to adopt PPFP. Methods: We used 3298 women of reproductive ages 15–49 from the 2011 UDHS dataset, who had a birth in the 5 years preceding the survey. We then applied both descriptive analyses comprising Pearson’s chi-square test and later a binary logistic regression model to analyze the relative contribution of the various predictors of uptake of modern contraceptives during the postpartum period. Results: More than a quarter (28%) of the women used modern family planning during the postpartum period in Uganda. PPFP was significantly associated with primary or higher education (OR=1.96; 95% CI=1.43-2.68; OR=2.73; 95% CI=1.88-3.97 respectively); richest wealth status (OR=2.64; 95% CI=1.81-3.86); protestant religion (OR=1.27; 95% CI=1.05-1.54) and age of woman (OR=0.97, 95% CI=0.95-0.99). In addition, PPFP was associated with number of surviving children (OR=1.09; 95 % CI=1.03-1.16); exposure to media (OR=1.30; 95% CI=1.05-1.61); skilled birth attendance (OR=1.39; 95% CI=1.12-1.17); and 1–2 days timing of post-delivery care (OR=1.68; 95% CI=1.14-2.47). Conclusions: Increasing reproductive health education and information among postpartum women especially those who are disadvantaged, those with no education and the poor would significantly improve PPFP in Uganda. Keywords: Predictors, Postpartum, Family Planning, Contraception, Women, Uganda Background The rationale for promotion of family planning (FP) to delay conception after a recent birth is a best practice that can lead to optimal maternal and child health outcomes. On the contrary, short inter-pregnancy intervals can result in negative health outcomes such as maternal anaemia, low birth weight, and neonatal/infant mortality [1,2]. The postpartum period is a time when many routine interventions are provided to mothers [3]. Uptake of postpartum family planning (PPFP) remains low in subSaharan Africa and very little is known about how * Correspondence: 1 Centre for Population and Applied Statistics (CPAS), Makerere University, Kampala, Uganda Full list of author information is available at the end of the article pregnant women arrive at their decisions to adopt PPFP [4]. Yet, the benefit of early adoption or continuation of family planning are well known and are positive [5-7]. Postpartum months are a challenging time for women because of breastfeeding, childcare, menstrual resumption, and resumption of sexual relations. In a study of women residents of two Nairobi settlements of Korogocho and Viwandani, results showed that sexual resumption occurred earlier than that of menstruation and postpartum contraceptive use [2]. Resumption of sex puts woman at the risk of conception and therefore, creates the need for postpartum contraception. Some evidence is available to support selected postpartum contraceptive methods [3,8-14]. These methods include the Intra Uterine Device (IUD), the progestin-only © 2015 Rutaremwa et al.; licensee BioMed Central. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Rutaremwa et al. BMC Public Health (2015) 15:262 oral contraception (POC) among others. Some authors have pointed out that an efficient contraceptive during the postpartum period is lactational amenorrhea (LAM), which is highly acceptable by some religious authorities [8]. The choice of a post-partum contraceptive method depends on many factors, including the need for a temporary versus a permanent method, the infant feeding choice and the extent to which informed consent is made prior to delivery [12]. One of the reasons put forward for limited use of some hormonal contraceptive methods during the postpartum period is often their effects on lactation and infant growth [15]. In addition, other side effects such as heavy menstrual bleeding and pain, have been associated with these methods [16]. Although concerns remain that using a progestin contraceptive in the early postpartum period could negatively affect lactogenesis, as well as the quantity and quality of the breast milk [12], the postpartum contraceptive options available to mothers include progestinonly oral contraceptives; intrauterine devices, including the levonorgestrel intrauterine contraceptive; barrier methods; and the etonogestrel implant [6,11]. Earlier research evidence [17] suggests that postpartum and intrapartum application of the IUD technique is feasible and does not interfere with normal uterine involution. Moreover, the ability to utilize the IUD in the immediate postpartum period, when motivation for acceptance of birth control devices is at its peak, provides a clinician with another tool for use in women who are unlikely to return for follow-up visits [11,16,18]. High rates of acceptance of contraceptive services in the immediate postpartum period indicate that this period is the most effective means of initially reaching the women in need of family planning services [19]. In the United States, the National Surveys of Family Growth data showed that as of 1982, most lactating women who were sexually active used a contraceptive method; barrier methods were most frequently used. However, black women and those of higher parity and lower educational level, were more likely to be sexually active and not using a method [7]. In a related study, Weston, Neustad and Gilliam [20], suggest that the facilitators to IUD uptake included strong recommendations from providers or family members, planning for IUD during pregnancy, and perceived reproductive autonomy. Incidences of repeat pregnancy were reported among participants who did not obtain IUDs and instead used condoms, used no method, or intermittently used hormonal methods in the same study. Planning for postpartum contraception is particularly important for pregnant women at risk of rapid repeat unintended pregnancy. Yee and Simon in 2012 [5] in their study at a medical center in Chicago, used a P (...truncated)