Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
BMC Pregnancy and Childbirth
Published in: BMC Pregnancy and Childbirth 1/2018

Open Access 01-12-2018 | Research article

Association between skilled maternal healthcare and postpartum contraceptive use in Ethiopia

Authors: Gizachew Assefa Tessema, Tensae Tadesse Mekonnen, Zelalem Birhanu Mengesha, Katherine Tumlinson

Published in: BMC Pregnancy and Childbirth | Issue 1/2018

Login to get access

Abstract

Background

The postpartum period provides an important opportunity to address unmet need for contraception and reduce short birth intervals. This study aims to assess the association between skilled maternal healthcare and postpartum contraceptive use in Ethiopia.

Methods

Data for this analysis come from the 2011 to 2016 Ethiopian Demographic and Health Surveys (EDHS) and include nearly 5000 married women of reproductive age with a recent birth. Multivariate logistic regression was conducted to investigate the relationship between skilled maternal healthcare and postpartum contraceptive use.

Results

Between rounds of the 2011 and 2016 EDHS, the postpartum contraceptive prevalence increased from 15 to 23% and delivery in public facilities, use of skilled birth assistance, and skilled antenatal care also grew. In both survey rounds, educated women had approximately twice the odds of postpartum contraceptive use, compared with non-educated women, while an initially significant relationship between wealth and postpartum contraceptive use diminished in significance by 2016. Women with a desire to limit future pregnancy had five to six times the odds of postpartum contraceptive use in both survey rounds, and women in 2016 – unlike those in 2011 – with a desire to delay pregnancy were significantly more likely to use contraception (adjusted odds ratio (AOR) = 4.38, 95% CI: 1.46-13.18) compared to women who wanted another child soon. In 2011, no statistically significant associations were found between any maternal healthcare and postpartum contraceptive use. In contrast, in 2016, postpartum contraceptive use was significantly associated with an institutional delivery (AOR = 1.71, 95% confidence interval (CI): 1.12-2.62) and skilled antenatal care (AOR = 2.41, 95% CI: 1.41-4.10). No significant relationship was observed in either survey round between postpartum contraceptive use and skilled delivery or postnatal care.

Conclusions

A comparison of postpartum women in the 2011 and 2016 EDHS reveals increased use of both contraception and skilled maternal healthcare services and improved likelihood of contraceptive use among women with an institutional delivery or antenatal care, perhaps as a result of increased attention to postpartum family planning integration. Additionally, results suggest postpartum women are now using contraception to space future pregnancies, with the potential to help women achieve more optimal birth intervals.
Literature
1.
Ahmed S, Ahmed S, McKaig C, Begum N, Mungia J, Norton M, Baqui AH. The effect of integrating family planning with a maternal and newborn health program on postpartum contraceptive use and optimal birth spacing in rural Bangladesh. Stud Fam Plan. 2015;46(3):297–312.CrossRef
2.
Rutstein SO, Winter R. The effects of fertility behavior on child survival and child nutritional status: evidence from demographic and health surveys, 2006-2012. In: DHS Analystical studies no 37. Rockville: ICF International; 2014.
3.
World Health Organization (WHO). Report of a WHO technical consultation on birth spacing. Geneva: WHO; 2005.
4.
Cleland J, Bernstein S, Ezeh A, Faundes A, Glasier A, Innis J. Family planning: the unfinished agenda. Lancet. 2006;368(9549):1810–27.CrossRefPubMed
5.
Rutstein SO. Further evidence of the effects of preceding birth intervals on neonatal, infant, and under-five-years mortality and nutritional status in developing countries: evidence from the demographic and health surveys. DHSWorking papers no. 41. Calverton: Macro International; 2008.
6.
Zhu BP, Rolfs RT, Nangle BE, Horan JM. Effect of the interval between pregnancies on perinatal outcomes. N Engl J Med. 1999;340(8):589–94.CrossRefPubMed
7.
DaVanzo J, Hale L, Razzaque A, Rahman M. The effects of pregnancy spacing on infant and child mortality in Matlab, Bangladesh: how they vary by the type of pregnancy outcome that began the interval. Popul Stud. 2008;62(2):131–54.CrossRef
8.
Conde-Agudelo A, Rosas-Bermudez A, Kafury-Goeta AC. Effects of birth spacing on maternal health: a systematic review. Am J Obstet Gynecol. 2007;196(4):297–308.CrossRefPubMed
9.
Cleland J, Conde-Agudelo A, Peterson H, Ross J, Tsui A. Contraception and health. Lancet. 2012;380(9837):149–56.CrossRefPubMed
10.
Tegegn M, Arefaynie M, Tiruye TY. Unmet need for modern contraceptives and associated factors among women in the extended postpartum period in Dessie town, Ethiopia. Contracept Reprod Med. 2017;2:21.CrossRefPubMedPubMedCentral
11.
Ross JA, Winfrey WL. Contraceptive use, intention to use and unmet need during the extended postpartum period. Int Fam Plan Perspect. 2001;27(1):20–7.
12.
MacQuarrie Kerry LD. Unmet need for family planning among young women: levels and trends. DHS comparative reports no. 34. Rockville: ICF International; 2014.
13.
Gaffield ME, Egan S, Temmerman M. It's about time: WHO and partners release programming strategies for postpartum family planning. Glob Health Sci Pract. 2014;2(1):4–9.CrossRefPubMedPubMedCentral
14.
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.CrossRefPubMedPubMedCentral
15.
Abera Y, Mengesha ZB, Tessema GA. Postpartum contraceptive use in Gondar town, Northwest Ethiopia: a community based cross-sectional study. BMC Womens Health. 2015;15:19.
16.
Achyut P, Mishra A, Montana L, Sengupta R, Calhoun LM, Nanda P. Integration of family planning with maternal health services: an opportunity to increase postpartum modern contraceptive use in urban Uttar Pradesh, India. J Fam Plann Reprod Health Care. 2016;42(2):107-15.
17.
Akinlo A, Bisiriyu A, Esimai O. Influence of use of maternal health care on postpartum contraception in Nigeria. DHSWorking papers no. 92. Calverton: ICF International; 2013.
18.
Rutaremwa G, Kabagenyi A, Wandera SO, Jhamba T, Akiror E, Nviiri HL. Predictors of modern contraceptive use during the postpartum period among women in Uganda: a population-based cross sectional study. BMC Public Health. 2015;15:262.CrossRefPubMedPubMedCentral
19.
Tappis H, Kazi A, Hameed W, Dahar Z, Ali A, Agha S. The role of quality health services and discussion about birth spacing in postpartum contraceptive use in Sindh, Pakistan: a multilevel analysis. PLoS One. 2015;10(10):e0139628.CrossRefPubMedPubMedCentral
20.
Teklehaimanot HD, Teklehaimanot A. Human resource development for a community-based health extension program: a case study from Ethiopia. Hum Resour Health. 2013;11:39.
21.
CSA [Ethiopia] and ICF International. Ethiopia demographic and health survey 2016. Addis Ababa and Rockville: CSA [Ethiopia] and ICF International; 2016.
22.
Ethiopia: Commitment Maker Since 2012 [http://​www.​familyplanning20​20.​org/​entities/​56].
23.
Ethiopia Ministry of Health. National Guideline for family planning Services in Ethiopia. Addis Ababa: Federal Democratic Republic of Ethiopia Ministry of Health; 2011.
24.
FMOH. Health sector transformation plan (HSTP) 2015/16 - 2019/20. Addis Ababa: Federal Ministry of Health (FMOH); 2015.
25.
FMOH. Draft National Reproductive Health Strategy (2016 – 2020). Addis Ababa: Federal Ministry of Health (FMOH); 2016.
26.
27.
Central Statistics Agency (CSA) of Ethiopia and ICF International. Ethiopian demographic and health survey report 2011. Addis Ababa, Ethiopia and Calverton: Central Statistical Agency and ICF International; 2012.
28.
Wilopo SA, Setyawan A, Pinandari AW, Prihyugiarto T, Juliaan F, Magnani RJ. Levels, trends and correlates of unmet need for family planning among postpartum women in Indonesia: 2007-2015. BMC Womens Health. 2017;17(1):120.CrossRefPubMedPubMedCentral
29.
30.
Kandala NB, Lukumu FK, Mantempa JN, Kandala JD, Chirwa T. Disparities in modern contraception use among women in the democratic republic of Congo: a cross-sectional spatial analysis of provincial variations based on household survey data. J Biosoc Sci. 2015;47(3):345–62.CrossRefPubMed
31.
Abraha TH, Teferra AS, Gelagay AA. Postpartum modern contraceptive use in northern Ethiopia: prevalence and associated factors. Epidemiol Health. 2017;39:e2017012.CrossRefPubMedPubMedCentral
32.
Mahmood SE, Srivastava A, Shrotriya VP, Shaifali I, Mishra P. Postpartum contraceptive use in rural Bareilly. Indian J Commun Health. 2011;23(2):56–7.
33.
Hahn Y, Islam A, Nuzhat K, Smyth R, Yang H-S. Education, marriage and fertility: long-term evidence from a female stipend program in Bangladesh. Melbourne: Monash University; 2015.
34.
Becker SO, Cinnirella F, Woessmann L. Does women's education affect fertility? Evidence from pre-demographic transition Prussia. Eur Rev Econ Hist. 2013;17(1):24–44.CrossRef
35.
Lam D, Sedlacek G, Duryea S. Increase in women’ s education and fertility decline in Brazil. Anais. 2016:89–118.
36.
Teshome A, Birara M, Rominski SD. Quality of family planning counseling among women attending prenatal care at a hospital in Addis Ababa, Ethiopia. Int J Gynaecol Obstet. 2017;137(2):174–9.CrossRefPubMed
37.
Das J, Hammer J, Leonard K. The quality of medical advice in low-income countries. J Econ Perspect. 2008;22(2):93–114.CrossRefPubMed
38.
Mohanan M, Vera-Hernandez M, Das V, Giardili S, Goldhaber-Fiebert JD, Rabin TL, Raj SS, Schwartz JI, Seth A. The know-do gap in quality of health care for childhood diarrhea and pneumonia in rural India. JAMA Pediatr. 2015;169(4):349–57.CrossRefPubMedPubMedCentral
39.
40.
Tumlinson K, Speizer IS, Curtis SL, Pence BW. Accuracy of standard measures of family planning service quality: findings from the simulated client method. Stud Fam Plan. 2014;45(4):443–70.CrossRef
Metadata
Title
Association between skilled maternal healthcare and postpartum contraceptive use in Ethiopia
Authors
Gizachew Assefa Tessema
Tensae Tadesse Mekonnen
Zelalem Birhanu Mengesha
Katherine Tumlinson
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Pregnancy and Childbirth / Issue 1/2018
Electronic ISSN: 1471-2393
DOI
https://doi.org/10.1186/s12884-018-1790-5

Other articles of this Issue 1/2018

BMC Pregnancy and Childbirth 1/2018 Go to the issue

Research article

Stakeholders’ perspectives on facilitators of and barriers to the utilisation of and access to maternal health services in Eritrea: a qualitative study

Research article

An account for barriers and strategies in fulfilling women’s right to quality maternal health care: a qualitative study from rural Tanzania

Research article

Vaginal birth after caesarean birth in Italy: variations among areas of residence and hospitals

Research article

Dietary practices and associated factors during pregnancy in northwestern Ethiopia

Research article

Do elevated symptoms of depression predict adherence and outcomes in the UPBEAT randomised controlled trial of a lifestyle intervention for obese pregnant women?

Research article

Incidence and factors associated with outcomes of uterine rupture among women delivered at Felegehiwot referral hospital, Bahir Dar, Ethiopia: cross sectional study