Postpartum modern contraceptive use and associated factors in Northern Ethiopia Name of Authors Teklehaymanot Huluf Abraha 1*, Alemayehu Shimeka Teferra2, Abebaw Addis Gelagay3 1
Department of Public Health, College of Health Sciences, Aksum University, Aksum, Ethiopia
2
Department of Epidemiology and Biostatistics, College of Medicine and Health Sciences,
University of Gondar, Gondar, Ethiopia 3
Department of Reproductive Health, College of Medicine and Health Sciences, University of
Gondar, Gondar, Ethiopia
*
Corresponding Author
Teklehaymanot Huluf Abraha Email addresses: TH:
[email protected] Postal address: P.O. Box 1010, Aksum University, Ethiopia AS:
[email protected] AA:
[email protected]
Abstract OBJECTIVES: Postpartum period is a critical period to address high unmet needs of family planning and to reduce the risks of closely spaced pregnancies. However, contraception during extended postpartum period has given less emphasis concerning contraceptive practice in Ethiopia. Therefore, this study was aimed to assess postpartum modern contraceptive use and associated factors among postpartum women in Northern Ethiopia.
METHODS: A community based cross sectional study was done from March to April, 2015.Data was entered using Epi Info version 7 and then exported STATA version 12 for analysis. Bivariable and multivariable logistic regression models were fitted to identify the determinants of postpartum modern contraceptive. Adjusted odds ratios (aOR) with 95% confidence interval (CI) and p-value =35 65 11.0 Marital status Married 543 92.0 Others* 47 8.0 Educational level No formal education 80 13.6 Primary school(1-8) 202 34.2 Secondary school(9-12) 236 40.0 Tertiary school(12+) 72 12.2 Partner’s education (545) ** No formal education 24 4.4 Primary school(1-8) 210 38.5 Secondary school(9-12) 185 34.0 Tertiary school(12+) 126 23.1 Occupation House wife 383 64.9 Government employee 46 7.8 Private employee 103 17.5 Daily Labourer 43 7.3 Others*** 15 2.5 Partner Occupation (545)** Government Employee 125 22.9 Private employee 257 47.2 Daily Labourer 131 24.0 Others**** 32 5.9 Monthly family income 2000 Birr 127 21.5 * Single, separated, divorced, widowed **among those married women *** Alcohol /Tella seller, farmer, student **** farmer, pension, guard.
Reproductive health services related characteristics of the study participants
6
The mean parity of the study participants was 2.52(SD± 1.46). The mean number of living children was 2.4 per women (SD±2.4). One hundred eighty two (30.8%) of the study participants have had one child. The median birth interval was 36 months. One hundred four (17.8%) of the study participants did not have an intention to have more children in the future. Three fourth (76.5%) of women were supported by their husband to use contraceptives. Nearly two third (66.4%) of women were using modern contraceptive prior to last child. In addition, one hundred twenty one (30.9%) had experienced problems while using contraceptive methods prior to their last child. More than a third of (34.75%) the women returned their menses since last birth at the time of survey. Among all women 39.45% of them had resumed sexual intercourse at 6 weeks postpartum period (Table2).
Maternal health services use related characteristics of the study participants Five hundred seventy nine (98.1%) of the study participants had at least one ANC follow up. Five hundred twenty four (90.5%) of study participants had the WHO recommended four or more focused antenatal care visits for their most recent birth. Five hundred seventy seven (97.8%) women gave birth at health facilities. Two hundred fifty eight (43.7%) had PNC follow up. Three hundred twenty two (54.58%) of study participants had received family planning counseling during prenatal and postnatal care (Table2). Table 2: Reproductive and maternal health service use related characteristics of study participants in Aksum town, Northern Ethiopia, June, 2015 (n = 590). Variables/Category
Frequency
Percentage
Parity
1-4 >=5
536 54
90.8 9.2
182 281 127
30.9 47.6 21.5
105 131 180
24.24 31.49 43.27
396
67.1
Living Children 1 2-3 >=4 Birth Interval =48 Months
Reproductive intention Want to space 7
Want to limit Undecided Went to have a child Who decide to use FP Mainly respondents Mainly the husband Jointly decision ANC visits 1-3 >=4 PNC Yes No Place of delivery Home Health institution Postpartum Period 0-12 week 13-26 week 27-38 week 39-51 week FP counseling during prenatal and postnatal care Yes No Menses returned after birth Yes No
86 99 9
14.7 16.8 1.5
104 36 405
19.08 6.6 74.3
55 524
9.5 90.5
258 332
43.7 56.3
13 577
2.2 97.8
186 198 141 65
31.5 33.6 23.9 11.0
322 268
54.6 45.4
205 385
34.8 65.2
403 187
68.3 31.7
Resumed sexual activities by the time of survey Yes No
Modern contraceptive use in postpartum period The proportion of modern contraceptive use was found to be two hundred eighty three (48%) [95% CI :( 43.9, 52.2)] . The most widely used type of modern contraceptive methods was injectable (59.7%) followed by implants (24.7%) and pills (12%). Two hundred forty five (86.6%) were using for spacing (Figure 2). Two third (65.5%) of the study participants had started contraceptives before the returned of their menses. One hundred forty fife (51.24%) of women started modern contraceptive at six weeks. Two hundred fifty four (89.8%) of women received their contraceptive service from government health facilities. 8
Those who were not practicing modern contraceptives methods were asked about their future intention to practice a modern contraceptive method. The majority (84.3%) of the study participants had intention to practice a contraceptive in the future and two hundred fifteen (83.3%) planned to use for spacing. The postpartum women pointed out various reasons for currently not using contraceptives such as menses did not resume/less perceived risk for pregnancy 65.5% and fear of side effects 11.1% (Figure 3).
Factors associated with postpartum modern contraceptive use In multi-variable logistic regression analysis, six variables were identified as independently associated with postpartum modern contraceptive use. These were: educational status, family planning counseling during prenatal and postnatal care, having postnatal care, menses returned after birth, resuming sexual activities, experiencing problem with previous modern contraceptive use. Women attended secondary school were 4.25 time more likely to use postpartum modern contraceptives compared to those with no formal education [aOR=4.25 95%, CI: (1.29, 14.00)] and those who achieved tertiary level were 5.36 time more likely to use postpartum modern contraceptives compared to those with no formal education [aOR, 5.36, 95%, CI: (1.13, 25.45). Women who attended postnatal care were 2.36 times higher odds to use modern contraceptives in the extended postpartum period than compared to women did not attend postnatal care [aOR =2.36,95%,CI:(1.15, 4.87)]. Women who were received family planning counseling during prenatal and postnatal care were 5.72 times higher odds to use modern contraceptive in the
extended
postpartum period than
those
who
did not
[aOR=5.72 ,95% ,CI: (2.67 ,12.28)]. The odds of using modern contraceptive use for women with returned menses was 6.35 times higher compared to those not returned menses [aOR = 6.35, 95%, CI: (3.14, 13.39)]. The odds of using modern contraceptives in women with resumed sexual activities were 9.53 higher than those who did not resume sexual activities since birth [aOR= 9.53, 95%, CI :( 3.74, 24.27)]. The odds of using postpartum modern contraceptive use in women who had experienced problem during previous contraceptive use were 66% lower than those who did not have problems with previous contraceptives use [aOR=0.34, 95%,CI:(0.16,0.71)] (Table 3).
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Table 3: Factors associated with postpartum modern contraceptive use in Aksum town, Northern Ethiopia, June, 2015 (n = 590). Variable/Category
Education level No formal education Primary school(1-8) Secondary school(9-12) Tertiary school(12+) Parity 1-4 >=5 Living Children 1 2-3 >=4 Currently Breast Feed Yes No ANC visits
Postpartum modern contraceptive use Yes No
aOR(95% CI)
P-Value
27 100 115 41
53 102 121 31
1 1.92(1.12,3.30) 1.86(1.09,3.16) 2.59(1.35,5.01)
1 2.87(0.98, 8.38) 4.25(1.29,14.00)* 5.36(1.14 ,25.45)*
0.053 0.017 0.034
269 14
267 40
1 0.35(0.18,0.65)
1 0.4(0.105,1.51)
0.178
83 157 43
99 124 84
1 1.5(1.038,2.19) 0.61(0.38,0.97)
1 1.4(0.53,3.68) 0.81 (0.21,3.01)
271
304
1
1
12
3
4.48(1.25,16.06)
11.01(0.75,160)
0.079
37 262
1 2.0 (1.14,3.70)
1 2.0(0.59 ,6.75)
0.262
105
6.4(4.4,9.2)
5.72(2.67,12.28)* 0.000
1-3 18 >=4 262 FP counseling during Prenatal care and PNC Yes 217 No
cOR(95% CI)
1
0.487 0.756
66
202
1
Yes
173
85
No
110
222
1
1
43 103 92 45
143 95 49 20
1 3.6(2.3,5.6) 6.2(3.83,10.15) 7.4(3.99,14.01)
1 1.3(0.54,3.27) 2.1(0.77,5.76) 3.8(0.94,15.27)
232 34
209 70
2.28(1.45,3.58) 1
2.77(0.67,11.32) 1
0.156
217
200
1.74(1.16,2.62)
0.94(0.26,3.34)
0.929
PNC 4.1(2.9,5.8)
2.36(1.15,4.87)*
0.020
Postpartum period 0-12 week 13-26 week 27-38 week 39-51 week Discussed FP with husband in last 12month Yes No Husband approval FP Yes
10
0.536 0.146 0.059
No Knowledge on PPFP Yes No Got FP counseling by HEW Yes
49
79
1
1
280 3
284 23
7.55(2.24,25.46) 1
0.37(0.04,3.21) 1
0.373
245
212
2.88(1.90,4.39)
0.92(0.36,2.35)
0.866
No 38 95 1 1 Experiencing problem with previous contraceptive use Yes 49 72 0.41(0.26,0.64) 0.34(0.16,0.72)* 0.005 No 168 103 1 1 Menses returned after birth Yes 156 49 6.46(4.4,9.50) 6.35(3.14,13.39)* 0.000 No 127 258 1 1 Resume sexual intercourse by the time of survey Yes 264 139 16.8(10.0,28.16) 9.53(3.74,24.27)* 0.000 No 19 168 1 1 Homers -Lemeshow test (P-value=0.52) 1=Reference Category *P- value
