ArticlePDF Available

Time to initiate postpartum modern contraceptive use and predictors among women of reproductive age group in Dilla Town, Southern Ethiopia: a retrospective cohort study

Authors:

Abstract and Figures

Background Globally 1 in 7 women aren’t using family planning as a result, larger numbers of women get pregnant within 7–9 months of childbirth. The aim of this study was to estimate the time to initiate postpartum modern contraceptive use and predictors among women of reproductive age group within the first 12 months of delivery in Della Town, Southern, Ethiopia. Methods A retrospective cohort study from March 25, 2019, to March 25, 2020, was conducted in Dilla town. A Systematic sampling technique was used to select 594 study participants. A Cox proportional hazards model was used to determine factors associated with time to initiate postpartum modern contraceptive use at 95% CI with a P-value of < 0.05. Results A total of 576 postpartum women were participated making a response rate of 96.9%. The median time to initiate postpartum modern contraceptive use was 7 months (IQR: 6, 8). Education [AHR = 3.01 (95% CI = 1.32, 6.83)], knowledge on family planning [AHR = 1.56(95% CI = 1.20, 2.02)], and family planning counseling during postnatal care [AHR = 2.22 (95% CI = 1.46, 3.38)] were predictors positively associated with time to initiate postpartum modern contraceptive. Conclusions The time to initiate postpartum modern contraceptive use was delayed longer than compared to the World Health Organization recommendation. Education level of women, knowledge of family planning, and family planning counseling during postnatal care were some predictors positively associated with time to initiate postpartum modern contraceptive use.
Content may be subject to copyright.
MaeregayehuTiboetal.
Contraception and Reproductive Medicine (2022) 7:20
https://doi.org/10.1186/s40834-022-00189-6
RESEARCH
Time toinitiate postpartum modern
contraceptive use andpredictors
amongwomen ofreproductive age group
inDilla Town, Southern Ethiopia: aretrospective
cohort study
MaeregayehuTibo1,2, Atnafu Adem1,2 and Azmach Dache3,4*
Abstract
Background: Globally 1 in 7 women aren’t using family planning as a result, larger numbers of women get pregnant
within 7–9 months of childbirth. The aim of this study was to estimate the time to initiate postpartum modern con-
traceptive use and predictors among women of reproductive age group within the first 12 months of delivery in Della
Town, Southern, Ethiopia.
Methods: A retrospective cohort study from March 25, 2019, to March 25, 2020, was conducted in Dilla town. A Sys-
tematic sampling technique was used to select 594 study participants. A Cox proportional hazards model was used to
determine factors associated with time to initiate postpartum modern contraceptive use at 95% CI with a P-value of
< 0.05.
Results: A total of 576 postpartum women were participated making a response rate of 96.9%. The median time to
initiate postpartum modern contraceptive use was 7 months (IQR: 6, 8). Education [AHR = 3.01 (95% CI = 1.32, 6.83)],
knowledge on family planning [AHR = 1.56(95% CI = 1.20, 2.02)], and family planning counseling during postnatal
care [AHR = 2.22 (95% CI = 1.46, 3.38)] were predictors positively associated with time to initiate postpartum modern
contraceptive.
Conclusions: The time to initiate postpartum modern contraceptive use was delayed longer than compared to the
World Health Organization recommendation. Education level of women, knowledge of family planning, and family
planning counseling during postnatal care were some predictors positively associated with time to initiate postpar-
tum modern contraceptive use.
Keywords: Time to initiate, Modern contraception use, postpartum period, Ethiopia
© The Author(s) 2022. 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:// creat iveco mmons. org/ licen ses/ by/4. 0/. The Creative Commons Public Domain Dedication waiver (http:// creat iveco
mmons. org/ publi cdoma in/ zero/1. 0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
Introduction
Postpartum family planning (PPFP) is defined as the
prevention of unintended pregnancy and closely spaced
pregnancies through the first 12 months following child-
birth [1]. During the postpartum period family planning
(FP) can prevent about 30% of maternal mortality and
10% of child mortality if couples space their pregnancies
Open Access
Contraception and
Reproductive Medicine
*Correspondence: dacheazm@gmail.com
3 Social and Population Health Department, Yirgalem Hospital Medical
College, Addis Ababa, Ethiopia
Full list of author information is available at the end of the article
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
Page 2 of 11
MaeregayehuTiboetal. Contraception and Reproductive Medicine (2022) 7:20
more than 2 years apart [2]. World health organization
(WHO) recommended time for the initiation of contra-
ceptives in the postpartum period is 6 weeks after deliv-
ery [3].
Globally, more than 90% of women during the first
year of the postpartum period want to either delay or
avoid future pregnancies. However, 70% are not using
29 PPFP. In most cases, sexual activity in the postpartum
is resumed before the menstruation following delivery
without the use of any contraceptive method [1]. World-
wide, there are 265 million unwanted pregnancies, 110
million unnecessary abortions, 590,000 avoidable mater-
nal deaths, and 8 million preventable infant deaths [4].
According to the analysis done in 172 countries 33 with-
out family planning use the number of maternal deaths
would have been 1.8 times higher (equivalent to 614,000
deaths) than with family planning use which means that
contraceptive use averted 44.3% of maternal deaths [5].
e WHO reports that over 60% of maternal deaths
in developing countries occur during this postpartum
period [6]. A woman in a developing country is 97 times
more likely to die as a result of pregnancy than a woman
in a developed country. e developing regions share
approximately 99% of the estimated global maternal
deaths in 2015 and out of this, 66% were from Sub-Saha-
ran Africa (SSA) [6]. An estimated 30 million unplanned
births and 40 million abortions, half of them illegal and
unsafe, occurred annually in low and middle-income
countries [7].
In SSA, 40% of married women do not want a child in
the next 2 years but are not using contraception. As a
consequence, nearly 25% of pregnancies in the region are
unintended [8]. A demographic and health survey (DHS)
data from 57 countries indicated that, right after delivery
62%, after 6 months of amenorrhea 43% and at the end
of amenorrhea 32% of women in the first year after birth
have an unmet need for contraception [9].
Despite all these efforts done the utilization of mod-
ern contraceptives is low special during the postpar-
tum period. Study shows Ethiopia that about 86% of the
women in Ethiopia have an unmet need during the first
year of the postpartum period [10, 11]. erefore, the
purpose of this study is to estimate the time to initiate
postpartum modern contraceptive use and predictors
among women of reproductive age group within the first
12 months of delivery in Dilla town, southern, Ethiopia.
Methods
Study area, design, andperiod
e study was conducted at Dilla Town, which is the
administrative center of the Gedeo zone in the Southern
region of Ethiopia. It is 365 km away from Addis Ababa
capital city of Ethiopia and 95 km from Hawassa the
administrative center of the southern region of Ethiopia
and the main road from Addis Ababa to Nairobi, Kenya
crosses the town. e town is surrounded in the north
by Sidama, in the south by Wonago, in the east by Bule
and Oromia and in the west by Oromia regional state.
Administratively the town is divided into 9 Kebeles (small
local administrative units of Ethiopia). According to the
2007 census conducted by the Central Statistical Agency
of Ethiopia (CSA); Dilla town has a total population
of 102,624 in 2016 as projected from the 2007 Census
among these 50,286 (48.9%) are males & 52,338 (51.1%)
are females and the total number of women in the repro-
ductive age group is 23,911 and the total number deliv-
ery is 3274. A community-based retrospective cohort
study was conducted among women of the reproductive
age group who gave birth 12 months prior to the study in
Dilla town, southern, Ethiopia from March 25, 2019, to
March 25, 2020.
Study population andsample size determination
All women of the reproductive age group who gave
birth 12 months prior to the study in Dilla town were
source population; women of the reproductive age
group who gave birth 12 months prior to the study in
randomly selected kebeles in Dilla town were study
population; women of the reproductive age group who
gave 12 months prior to the study and residing for at
least 12 months in the Dilla town were included in the
study; women of the reproductive age group who gave
12 months prior to the study but critically ill and una-
ble to respond during the data collection period and
not residing for at least 12 months in Dilla town were
excluded from the study. e sample size was calculated
by using the double population proportion formula by
Epi Info 78 version 7 software. We took the maximum
sample among the most significant predictors of time to
initiate postpartum modern contraceptive use in most
work of literature [1214]. Unfortunately, a study done
in Kenya factor place of delivery was selected as an inde-
pendent variable since it gave maximum sample size as
compared to other exposure variables. e calculation
was based on the assumption that 95% confidence level,
80% power, the ratio of non-exposed to exposed 1, out-
come variable among exposed 49% and non-exposed
24.7%. e highest sample size was 360 then after consid-
ering 10% non-response rate and 1.5 design effects finally
sample size was 594 used for this study.
Sampling procedure
A Systematic sampling technique was used to select
study participants. Nine [9] kebeles were found in Dilla
Town, from these randomly 5 Kebeles were selected. In 5
selected kebeles census was done to identify households
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
Page 3 of 11
MaeregayehuTiboetal. Contraception and Reproductive Medicine (2022) 7:20
where the women found who gave birth 12 months before
the study period in each selected kebeles reside and iden-
tification number was given for households with eligi-
ble women. A sampling frame was developed for each
selected kebele separately based on the result of censes.
en calculated sample size was proportionally allocated
to each selected Kebele based on its number of eligible
women. en study participants were selected by sys-
tematic sampling techniques. e sampling interval was
obtained by dividing the total number of postpartum
women in each of Kebele by the proportionally allocated
sample of each Kebele. e first postpartum women was
selected by lottery method. Every 2 postpartum woman
was included until the required sample size for each
Kebele was achieved. If the selected postpartum woman
was absent at the time of data collection, the data col-
lectors revisited for two consecutive times, and if the
interviewers failed to find the study participant after two
visits, the next postpartum woman was included in the
study.
Data collection procedure andquality control
Data were collected by using interviewer-administered
structured and pretested questionnaire. e question-
naire was adapted from different related literature in
such a way it includes all relevant variables to meet the
objective of the study [1518]. e questionnaire con-
sisted of six pages and five of the sections were tries to
cover: socio-demographic characteristics, reproductive
health-related characteristics, Contact with a health care
professionals, knowledge on FP, and time to initiate post-
partum modern contraceptive use. e questionnaire
was first prepared in English and translated into Amharic
and Gedeofa (local language) by language experts. Data
was collected by 4 data collectors who have diploma mid-
wifery and 2 supervisors who have Bachelor of Science
nurse (BSc) were involved. Interview conducted in each
study participants’ home.
To maintain data quality properly designing, translat-
ing and pre-testing the questionnaire was done. Data was
collected by 4 data collectors who have diploma mid-
wives and could speak the local language (Gedeofa) and 2
supervisors who have BSc in nursing working in the study
area. Data was collected after giving Two-day proper
training on the interviewing techniques, the importance
of privacy, discipline, and confidentiality of the study par-
ticipant. e pretest was done 1 week prior to the actual
data collection time on 5% of the total sample size [19] at
Chuchokebele in Dilla Zuriya woreda which is outside of
the study area. It was done to see for the exactness of the
responses for the questions asked, language clarity, and
appropriateness of the tools before the actual data collec-
tion was conducted. Based on the results of the pretest,
the time required for interviewing each participant was
estimated and the skip pattern of some of the questions
was corrected. Closer supervision was made to check the
data collectors whether they are in their work and inter-
view the right women who were included in the study.
Confusions and questions were solved by the supervisors
and principal investigator during data collection.
Study variables
Time to initiate postpartum modern contraceptive use
was a dependent variable, and the independent variables
are socio-demographic and economic characteristics: age
of women, marital status, educational status of women,
occupation status of women, and wealth status; Con-
tact with a health care professional: Antenatal Care visit
(ANC), Number of ANC visit, Postnatal care visit (PNC),
Place of delivery, Distance to the health facility, FP coun-
seling during ANC, FP counseling during PNC, Child
immunization and FP counseling during child immuniza-
tion; Reproductive health character: Parity, birth interval,
fertility desire, resume sexual intercourse, resume men-
ses, discuss with the partner on FP, who decide on PPFP
use and previous use of modern contraceptive, Knowl-
edge of Postpartum family planning.
Operational denition
Time to initiate postpartum modern contraceptive use:
Time to initiate postpartum modern contraceptive use
was calculated at the time between the date of giving
birth to the date of initiating postpartum modern con-
traceptive use (in the month) [20] . Event: initiation of
postpartum modern contraceptive use. Censored: study
participant who lost to follow-up and not initiate post-
partum modern contraceptive use up to the end of the
study period. Good knowledge: is defined as those study
participants who score yes 4 knowledge on PPFP related
question was good knowledge [16, 21] . Poor knowledge:
is defined as a study participant score yes less than < 4
knowledge on PPFP related question was poor knowledge
[16, 21]. Pills users: postpartum women in the reproduc-
tive age group who are continuously using progesterone-
only pill (POP) for 1 month period and longer.
Data processing andanalysis
e tool’s completeness was verified prior to data entry,
and the data were coded, entered, and stored in Epi Data
version 3.1 before being analyzed in Statistical Package
for Social Science software version 20 (SPSS). Descriptive
statistics were done for categorical variables. Continuous
variables were expressed as a medians and inter-quartile
ranges. Wealth status was measured by the wealth index
generated from the household’s cumulative living stand-
ard based on ownership of specified assets using factor
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
Page 4 of 11
MaeregayehuTiboetal. Contraception and Reproductive Medicine (2022) 7:20
analysis and was later categorized into quintiles (Lowest,
Second, Middle, Fourth, and Highest). e life table was
constructed to estimate the overall probability of the ini-
tiation of postpartum modern contraceptives over time.
A Kaplan Meier survival curve was used to estimate the
time to initiation of postpartum modern contraceptive
use among different groups of variables. A Log rank test
was used to compare survival curves between different
categories of explanatory variables. A bivariate and mul-
tivariable Cox proportional hazards model was used to
assess the independent variable associated with time to
initiate postpartum modern contraceptive use. Variables
with a p-value of < 0.25 in the bivariate analysis were
fitted in to multivariate analysis. e final model was
checked for satisfying the assumption of proportional-
ity with the time-dependent Cox model and graphically
by the log-log hazard plot and the proportional haz-
ard assumption was not violated. e model fitness was
also checked using Cox and Snell’s residual analysis. An
adjusted hazard ratio (AHR) with a 95% confidence inter-
val (CI) was calculated to estimate the strength of the
association between independent predictors and the time
to initiate postpartum modern contraceptive use. Statisti-
cal significance was defined as a p value of 0.05.
Results
Socio‑demographic characteristics ofstudy participants
From 594 study participants planned for interview, about
576 respondents were interviewed making a response
rate of 96.9%. e mean age of the respondents was 28.9
(SD 5.4). Regarding respondents marital status, reli-
gion, ethnicity, occupation, and education, 403 (70%)
were married, 324 (56.2%) were protestant followers,
274 (47.6%) were Gedeo, 280 (48.6%) were housewives,
and 289 (50.2%) attended primary education. Regard-
ing wealth status, 137 (23.8%) were in the second wealth
quintile (Table1).
Reproductive characteristics ofstudy participants
e average number of children per woman was two.
Among the study participants, 485 (84.2%) had recent
child birth alive. Approximately 178 (30.9%) of study par-
ticipants had a gap of more than 2 years between their
previous and current births. Majority of the respondents
472 (81.9%) had a previous history of FP use, and the rest
of respondents had no history of previous FP use. Reason
for not using 24 (4.2%): fear of side effects. e major-
ity of respondents (409, or 71.0%) want another child
after 2 years. Of respondent 351 (60.9%) did not discuss
with their partner family planning. e majority of study
participants 439 (76.2%), had resumed menses and the
median time was 9 weeks, and 398 (69.1%) of the study
participants had already 184 resumed sexual intercourse
at the median time of 11 weeks (Table2).
Contact ofstudy participants withahealth care
professional
Almost all 559(97.0%) study participants received ANC
service, with 444(81.1%) receiving two or more ANC vis-
its during pregnancy and361 (64.6%) receiving FP coun-
seling during ANC service. About 470(81.6%) of mothers
Table 1 Socio-demographic characteristics of study participants
in Dilla Town, southern, Ethiopia, 2020
Variables Frequency Percent
Age of the women
19–24 160 27.8%
25–34 278 48.2%
35 138 24.0%
Marital status
Married 403 70%
Single 133 23.1%
(divorced & widowed) 40 6.9%
Religion
Protestant 324 56.3%
Orthodox 159 27.7%
Muslim 49 8.5%
Catholic 33 5.6%
Others 11 1.9%
Ethnicity
Gedeo 274 47.6%
Oromo 90 15.6%
Sidama 74 12.9%
Gurage 101 17.5%
Others 37 6.4%
Education level of women
No formal education 35 6.1%
Read and write 40 6.9%
Primary completed 289 50.2%
Secondary and above 212 36.8%
Occupation status of women
Housewife 280 48.6%
Government employee 134 23.3%
Private employee 77 13.4%
Merchant 75 13.0%
Others (Daily laborer & student) 10 1.7%
Wealth status
Lowest 107 18.6%
Second 137 23.8%
Middle 113 19.6%
Fourth 96 16.7%
Highest 123 21.3%
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
Page 5 of 11
MaeregayehuTiboetal. Contraception and Reproductive Medicine (2022) 7:20
Table 2 Reproductive related characteristics of study participants in Dilla Town, southern Ethiopia, 2020
Variables Frequency Percent
Parity
1 150 26.0%
2–3 274 47.6%
4+152 26.4%
Birth interval
It is my first child 150 26.1%
< 12 months 37 6.4%
12–24 months 211 36.6%
> 24 months 178 30.9%
Status of recent birth
Alive 485 84.2%
Died 91 15.8%
Previous history of modern family planning use
No 104 18.1%
Yes 472 81.9%
Reason for not use Previously modern family planning
fear of side effects 24 4.2%
husband disproval 14 2.4%
in breastfeeding 9 1.6%
menses not return 14 2.4%
far distance heath facility 11 1.9%
want deliver soon 13 2.3%
Others 19 3.3%
Future desire
Want before 2 years 91 15.4%
Want after 2 years 409 71.0%
Want no more children 76 13.6%
Discus with partner on family planning use
No 351 60.9%
Yes 225 39.1%
Who decide on family planning use
Respondent (women) 214 37.2%
Husband 137 23.8%
Both 225 39.0%
Menses resumption after recent birth
No 137 23.8%
Yes 439 76.2%
Months menses resumed
Less than 3 months 431 98.2%
3–5 months 3 0.7%
Greater than 5 months 5 1.1%
Sexual intercourse resumed after recent birth
No 178 30.9%
Yes 398 69.1%
Months Sexual intercourse resumed
Less than 3 months 308 77.4%
3–5 months 82 20.6%
Greater than 5 months 8 2.0%
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
Page 6 of 11
MaeregayehuTiboetal. Contraception and Reproductive Medicine (2022) 7:20
gave birth to their current child in governmental and pri-
vate health institutions with health professionals. Almost
all of the 556(96.5%) and 517 (89.8%) respondents were
born via spontaneous vaginal delivery or as a single child,
respectively. About 364(63.2%) of respondents had got-
ten PNC service; of these 251(69.0%) of respondents had
family planning counseling during the postnatal period.
e majority of respondents 518 (89.9%) went health
facility for child immunization, butonly206, (39.8%) get
family planning counseling during child immunization
(Table3).
Knowledge ofpostpartum FP ofstudy participants
Among the respondents, only 242 (42%) had good knowl-
edge. Whereas the majority 334 (58%) of the respondents
had poor knowledge of post partum FP use (Table4).
Time toinitiate postpartum modern FP use
In this study, 576 postpartum women were retrospec-
tively followed for 12 months (1 year). e 200 cumula-
tive proportion of postpartum modern contraceptive
use was 383 (66.5%) with a 95% CI 201 (62.3–70.1%) at
the end of 12 months. While the remaining 193 (33.5%)
were rightly censored as the time of the follow up study
period. Within the first 12 months of delivery, the median
time for women of reproductive age to begin postpar-
tum modern contraception was 7 months (IQR: 6, 8).
Our findings revealed that only 11.2% of the postpartum
women followed up started to use postpartum mod-
ern contraceptives by the second month after delivery.
e proportion of users then increased steadily over
the months, reaching 43.7, 60.4, and 65.5% at 6, 9, and
12 months, respectively (Fig.1).
Predictors ofthetime toinitiate postpartum modern
contraceptive use
After adjustment for possible confounders in multivari-
able Cox proportional hazard regression analysis, Edu-
cation level of women, decide jointly on FP use, menses
resumption, knowledge of postpartum family planning,
number of ANC visits, distance to health facility and FP
counseling during PNC service have significant associa-
tion with the time to initiate postpartum modern con-
traceptive use. Women with a primary education were
3.01 [AHR = 3.01 (95% CI = 1.32–6.83)] times more likely
than women with no formal education to begin postpar-
tum modern contraception early. When compared to
their counterpart, women who decide jointly with their
partner are 8.85 [AHR = 8.85 (95% CI: =5.00–15.65]
times more likely to initiate postpartum modern con-
traceptive use early. Postpartum women whose men-
ses had returned were 9.24 [AHR = 9.24 (95% CI: 4.95,
17.25)] times more likely to initiate postpartum modern
contraceptives early than their counterparts. Knowledge
of PPFP Women who had good knowledge of postpar-
tum family planning were positively associated with hav-
ing the time to initiate postpartum modern contraceptive
use after delivery. Women who had good knowledge of
postpartum family planning were 1.56 [AHR = 1.56, (95%
Table 3 Contact of study participants with Health Care
Professional in Dilla Town, southern, Ethiopia, 2020
Variables Frequency Percent
ANC visit for recent pregnancy
No 17 3.0%
Yes 559 97.0%
Number of ANC visit
1 115 20.3%
2–3 299 53.8%
4+145 25.9%
FP counseling during ANC service
No 198 35.4%
Yes 361 64.6%
Place of delivery recent birth
Government health facility 362 62.8%
Private health facility 108 18.8%
Home 106 18.4%
Distance to health facility
Less than half hours 108 18.8%
Half hour-1 hour 305 53.0%
Greater than 1 hours 163 28.2%
Birth attendants for recent birth
Health professionals 463 80.4%
Non health professionals (TBA) 101 17.5%
Others (relatives) 12 2.1%
Mode of delivery for recent birth
Spontaneous vaginal delivery 556 96.5%
Caesarian section 20 3.5%
Type of birth for recent birth
Single 517 89.8%
Multiple (twins) 59 10.2%
Postnatal care visit for recent birth
No 212 36.8%
Yes 364 63.2%
FP counseling during postnatal care service for recent birth
No 113 31.0%
Yes 251 69.0%
Gone to health facility for child immunization
No 58 10.1%
Yes 518 89.9%
FP counseling during child immunization
No 312 60.2%
Yes 206 39.8%
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
Page 7 of 11
MaeregayehuTiboetal. Contraception and Reproductive Medicine (2022) 7:20
CI: 1.20, 2.02)] times more likely to initiate postpar-
tum modern contraceptives early than women who had
poor knowledge of PPFP. In terms of the time it takes to
get to a medical facility, Women who traveled less than
0.5 hours to reach a health facility were 1.75 [AHR = 1.75,
(95% CI: 1.05, 2.92)] times more likely than 228 women
who traveled more than 1 hour to reach a health facility
to begin postpartum modern 229 contraception early.
ose women who had a number of ANC visits were
2.47 [AHR = 2.47, (95% CI: 1.17–5.19)] times more likely
to initiate postpartum modern contraceptives early as
compared to those women who had only a single num-
ber of ANC visits during their last pregnancy. FP coun-
seling during PNC service was also found to be one of the
predictors of time to initiate postpartum modern contra-
ceptive use after delivery. e rate of using postpartum
modern contraceptive use was 2.22 [AHR = 2.22 (95% CI:
1.46–3.38)] times shorter among women who received
counseling service about FP during PNC service than
among those women who weren’t counseled (Table5).
Discussion
According to this study, the median time to begin post-
partum modern contraception among women of repro-
ductive age within the first 12 months of delivery was
7 months. Women’s education level, deciding jointly
on postpartum modern contraceptive use, menstrual
resumption, knowledge of postpartum family planning,
Table 4 Knowledge of study participants about postpartum family planning in Dilla Town, southern, Ethiopia, 2020
Knowledge factors Frequency percent
know contraceptive used to prevent unwanted pregnancy Yes 564 97.9%
know contraceptive used to space pregnancy Yes 532 92.4%
know contraceptive used to limit pregnancy Yes 401 69.6%
Know time to initiate postpartum family planning Yes 118 20.5%
know modern family planning methods Yes 166 28.8%
Know side effects of modern family planning methods yes 72 12.5%
Know exclusive breastfeeding used as family planning Yes 133 23.1%
Know that fertility resumed after stopping family planning Yes 251 43.6%
Knowledge of postpartum family planning Poor Knowledge 334 58%
Good knowledge 242 42%
Fig. 1 The Kaplan-Meier survival curve estimate time to initiate of postpartum modern contraceptive use among women of reproductive age
group within the first 12 months of delivery in Dilla town, southern Ethiopia, 2020
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
Page 8 of 11
MaeregayehuTiboetal. Contraception and Reproductive Medicine (2022) 7:20
Table 5 Bivariate and Multivariate Cox proportional Hazard regression analysis for factors associated with time to initiate of
postpartum modern contraceptive use, in Dilla Town, southern Ethiopia, 2020
Variables Use of postpar tum modern contraceptive Hazard ratio (95% CI)
Yes (user) No (censored) Unadjusted (CHR) Adjusted (AHR)
Educational level of women
No formal education 18 (3.1%) 17 (3.0%) 1 1
Read and write 16 (2.8%) 24 (4.2%) 1,09 (0.89, 1.64)** 3.01 (1.32, 6.83)***
Primary complete 168(29.2%) 121 (21.0%) 1.49 (0.92, 2.43)*** 2.90 (1.53, 5.48)***
Secondary and above 181(31.4%) 31(5.4%) 2.98 (1.83, 4.86)*** 2.66 (1.37, 5.18)***
Occupation status of women
Housewife 149(25.9%) 131(22.7%) 1 1
Government employee 129(22.4%) 5(0.9%) 4.16 (3.26, 5.31)*** 1.15 (0.80, 1.66)
Private employee 30 (5.2%) 47 (8.2%) 2.52 (1.68, 3.77)*** 0.84 (0.51, 1.39)
Merchant 70 (12.2%) 5 (0.9%) 3.80 (2.82, 5.11)*** 1.26 (0.82, 1.95)
Othersa5 (0.9%) 5 (0.9%) 0.87(0.35, 2.12) 0.91 (0.355, 2.3)
Fertility desire
Went before 2 years 39 (6.8%) 52 (9.0%) 1 1
Went after 2 years 282 (49.0%) 126 (21.9%) 2.08 (1.49, 2.91)*** 0.90 (0.53, 1.54)
Went no more children 61(10.6%) 15 (2.6%) 2.46 (1.64, 3.68)*** 1.04 (0.71, 1.53)
Discus with partner on modern family planning
No 179(31.1%) 172(29.9%) 1 1
Yes 204(35.4%) 21(3.6%) 3.76 (3.05, 4.64)** 0.84 (0.60, 1.19)
Decide on use of modern family planning
Respondent (women) 53 (9.2%) 161 (28.0%) 1 1
Husband 115(20.0%) 22(3.8%) 4.89 (3.52, 6.79) ** 9.19 (5.84, 14.4) ***
Both 215(37.3%) 10(1.7%) 10.1 (7.44, 13.9)** 8.85 (5.00,15.65) ***
Menstruation resumed after recent birth
No 43(7.4%) 94(16.4%) 1 1
Yes 343(59.5%) 96(16.7%) 4.23 (3.07,5.82)*** 9.24(4.95, 17.25)***
Sexual intercourse resumed after recent birth
No 69 (12.0%) 109 (18.9%) 1 1
Yes 314(54.5%) 84(14.6%) 3.28 (2.52,4.26)*** 0.86 (0.51, 1.44)
Number of ANC visit
1 25(4.5%) 90(16.1%) 1 1
2–3 204(36.5%) 95(17.0%) 4.90 (3.23,7.44)*** 2.20(1.20, 4.06)**
4+140(25.0%) 5(0.9%) 13.0(8.47, 20.2)*** 2.47(1.17,5.19)**
FP counseling during ANC service
No 88(15.7%) 110(19.6%) 1 1
Yes 286(51.1%) 75(13.4%) 3.09 (2.44, 3.91)*** 1.28 (0.86, 1.90)
Distance to health facility
Less than 0.5 hours 54 (9.4%) 54(9.4%) 1.46 (1.02, 2.09)** 1.75(1.05, 2.92)**
0.5–1 hours 260(45.1%) 45(7.8%) 3.08 (2.35,4.02)*** 1.95(1.38, 2.74)***
Greater than 1 hours 69(12.0%) 94(16.3%) 1 1
FP counseling during PNC service for current child
No 25(6.8%) 88(24.2%) 1 1
Yes 226(62.1%) 25(6.9%) 4.16 (3.37, 5.13)*** 2.22 (1.46, 3.38)***
FP counseling during child immunization
No 132(25.4%) 180(34.8%) 1 1
Yes 201(34.9%) 5(0.9%) 6.01(4.83,7.48)*** 1.14 (0.69, 1.90)
knowledge of women on postpartum modern family planning
Poor Knowledge 178(30.9%) 156(27.1%) 1 1
Good knowledge 205(35.6%) 37(6.4%) 2.54 (2.07, 3.11)** 1.56 (1.20, 2.02) ***
a Daily laborer & student, p value = ** < 0.05 *** < 0.001
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
Page 9 of 11
MaeregayehuTiboetal. Contraception and Reproductive Medicine (2022) 7:20
number of ANC visits, distance to health facility, and
FP counseling during PNC service were factors asso-
ciated with the time to begin postpartum modern
contraception.
e median time to initiate postpartum modern con-
traceptives is in line with a study conducted in Nairobi
Urban Slums, Kenya [22]. It has been reported that the
median time to postpartum modern contraceptive use
after delivery was 6 months. is finding indicates that
a number of women are at a high risk of unwanted or
unplanned pregnancies because of the late initiation of
postpartum modern contraceptive use, which is much
later than WHO recommendation [3].
is study finding is lower than the studies conducted
in Gozamen district, northwest Ethiopia (3.2 months of
mean time to initiate postpartum modern contracep-
tive use) [23] and Kebribeyah 252 Town, eastern Ethi-
opia (2–3 months of mean time to initiate postpartum
modern contraceptive use) [16]. is difference might
be due to statistical analysis method variation, as these
studies calculated the mean as a measure of the average
for the time of postpartum modern contraceptive ini-
tiation after childbirth.
However, this study finding is higher than the
study conducted in Uganda, [20], which documented
19 months of median time to postpartum modern con-
traceptive use. e reason might be due to target pop-
ulation variation, as the studies in Uganda included
women who had given birth within the 5 years that
increased the median time to postpartum modern con-
traceptive use after childbirth.
In this study, the cumulative proportion of post-
partum modern contraceptive use among women of
reproductive age was found to be 66.5% with a 95% CI
(62.3–70.1%) at the end of 12 months of follow up. is
finding is in line with a study conducted in Ganta-Afe-
shum district, Tigray, Ethiopia (68.1%) [24] and Debre
Tabor town, North West Ethiopia (63%) [25]. is simi-
larity might be due to the resemblance in socio-demo-
graphic characteristics and the time period of study in
both reports, which assess the prevalence of postpar-
tum modern contraceptive use after 12 months of study.
is finding is higher than that of studies conducted
among postpartum women in Nigeria (8.32%), [26],
Dabat district, northwest Ethiopia (10.3%), [27] and
Gondar Town, Northwest Ethiopia (45.8%) [21]. e
possible explanation for this variation may 270 be due
to improvement in health service delivery, differences
in study period, as well as the 271 socio-demographic
status of the study participants.
However, this finding is lower than the study car-
ried out in Addis Ababa, Ethiopia (80.3%) [15] Hos-
sana town (73.9%), South Ethiopia (73.9%), and Kenya
(86.3%). is difference might be due to differences
in the study area’s socio demographic characteristics,
cultural variations, and service accessibility. e study
in Addis Ababa was done among urban residents, and
such participants could have better access to informa-
tion and health education.
is study shows that women who had primary edu-
cation were 3 times more likely to initiate postpartum
modern contraceptives early than those with no formal
education. is finding is consistent with other studies
carried out in rural Kenya [28] and Debre Tabor town,
Northern Ethiopia [29]. is might be due to the fact
that educated women have a better understanding of the
benefits of modern contraceptives and the risks of short
interval pregnancies. ey also have a better inclination
to visit health institutions and get the service than those
with no formal education.
Postpartum women who decide jointly with their part-
ner on postpartum modern contraceptive use are 8.8
times more likely to initiate postpartum modern con-
traceptive use earlier than those women who decide by
themselves. is finding is also supported by other stud-
ies done in Gozamen District, Ethiopia [23], Gondar
Town, northwest Ethiopia [21], and Arroresa district,
Southern Ethiopia [18]. e reason for this finding could
be the fact that decisions made jointly with agreement
will have a better outcome regarding the use of postpar-
tum contraceptives as compared with decisions made
by only one side since the issue of family planning is not
only the concern of one partner.
Women whose menses returned after delivery were 9
times more likely to initiate postpartum modern con-
traceptive use earlier than those women who hadn’t
seen menses after their last delivery. is finding is
consistent with studies done in Addis Ababa, Ethio-
pia [15], Gozamen district, Ethiopia [23], and Gondar
Town, northwest Ethiopia [21]. e reason for this may
be that menses resumption may make women aware of
their fertility returning, which motivates them to start
postpartum modern contraceptive use early. Moreo-
ver, different studies indicated that menses returning
after birth was found to be a stimulating factor affect-
ing the use of postpartum modern contraceptives and
the absence of menses as the main factor for not using
postpartum modern contraceptives.
Postpartum women who had good knowledge of
postpartum family planning were 1.5 times more likely
to initiate postpartum modern contraceptive use ear-
lier than women who had poor knowledge of post-
partum family planning. is finding is in line with
previous reports from KebriBeyah Town, Eastern Ethi-
opia [16], Gondar Town, Northwest Ethiopia [21], and
urban Ghana [19]. is is explained by the fact that
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
Page 10 of 11
MaeregayehuTiboetal. Contraception and Reproductive Medicine (2022) 7:20
knowledge determines the use of postpartum modern
contraceptives.
e findings of this study show that mothers who had
four or more ANC visits during their last pregnancy were
2.4 times more likely to use postpartum modern contra-
ceptives early compared to those women who had only
one ANC visit during their last pregnancy. is finding is
consistent with studies from Kenya [30] and Uganda [20].
is could be due to the fact that mothers who attended
more ANC visits had an opportunity to communicate
with providers and to receive counseling regarding post-
partum modern contraceptive use.
e present study revealed a significant difference in
time to postpartum modern contraceptive use based on
distance to a health facility. Women who had traveled less
than 0.5 hours to reach a health facility were 1.7 times
more likely to initiate postpartum modern contraceptive
use early as compared to those women who had traveled
more than 1 hour to reach a health facility. is finding
is consistent with studies carried out in the rural Tigray
region of northern Ethiopia [31]. e explanation for this
finding is that the proximity of women to health facili-
ties created an opportunity to use postpartum modern
contraceptives.
Women who received FP counseling during PNC ser-
vice were 2.2 times more likely to initiate postpartum
modern contraceptive use early compared with their
counterpart women. is finding is in line with a study
conducted in Debre Tabor town, northern, Ethiopia [29].
is might be due to the fact that postnatal care visits
give the opportunity to get more information and coun-
seling from health professionals and can help postpartum
women use modern contraceptive methods in an effec-
tive and timely manner.
e limitation of this study was that due to the retro-
spective nature of the study, there might be a recall bias
might have been introduced on some of the questions
that required the women to recall past information.
Another limitation is that women who have lost appoint-
ment cards or family planning to check the date of start.
Reporting inaccurate information to an interviewer in
order to please him or her could also result in a social
desirability bias. It mainly focuses on individual level
factors, socio-cultural factors, and the male partner’s
involvement related factors not assessed in this study.
Conclusions
is study found that postpartum modern contracep-
tive use among women of reproductive age was delayed
longer than compared to the WHO recommendation
within the first 12 months of delivery. Women’s education
level, deciding on family planning use jointly with their
partner, menstrual resumption, knowledge of postpar-
tum family planning, number of ANC visits during last
pregnancy, distance to health facility, and family planning
counseling during PNC services were factors that posi-
tively correlated with the time to begin postpartum mod-
ern contraception.
Based on our finding we recommend that, the Dilla
town health office, should provide support and encour-
age basic education for all women who have not attended
formal education to improve the late initiation of the FP
services in collaboration with the education bureau.
Health facilities and health professionals should be
support pregnant women to increase the number of
antenatal care visits. Further we suggest that for those
researchers who are interested should conduct prospec-
tive cohort design by including other factors such as
gender norms, socio cultural factors, and male partner-
related factors that hinder postpartum modern contra-
ceptive use.
Abbreviations
ANC: Antenatal Care; AHR: Adjusted Hazard Ratio; CHR: Crude Hazard Ratio;
CSA: Central Statistical Agency; DHS: Demographic Health Survey; EDHS:
Ethiopian Demographic and Health Survey; FP: Family Planning; HIV: Human
Immune Deficiency virus; IUCD: Intra Uterine Contraceptive Device; KM: Kilo
meter; LAM: Lactational Amenorrhea; PCA: Principal Component Analysis;
PNC: Post Natal Care; POP: Progesterone Only Pill; PPFP: Postpartum Family
Planning; RR: Relative Risk; SSA: Sub-Saharan Africa; STI: Sexual Transmit-
ted Infection; STD: Sexually Transmitted Diseases; WHO: World Health
Organization.
Acknowledgements
First of all, we would like to acknowledge Dilla University College of Health Sci-
ences and Medicine for giving us the chance to conduct this research project.
We would also like to Acknowledge the data collectors for their faithfulness in
collecting the data. Last but not least, Our gratitude goes to study participants
for being involved in the study.
Authors’ contributions
MT was involved in conceptualization and investigation. AA was involved in
formal analysis and interpretation; and AD was participated in design, data
curation, and manuscript preparation. The authors read and approved the
final manuscript.
Funding
No funding.
Availability of data and materials
The data sets used during the current study are available from the corre-
sponding author on reasonable request.
Declarations
Ethics approval and consent to participate
The Dilla University, College of Health Science and Medicine’s institution
review board granted ethical clearance. Permission was obtained from the
Dilla town health office administrative body and given to the respective
health facility. The data collection was done after written consent was taken
from each study participant. The privacy and confidentiality of the respond-
ents were ensured by excluding their names from the questionnaire and
interviewing them in a private space that is free from interruption and cannot
be observed or heard by other people within the facility environment. All
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
Page 11 of 11
MaeregayehuTiboetal. Contraception and Reproductive Medicine (2022) 7:20
methods were carried out in accordance with relevant guidelines and regula-
tions, with ethics approval and consent to participate.
Consent for publication
Not applicable.
Competing interests
The authors declared that they have no competing interests.
Author details
1 Dilla University College of Health Sciences, Addis Ababa, Ethiopia. 2 Department
of Reproductive Health, Dilla University, College of Health Sciences, Dilla, Ethiopia.
3 Social and Population Health Department, Yirgalem Hospital Medical College,
Addis Ababa, Ethiopia. 4 Social and Population Health Depar tment, Yirgalem
Hospital Medical College, Yirgalem, Ethiopia.
Received: 5 May 2021 Accepted: 10 July 2022
References
1. World Health Organization. Programming strategies for postpartum fam-
ily planning; 2013. WHO, Geneva; 2(2):1–38.
2. World Health Organization. Report of a WHO technical consultation on
birth spacing. WHO/RH. 2005;7(1):1–34.
3. World Health Organization. WHO recommendations on postnatal care
of the mother and newborn: World Health Organization. WHO Maternal
Child. 2013;2(3):1–6.
4. Ross JA, Winfrey WL. Unmet need for contraception in the developing
world and the former Soviet Union: an updated estimate. Int Fam Plan
Perspect. 2012;3(4):138–43.
5. Ahmed S, Li Q, Liu L, Tsui AO. Maternal deaths averted by contraceptive
use: An analysis of 172 countries. Lancet. 2012;380(543):111–25.
6. Africa WHO, UNICEF, UNFPA, World Bank Group and the United Nations
Population Division. Trends in Maternal Mortality Estimates from 1990 to
2015. WHO/RH. 2016;5(6):1–32.
7. Sedgh G, Singh S, Husain R. Intended and unintended pregnancies
worldwide in 2012 and recent trends. Stud Fam Plan. 2014;45(3):301–14.
8. United Nations (UN). “World contraceptive use 2011”. New York: UN
Department of Economic and Social Affairs. Vernon, Ricardo. “Meet-
ing the family planning needs of postpartum women”. Stud Fam Plan.
2009;40(3):235–45.
9. Rossier C, Bradley SE, Ross J, Winfrey W. Reassessing unmet need for fam-
ily planning in the postpartum period. Stud Fam Plan. 2015;46(4):355–67.
10. Moore Z, et al. Missed opportunities for family planning: an analysis
of pregnancy risk and contraceptive method use among postpartum
women in 21 low- and middle-income countries. Contraception.
2015;92(1):31–9.
11. Central Statistical Agency (CSA) and ICF International. Ethiopia
Demographic and Health Survey. Ethiopian Demographic and Health
Survey. 2016;1(4):1–36.
12. Mumah J, Kazuyo M, Mutua M, et al. Contraceptive adoption, discon-
tinuation, and switching among postpartum women in Nairobi’s urban
slums. Stud Fam Plan. 2015;46(4):1–9.
13. Fagbamigbe AF, Adebowale AS. Survival analysis of time to uptake of
modern contraceptives among sexually active women of reproductive
age in Nigeria. BMJ Open. 2015;2(3):1–71.
14. Gebreselassie T, Rutstein SO, Mishra V. Contraceptive use, breastfeeding,
amenorrhea and abstinence during the postpartum period: an analysis
of four countries. In: DHS Analytical Studies, vol. 14. Calverton: Macro
International Inc; 2008. p. 1–5.
15. Gebremedhin AY, Kebede Y, Gelagay AA, Habitu YA. Family planning use
and its associated factors among women in the extended postpartum
period in Addis Ababa, Ethiopia. Contracept Reprod Med. 2018;3(2):1–7.
16. Nigussie AT, Girma D, Tura G. Postpartum family planning utilization and
associated factors among women who gave birth in the past 12 months,
Kebri Beyah town, Somali region, eastern Ethiopia. J Women’s Health
Care. 2016;5(6):1–340.
17. Abdulbasit M, Nega F, Fitsum W, Habtamu M, Zelalem T. Factor associated
with experience of modern contraceptive use before pregnancy among
women who gave birth in Kersa HDSS, Ethiopia. BMC Public Health.
2016;16(7):1–61.
18. Aregahegn D, Muluemebet A, Tsedach A, Dawit H. Timely initiation of
postpartum contraceptive utilization and associated factors among
women of child bearing age in Aroressa District, Southern Ethiopia. BMC
Public Health. 2018;18(3):1–11.
19. Coomson JI, Manu A. Determinants of modern contraceptive use among
postpartum women in two health facilities in urban Ghana: a cross-
sectional study. Contracept Reprod Med. 2019;4(7):1–17.
20. Wamala R, Kabagenyi A, Kasasa S. Predictors of time-to-contraceptive
use from resumption of sexual intercourse after birth among women in
Uganda. Int J Popul Res. 2017;1-12.
21. Berta M, Feleke A, Abate T, Worku T, Gebrecherkos T. Utilization and asso-
ciated factors of modern contraceptives during extended postpartum
period among women who gave birth in the last 12 months in Gondar
Town, northwest Ethiopia. Ethiop J Health Sci. 2018;28(2):207–16.
22. Ndugwa RP, et al. Menstrual pattern, sexual behaviors, and contraceptive
use among postpartum women in Nairobi urban slums. J Urban Health.
2011;88(Suppl 2):S341–55.
23. Gizaw W, Zewdu F, Abuhay M, Bayu H. Extended Postpartum Modern
Contraceptive Utilization and Associated Factors among Women in Goza-
men District, East Gojam Zone, Northwest Ethiopia, 2014. Insights Reprod
Med. 2017;1(2):1–8.
24. Gebremariam A, Gebremariam H. Contraceptive use among lactat-
ing women in Ganta Afeshum District, Eastern Tigray, Northern
Ethiopia, 2015: a cross sectional study. BMC Pregnancy Childbirth.
2017;17(1):1–421.
25. Taye EB, Mekonen DG, Tibeb Zena D. Prevalence of post partum modern
family planning utilization and associated factors among postpartum
4mothers in Debre Tabor town, North West Ethiopia. BMC Res Notes.
2018;12(4):1–4.
26. Akinlo A, Bisiriyu A and Esimai O. Influence of Use of Maternal Health Care
on Postpartum Contraception in Nigeria. DHS Working Paper Series No.
92. Calverton: ICF International. 2013 7(5) 1–9.
27. Zelalem B, Abebaw G, Senafikish A. Contraceptive adoption in the
extended postpartum period is low in Northwest Ethiopia. BMC Preg-
nancy Childbirth. 2015;15(7):1–16.
28. Rose J, Faith T, Barasa SO, Peter N. Determinants of contraceptive use
among postpartum women in a county hospital in rural Kenya. BMC
Public Health. 2017;17(4):1–604.
29. Abraha TH, Teferra AS, Gelagay AA. Postpartum modern contraceptive
use innorthern Ethiopia: prevalence and associated factors. Epidemiol
Health. 2017;39:e2017012.
30. Do M, Hotchkiss D. Relationships between antenatal and postnatal care
and post-partum modern contraceptive use: evidence from population
surveys in Kenya and Zambia. BMC Health Serv Res. 2013;13(6):1–9.
31. Abraha, et al. Predictors of postpartum contraceptive use in rural Tigray
region, northern Ethiopia: a multilevel analysis. BMC Public Health.
2018;18(5):1–1017.
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in pub-
lished maps and institutional affiliations.
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
1.
2.
3.
4.
5.
6.
Terms and Conditions
Springer Nature journal content, brought to you courtesy of Springer Nature Customer Service Center GmbH (“Springer Nature”).
Springer Nature supports a reasonable amount of sharing of research papers by authors, subscribers and authorised users (“Users”), for small-
scale personal, non-commercial use provided that all copyright, trade and service marks and other proprietary notices are maintained. By
accessing, sharing, receiving or otherwise using the Springer Nature journal content you agree to these terms of use (“Terms”). For these
purposes, Springer Nature considers academic use (by researchers and students) to be non-commercial.
These Terms are supplementary and will apply in addition to any applicable website terms and conditions, a relevant site licence or a personal
subscription. These Terms will prevail over any conflict or ambiguity with regards to the relevant terms, a site licence or a personal subscription
(to the extent of the conflict or ambiguity only). For Creative Commons-licensed articles, the terms of the Creative Commons license used will
apply.
We collect and use personal data to provide access to the Springer Nature journal content. We may also use these personal data internally within
ResearchGate and Springer Nature and as agreed share it, in an anonymised way, for purposes of tracking, analysis and reporting. We will not
otherwise disclose your personal data outside the ResearchGate or the Springer Nature group of companies unless we have your permission as
detailed in the Privacy Policy.
While Users may use the Springer Nature journal content for small scale, personal non-commercial use, it is important to note that Users may
not:
use such content for the purpose of providing other users with access on a regular or large scale basis or as a means to circumvent access
control;
use such content where to do so would be considered a criminal or statutory offence in any jurisdiction, or gives rise to civil liability, or is
otherwise unlawful;
falsely or misleadingly imply or suggest endorsement, approval , sponsorship, or association unless explicitly agreed to by Springer Nature in
writing;
use bots or other automated methods to access the content or redirect messages
override any security feature or exclusionary protocol; or
share the content in order to create substitute for Springer Nature products or services or a systematic database of Springer Nature journal
content.
In line with the restriction against commercial use, Springer Nature does not permit the creation of a product or service that creates revenue,
royalties, rent or income from our content or its inclusion as part of a paid for service or for other commercial gain. Springer Nature journal
content cannot be used for inter-library loans and librarians may not upload Springer Nature journal content on a large scale into their, or any
other, institutional repository.
These terms of use are reviewed regularly and may be amended at any time. Springer Nature is not obligated to publish any information or
content on this website and may remove it or features or functionality at our sole discretion, at any time with or without notice. Springer Nature
may revoke this licence to you at any time and remove access to any copies of the Springer Nature journal content which have been saved.
To the fullest extent permitted by law, Springer Nature makes no warranties, representations or guarantees to Users, either express or implied
with respect to the Springer nature journal content and all parties disclaim and waive any implied warranties or warranties imposed by law,
including merchantability or fitness for any particular purpose.
Please note that these rights do not automatically extend to content, data or other material published by Springer Nature that may be licensed
from third parties.
If you would like to use or distribute our Springer Nature journal content to a wider audience or on a regular basis or in any other manner not
expressly permitted by these Terms, please contact Springer Nature at
onlineservice@springernature.com
ResearchGate has not been able to resolve any citations for this publication.
Full-text available
Article
Background: Postpartum contraception is important for spacing and limiting childbirth. Although the use of modern contraception has been shown to reduce maternal and child morbidities and mortalities, postpartum women have one of the highest unmet needs for family planning. Inter-birth intervals less than 24 months have adverse effects on both the mother and the child, yet very limited empirical evidence exist on contraceptive use among postpartum women in Ghana. This study sought to determine the prevalence and determinants of modern contraceptive use among postpartum women in the Tema Metropolis, Ghana. Methods: A facility-based cross-sectional survey was conducted among 320 postpartum women with babies aged between three and 15 months. Participants were recruited from child welfare clinics in two government health facilities in the Tema metropolitan area using a simple random sampling technique. Data were analyzed using STATA version 15. Chi-square and multiple logistic regressions techniques were used to examine associations between postpartum contraceptive use and key independent variables. Statistical significance was set at p = 0.05. Adjusted odds ratios and their 95% confidence intervals were used to assess the strength of association. Results: The prevalence rate of modern contraceptive use among postpartum women was 26.3%. Postpartum contraceptive use was significantly associated with past contraceptive use [AOR = 7.7 (95%CI: 3.4-17.5)]; return of menses [AOR = 4.3 (95%CI: 1.7-11.3)]; resumption of sexual activity [AOR = 4.7 (95%CI: 1.4-15.4)]; discussion of family planning with male partner [AOR = 3.1 (95%CI: 1.03-9.2)]; male partners' approval of modern contraception [AOR = 18.1 (95%CI: 6.3-51.6)]; family planning counselling received during antenatal care [AOR = 3.5 (95%CI: 1.3-9.9)] and knowledge of at least one modern methods of contraception available at the health facility [AOR = 4.7 (95%CI: 1.9-11.5)]. Conclusions: Postpartum contraceptive uptake is low among women in the Tema area. Factors that influence modern contraceptive uptake among postpartum women include past modern contraceptive use, resumption of sexual activity and menstruation, male partner involvement in contraception, family planning counselling during antenatal care and knowledge of the modern methods of contraception available at the health facility. Strengthening family planning education and counselling during antenatal care and using a multi-prong strategy to engage men as partners in family planning will improve postpartum contraceptive uptake.
Full-text available
Article
Objective: The aim of this study was to assess the prevalence of postpartum modern family planning utilization and associated factors among postpartum mothers in Debre Tabor town, North West Ethiopia, 2018. Result: The proportion of postpartum modern contraceptive utilization in Debre Tabor town was 63% (95% CI 59%, 67.4%). In multivariable logistic regression analysis; age of the mother (25-29) [AOR: 2.004 (95% CI 1.079, 3.722)], married women [AOR 4.804 (95% CI 1.843, 12.521)], return of menses [AOR: 3.639 (95% CI 2.454, 5.396)] and previous history of family planning [AOR: 2.409 (95% CI 1.474, 3.937)] were the factors positively associated with utilization of postpartum modern contraceptive.
Full-text available
Article
Background Globally, more than 90% of women during the first year of postpartum period want to either delay or avoid future pregnancies. The first year postpartum period is more crucial time to use modern contraceptives that enhance maternal and child health, so more attention should be given on time of initiating modern contraceptive utilization after delivery. Therefore, the aim of this study was to assess the magnitude and associated factors of timely initiation of postpartum contraceptive utilization among women of child bearing age in Aroressa district, Southern Ethiopia. Methods The study was conducted in Aroressa district from March 15 to April 15, 2017. A community based cross-sectional study design with interviewer administered structured and pretested questionnaire was used. Multistage sampling technique was employed involving a total of 695 women of child bearing age who delivered a child in the past 12 months prior to the study period. Data were cleaned, coded and entered into Epi data version 3.1, then exported to statistical package for social science version 20 for analysis. Descriptive statistics, Bivariate and Multivariate logistic regression analysis were done. p-value < 0.05 was used to consider significant variables. Results The magnitude of timely initiation of postpartum contraceptive utilization was found to be 31.7% [95% CI (28, 36)]. Antenatal care [AOR = 1.94, 95% CI (1.23, 3.01)], postnatal care [AOR = 1.90, 95%CI (1.23, 2.94)], spousal communication on contraceptive methods [AOR = 1.63, 95% CI (1.09, 2.41)] and resumption of menses after delivery [AOR = 2.6, 95% CI (1.47, 3.81)] were predictors positively associated with timely initiation of postpartum contraceptive utilization. Conclusion The magnitude of timely initiation of postpartum contraceptive utilization was low. Strengthening integration of family planning information with antenatal and postnatal care follow up and encouraging spousal communication by promoting information, education and communication activities is important to enhance contraceptive use on timely manner.
Full-text available
Article
Background Postpartum family planning services is one of the recommended public health intervention aimed at reducing maternal and child morbidity and mortalities. However, there is a paucity studies in rural Tigray region. Therefore, determining the level and associated factors of contraceptive use among postpartum women has the potential to contribute in achieving the Ethiopian Health Sector Transformation Plan and to the Sustainable Development Goals on maternal and infant survival. Methods A community-based cross-sectional study was done among 1109 postpartum women from March 29, 2017 to April 29, 2017. Face –to–face interview was used for data collection. The collected data were entered and cleaned using EPI - INFO version 7statistical software and later exported to and analyzed using STATA version 12. Mixed-effects multilevel logistic regression analysis was used to identify the individual and community-level factors associated with contraception adoption. A two side p-value< 0.05 was considered to be statistically significant. Results The level of contraceptive use was 38.3%. Individual-level variables such as women belong to fourth (AOR = 1.2; 95% CI: 1.1–3.2) and fifth (AOR = 1.5; 95% CI: 1.3–2.5) wealth quintiles were identified as key predictors of contraception use. In addition, partner secondary (AOR = 2.3; 95% CI: 1.8–3.5) and diploma (AOR = 1.2; 95% CI, 1.1–2.6) educational-level and postnatal care (AOR = 2.0; 95% CI: 1.9, 4.3) were also significantly affected contraception use. Community-level variables such as high community-level antenatal care services use (AOR = 2.1; 95% CI: 1.9–4.2) and proximity of women to health facility (AOR = 3.0; 95% CI: 2.7–4.6) were also determinants of contraception uptake. Conclusions The status of contraceptive use in rural Tigray region was found to be low. It was found that both individual and community-level variables showed a marked determinant on postpartum contraception use. This study suggested that in order to increase contraceptive use the government should focus on increasing postnatal care, antenatal care services use and reduction of poverty level are important avenues for intervention.
Full-text available
Article
Background The postpartum period is a critical period for addressing widespread unmet needs in family planning and for reducing the risks of closely spaced pregnancies. However, many women do not realize that they are at risk for pregnancy during this period. Therefore, the aim of this study was to assess utilization and associated factors of modern contraceptives during extended post-partum period. Methods Institutional based cross-sectional study was conducted from March to April, 2015 in six health institutions among women who gave birth in the last 12 months prior to the study period in Gondar Town, Northwest Ethiopia. A systematic random sampling technique was used to select the study participants. Data were analyzed using SPSS version 20. Bivariate and multivariate logistic regression models were fitted to identify the determinants of postpartum modern contraceptive use. Adjusted odds ratios with 95% confidence intervals were calculated, and p-values <0.05 were considered to indicate statistical significance. Result Of the total 404 participants, 45.8% mothers used modern contraceptives during postpartum period. Injectable contraceptive was the most frequently used method. Menstruating [AOR =3.84, 95% CI: (2.33, 6.35)], resumption of sex [AOR= 3.17, 95% CI: (1.80, 5.58)], 37–51 weeks of postpartum period [AOR= 2.48, 95% CI: (1.11, 5.55)], husband approval of contraceptive [AOR= 2.10, 95% CI: (1.16, 3.82)] and current knowledge on FP [AOR= 5.01, 95% CI: (2.23, 11.24)] were factors affecting contraceptive use in postpartum period. Conclusion Utilization of modern contraceptive during the postpartum period was significantly decreased placing women at risk for a pregnancy in the extended postpartum period. Menstruating, resumption of sex, variation on postpartum period and husband approval of contraceptive were factors associated with contraceptive use. Strengthening FP counseling service at the ANC clinic and postnatal care would improve contraceptive use during the postpartum period.
Full-text available
Article
Background Postpartum period is an important entry point for family planning service provision; however, women in Ethiopia are usually uncertain about the use of family planning methods during this period. Limited studies have been conducted to assess postpartum family planning use in Addis Ababa, in particular and in the country in general. So, this study was conducted to assess postpartum family planning use and its associated factors among women in extended postpartum period in Kolfe Keranyo sub city of Addis Ababa. Materials and methodsA community-based cross sectional study was conducted from May to June 2015 on 803 women who have had live births during the year (2014) preceding the data collection in the sub city. The multi-stage cluster sampling technique was used to select study participants. Data were collected by interviewer administered structured questionnaire, entered into EPI INFO version 7 and analyzed by SPSS Version 20. Bivariable and Multivariable logistic regression models were employed to see the presence and strength of the association between the dependent and independent variables by computing the odds ratios with a 95% confidence intervals and p-values. ResultsThe prevalence of postpartum family planning use was 80.3% (95% CI: 74.5, 83.1). Marriage, (AOR 0.09, 95% CI: 0.03, 0.22), menses resumption after birth, (AOR 2.12, 95% CI: 1.37, 3.41), length of time after delivery, (AOR 2.37, 95% CI: 1.18, 4.75), and history of contraceptive use before last pregnancy, (AOR 0.12, 95% CI: 0.07, 0.18) were the factors associated with postpartum family planning use. Conclusion The prevalence of postpartum family planning use was high and the main factors associated with it were marriage, menses resumption, length of time after delivery, and history of previous contraceptive use. Therefore women should get appropriate information about the possibility of exposure to pregnancy prior to menses resumption by giving special emphasis to those who had no previous history of contraceptive use and exposure to the other identified factors.
Full-text available
Article
Background: Women who are not exclusively breastfeeding are at risk of pregnancy after four to six weeks of childbirth. Postpartum contraceptive use is crucial to prevent unintended pregnancy, and to have spaced births. The study was conducted to determine the magnitude of modern contraceptive utilization and factors associated with it among lactating women in Ganta-Afeshum district. Methods: A community based cross sectional study was conducted among lactating women with children in the age group of six to twelve months. A total of 605 women were included in the study. The study participants were selected using cluster sampling method. Data were collected using structured interviewer administered Tigrigna version questionnaire. Data were analyzed using SPSS version 21. Multivariable logistic regression was used to control the effect of confounders. Results: The magnitude of institutional delivery was 96.5%. The mode of delivery of the participants was spontaneous, instrumental and caesarean section, 95.5%, 2.0%, and 2.5%, respectively. The magnitude of modern contraceptive (MC) utilization was 68.1% (95% CI: 64.4-71.8). The contraceptive method mix was dominated by Depo-Provera (58.8%) followed by implants (31.8%). Almost all the study participants had at least one antenatal care (ANC) visit (99.7%) during the pregnancy of their index child. Participants who had radio and those who delivered their recent child by assisted delivery had higher odds of modern contraceptive use. Conclusions: The magnitude of contraceptive utilization among lactating mothers in the study area was higher than the national survey reports. However, significant numbers of women are not using contraceptives in their postpartum period, making them at risk of pregnancy. Mode of delivery of the women and having radio at home were significantly associated with the women's contraceptive utilization. Family planning information dissemination using radio in rural settings should be encouraged to increase the uptake of contraceptives in the lactating women.
Full-text available
Article
Abstract Background: There is a high unmet need for limiting and spacing child births during the postpartum period. Given the consequences of closely spaced births, and the benefits of longer pregnancy intervals, targeted activities are needed to reach this population of postpartum women. Our objective was to establish the determinants of contraceptive uptake among postpartum women in a county referral hospital in rural Kenya. Methods: Sample was taken based on a mixed method approach that included both quantitative and qualitative methods of data collection. Postpartum women who had brought their children for the second dose of measles vaccine between 18 and 24 months were sampled Participants were interviewed using structured questionnaires, data was collected about their socio-demographic characteristics, fertility, knowledge, use, and access to contraceptives. Chi square tests were used to determine the relationship between uptake of postpartum family planning and: socio demographic characteristics, contraceptive knowledge, use access and fertility. Qualitative data collection included focus group discussions (FDGs) with mothers and in-depth interviews with service providers Information was obtained from mothers’ regarding their perceptions on family planning methods, use, availability, access and barriers to uptake and key informants’ views on family planning counseling practices and barriers to uptake of family planning Results: More than three quarters (86.3%) of women used contraceptives within 1 year of delivery, with government facilities being the most common source. There was a significant association (p ≤ 0.05) between uptake of postpartum family planning and lower age, being married, higher education level, being employed and getting contraceptives at a health facility. One third of women expressing no intention of having additional children were not on contraceptives. In focus group discussions women perceived that the quality of services offered at the public facilities was relatively good because they felt that they were adequately counseled, as opposed to local chemist shops where they perceived the staff was not experienced. Conclusion: Contraceptive uptake was high among postpartum women, who desired to procure contraceptives at health facilities. However, there was unmet need for contraceptives among women who desired no more children. Government health facility stock outs represent a missed opportunity to get family planning methods, especially long acting reversible contraceptives, to postpartum women.
Full-text available
Article
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 <0.05 were considered as statistical significance. Results: Nearly half (48%) of women used modern contraceptive during extended postpartum period (EPP). Postpartum modern contraceptive use was significantly associated with secondary,tertiary education level [aOR=4.25; 95% CI,1.29, 14.00; aOR= 5.36;95%CI,1.13,25.45] respectively; family planning counseling during prenatal and postnatal care [aOR=5.72;95%CI,2.68,12.28],having postnatal care [aOR=2.36;95% CI,1.15, 4.87], resuming sexual activities [aOR=9.53; 95%CI, 3.74, 24.27], menses returned after birth [aOR= 6.35;95% CI, 3.14,13.39]. In addition, experiencing problem with previous contraceptive use was negatively associated with modern contraceptive use [aOR= 0.34; 95% CI, 0.16, 0.71]. Conclusions: Low postpartum modern contraceptive use was found in the study area. Therefore, strengthening family planning counseling during ANC and PNC visits, improved postnatal care services utilization and educational status to enhance modern contraceptive use for postpartum women is crucial.