Prevalence and factors associated with immediate family planning use by postpartum women in Bungoma East Sub County

Abstract

Background: Return to fertility after a pregnancy is unpredictable and may occur before the onset of regular menstrual cycles, even in breastfeeding women. In Kenya, the overall unmet need for family planning (FP) in women less than 6 months postpartum is 76%. This has led to interpregnancy intervals of less than the World Health Organization (WHO) recommended 24 months. Such pregnancies are at highest risk of adverse health outcomes to the mother and child. Therefore, the use of family planning should begin before sexual activity is resumed. Little is known about how women perceive the use of contraception in the early postpartum period. Objectives: Broadly, the study will assess the perception of postpartum women on family planning use before menses return. Specifically, this study will estimate prevalence of family planning uptake in women less than 6 months postpartum, assess postpartum women factors and family provider factors affecting immediate postpartum family planning uptake, and finally, establish the attitudes of postpartum women on family planning use before return to menses. The research inquiry will be guided by the Anderson behavioral model (ABM) of health service use, a multilevel model developed to explain and predict health service use. Methods: This was a cross-sectional study carried out in 12 community health units and 15 public health facilities in Bungoma East Sub-county. A total of 280 women responded to structured questionnaire. Fifteen in-depth interviews with family planning providers were conducted and one focus group discussion with mothers. Quantitative data was analyzed by both descriptive and inferential statistical methods. For purposes of inference, logistic regression was on possible factors as outlined in the ABM. Associations between categorical variables (use and non-use of FP before menses return, prior use or non-use of FP, etc) were examined using chi-square test for independence. All P-values were within a 95% confidence interval. Qualitative data will be analyzed thematically. Results: Overall, the prevalence of use of postpartum family planning (PPFP) before return of menses was at 35.6%. Nearly three quarters (69.1%) of the postpartum women had a positive attitude towards PPFP and perceived PPFP as acceptable and beneficial. Multiparous mothers were likely to be comfortable and have a more accommodating attitude compared to first time mothers. There was a significant association between use of immediate PPFP and the mother’s attitude (χ 2 = 8.047; df = 1; P = 0.005). The odds of a mother taking an immediate family planning method before her menses returned was 3.07 times significantly (p = 0.008) higher if a mother had positive attitude towards family planning. Facilities’ readiness to provide immediate post-partum family planning is not yet satisfactory Conclusion: Most mothers, especially maltiporous mothers are comfortable taking up an immediate family planning method postpartum and find it beneficial. Despite the perceived need for family planning post partum, uptake of a method is low. Attitude of a mother is a key determinant for uptake. Barriers to improved uptake especially in the health care set-up like gaps in provider counseling, skills gaps and unavailable equipment are paralyzing provision of post-partum family planning services