Uptake of sub-dermal contraceptive implant in the immediate postpartum period at Moi Teaching and Referral Hospital

Abstract

Background: Sub-dermal contraceptive implant is one of the safest and most effective contraceptive methods with the highest continuation rates; but its overall use is low at 0.3% globally and 1.3% in Kenya. In the postpartum period return to fertility is unpredictable and there is early return to sexual activity, yet the immediate postpartum period is a missed opportunity to offer the contraceptive implant, partly because only 4% of Kenyan women receive postnatal care.There is paucity of data on rates of uptake of this method and factors which influence immediate postpartum uptake, both worldwide and in Kenya. Objectives: To determine the proportion of women who adopt the sub-dermal contraceptive implant and the factors that influence its uptake in the immediate postpartum period at MTRH. Methods: This was a descriptive cross-sectional study conducted among women who delivered at the MTRH’s Riley Mother and Baby hospital. Eligible women in the immediate postpartum period were systematically sampled with every 4th and 4 per day recruited until the desired sample was reached. Data collection was performed between January and April 2014. Women who consented to participate in the study were counselled for all methods of contraception. The implant was inserted for all women who consented and the rest were referred to the family planning clinic.The Anderson model of health services utilization was used in relating factors affecting uptake. Data was collected using previously tested, structured interviewer-administered questionnaires and analysis was performed using STATA version 12 SE. Chi and t-test were used to determine associations among variables. Logistic regression at 5% alpha level was used to determine the relationship between variables and uptake of the sub-dermal contraceptive implant. Results: Data was collected from 353 respondents. The mean age of respondents was 27 years (SD: 5 years), 92% (325) were Christians, 43% (152) had attained secondary level of education, 29% (102) said that trading was their main source of income, 74% (261) were married and 9% (31) were HIV-positive. The reported median desired number of children was 3 (IQR: 3-4) while 35% (124) had achieved their desired family size, 87% (306) had ever heard of contraceptive implant while 46% (161) had ever used it before the current pregnancy. Overall 44.6% (156) of women received the contraceptive implant. After logistic regression older women (p=0.036), those who had reached their desired family size (p=0.003), those who had planned for the current pregnancy (p=0.027), those who had used it before (p<0.001) and those who were HIV-positive (p=0.001) were more likely to use the sub-dermal contraceptive implant. Conclusion: The uptake of sub-dermal contraceptive implant during the immediate post- partum period was higher (44.6%) than what is reported in previous Kenya based data (1.3%). Older age, achieved family size, previous use of the same method, HIV positivity and planned pregnancy positively affected uptake of this contraceptive method. Recommendation: The sub-dermal contraceptive implant should be offered in the immediate postpartum period. Further studies are necessary to validate the findings and investigate the contribution of various factors on uptake of contraceptive implant immediately postpartum.