Skip to main content
Top
Published in: BMC Public Health 1/2017

Open Access 01-12-2017 | Research article

Determinants of contraceptive use among postpartum women in a county hospital in rural KENYA

Authors: Rose Jalang’o, Faith Thuita, Sammy O. Barasa, Peter Njoroge

Published in: BMC Public Health | Issue 1/2017

Login to get access

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.
Appendix
Available only for authorised users
Literature
1.
go back to reference Moore Z, Pfitzer A, Gubin R, Charurat E, Elliott L, Croft T. 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. Jul. 2015;92(1):31–9.CrossRefPubMed Moore Z, Pfitzer A, Gubin R, Charurat E, Elliott L, Croft T. 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. Jul. 2015;92(1):31–9.CrossRefPubMed
2.
go back to reference Rutstein SO. 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. Int. J. Gynecol. Obstet. 2005;89:S7–S24.CrossRef Rutstein SO. 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. Int. J. Gynecol. Obstet. 2005;89:S7–S24.CrossRef
3.
go back to reference DaVanzo J, Hale L, Razzaque A, Rahman M. Effects of interpregnancy interval and outcome of the preceding pregnancy on pregnancy outcomes in Matlab, Bangladesh. BJOG Int. J. Obstet. Gynaecol. 2007;114(9):1079–87.CrossRef DaVanzo J, Hale L, Razzaque A, Rahman M. Effects of interpregnancy interval and outcome of the preceding pregnancy on pregnancy outcomes in Matlab, Bangladesh. BJOG Int. J. Obstet. Gynaecol. 2007;114(9):1079–87.CrossRef
4.
go back to reference M. I. Rodriguez, R. Chang, H. Thiel de Bocanegra, “The impact of postpartum contraception on reducing preterm birth: findings from California,” Am. J. Obstet. Gynecol., vol. 213, no. 5, pp. 703.e1–6, Nov. 2015. M. I. Rodriguez, R. Chang, H. Thiel de Bocanegra, “The impact of postpartum contraception on reducing preterm birth: findings from California,” Am. J. Obstet. Gynecol., vol. 213, no. 5, pp. 703.e1–6, Nov. 2015.
5.
go back to reference Singh S, Darroch JE. Adding it up: Costs and benefits of contraceptive services. UNFPA: Guttmacher Inst; 2012. Singh S, Darroch JE. Adding it up: Costs and benefits of contraceptive services. UNFPA: Guttmacher Inst; 2012.
6.
go back to reference Ndugwa RP, Cleland J, Madise NJ, Fotso J-C, Zulu EM. Menstrual Pattern, Sexual Behaviors, and Contraceptive Use among Postpartum Women in Nairobi Urban Slums. J. Urban Health. Jun. 2011;88(S2):341–55.CrossRef Ndugwa RP, Cleland J, Madise NJ, Fotso J-C, Zulu EM. Menstrual Pattern, Sexual Behaviors, and Contraceptive Use among Postpartum Women in Nairobi Urban Slums. J. Urban Health. Jun. 2011;88(S2):341–55.CrossRef
7.
go back to reference S. RamaRao, S. Ishaku, W. Liambila, B. Mane, “Enhancing contraceptive choice for postpartum women in sub-Saharan Africa with the progesterone vaginal ring: a review of the evidence,” Open Access J. Contracept., p. 117, Sep. 2015. S. RamaRao, S. Ishaku, W. Liambila, B. Mane, “Enhancing contraceptive choice for postpartum women in sub-Saharan Africa with the progesterone vaginal ring: a review of the evidence,” Open Access J. Contracept., p. 117, Sep. 2015.
8.
go back to reference 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. 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.
9.
go back to reference J. ACCESS-FP, “Strengthening Postnatal Care Services Including Postpartum Family Planning in Kenya,” 2008. J. ACCESS-FP, “Strengthening Postnatal Care Services Including Postpartum Family Planning in Kenya,” 2008.
11.
go back to reference C. Bwazi, A. Maluwa, A. Chimwaza, M. Pindani, “Utilization of Postpartum Family Planning Services between Six and Twelve Months of Delivery at Ntchisi District Hospital, Malawi,” Health (N. Y.), vol. 2014, 2014. C. Bwazi, A. Maluwa, A. Chimwaza, M. Pindani, “Utilization of Postpartum Family Planning Services between Six and Twelve Months of Delivery at Ntchisi District Hospital, Malawi,” Health (N. Y.), vol. 2014, 2014.
12.
go back to reference Mekonnen W, Worku A. Determinants of low family planning use and high unmet need in Butajira District, South Central Ethiopia. Reprod Health. 2011;8:37.CrossRefPubMedPubMedCentral Mekonnen W, Worku A. Determinants of low family planning use and high unmet need in Butajira District, South Central Ethiopia. Reprod Health. 2011;8:37.CrossRefPubMedPubMedCentral
13.
go back to reference M. Do D. Hotchkiss, “Relationships between antenatal and postnatal care and post-partum modern contraceptive use: evidence from population surveys in Kenya and Zambia,” BMC Health Serv. Res., vol. 13, no. 1, p. 6, 2013. M. Do D. Hotchkiss, “Relationships between antenatal and postnatal care and post-partum modern contraceptive use: evidence from population surveys in Kenya and Zambia,” BMC Health Serv. Res., vol. 13, no. 1, p. 6, 2013.
14.
go back to reference Blumenthal PD, Voedisch A, Gemzell-Danielsson K. Strategies to prevent unintended pregnancy: increasing use of long-acting reversible contraception. Hum. Reprod. Update. 2011;17(1):121–37.CrossRefPubMed Blumenthal PD, Voedisch A, Gemzell-Danielsson K. Strategies to prevent unintended pregnancy: increasing use of long-acting reversible contraception. Hum. Reprod. Update. 2011;17(1):121–37.CrossRefPubMed
15.
go back to reference Keesara SR, Juma PA, Harper CC. Why do women choose private over public facilities for family planning services? A qualitative study of post-partum women in an informal urban settlement in Kenya. BMC Health Serv. Res. 2015;15:335.CrossRefPubMedPubMedCentral Keesara SR, Juma PA, Harper CC. Why do women choose private over public facilities for family planning services? A qualitative study of post-partum women in an informal urban settlement in Kenya. BMC Health Serv. Res. 2015;15:335.CrossRefPubMedPubMedCentral
16.
go back to reference V. Naanyu, J. Baliddawa, E. Peca, J. Karfakis, N. Nyagoha, B. Koech, “An examination of postpartum family planning in western Kenya:‘I want to use contraception but I have not been told how to do so,’” Afr. J. Reprod. Health, vol. 17, no. 3, pp. 44–53, 2013. V. Naanyu, J. Baliddawa, E. Peca, J. Karfakis, N. Nyagoha, B. Koech, “An examination of postpartum family planning in western Kenya:‘I want to use contraception but I have not been told how to do so,’” Afr. J. Reprod. Health, vol. 17, no. 3, pp. 44–53, 2013.
17.
go back to reference Ndugwa RP, Cleland J, Madise NJ, Fotso J-C, Zulu EM. Menstrual pattern, sexual behaviors, and contraceptive use among postpartum women in Nairobi urban slums. J. Urban Health. 2011;88(2):341–55.CrossRef Ndugwa RP, Cleland J, Madise NJ, Fotso J-C, Zulu EM. Menstrual pattern, sexual behaviors, and contraceptive use among postpartum women in Nairobi urban slums. J. Urban Health. 2011;88(2):341–55.CrossRef
18.
go back to reference O. Pasha, S. S. Goudar, A. Patel, A. Garces, F. Esamai, E. Chomba, J. L. Moore, B. S. Kodkany, S. Saleem, R. J. Derman, E. A. Liechty, P. L. Hibberd, K. M. Hambidge, N. F. Krebs, W. A. Carlo, E. M. McClure, M. Koso-Thomas, R. L. Goldenberg, “Postpartum contraceptive use and unmet need for family planning in five low-income countries,” Reprod. Health, vol. 12, no. Suppl 2, p. S11, Jun. 2015. O. Pasha, S. S. Goudar, A. Patel, A. Garces, F. Esamai, E. Chomba, J. L. Moore, B. S. Kodkany, S. Saleem, R. J. Derman, E. A. Liechty, P. L. Hibberd, K. M. Hambidge, N. F. Krebs, W. A. Carlo, E. M. McClure, M. Koso-Thomas, R. L. Goldenberg, “Postpartum contraceptive use and unmet need for family planning in five low-income countries,” Reprod. Health, vol. 12, no. Suppl 2, p. S11, Jun. 2015.
20.
go back to reference T. C. Okech, N. W. Wawire, T. K. Mburu, “Contraceptive Use among women of reproductive Age in Kenya’s city slums,” Int J Bus Soc Sci, vol. 1, no. 2, 2011. T. C. Okech, N. W. Wawire, T. K. Mburu, “Contraceptive Use among women of reproductive Age in Kenya’s city slums,” Int J Bus Soc Sci, vol. 1, no. 2, 2011.
21.
go back to reference 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 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
22.
go back to reference Worku Z, Muchie M. intended postpartum contrceptiveuse among pregnant and. Afr. J. Sci. Technol. Innov. Dev. 2013;5(5):399–410.CrossRef Worku Z, Muchie M. intended postpartum contrceptiveuse among pregnant and. Afr. J. Sci. Technol. Innov. Dev. 2013;5(5):399–410.CrossRef
23.
go back to reference K. M. Elfstrom R. Stephenson, “The role of place in shaping contraceptive use among women in Africa,” PloS One, vol. 7, no. 7, pp. e40670–e40670, 2012. K. M. Elfstrom R. Stephenson, “The role of place in shaping contraceptive use among women in Africa,” PloS One, vol. 7, no. 7, pp. e40670–e40670, 2012.
24.
go back to reference Idowu A, Deji SA, Ogunlaja O, Olajide SO. Determinants of Intention to Use Post Partum Family Planning among Women Attending Immunization Clinic of a Tertiary Hospital in Nigeria. Am. J. Public Health Res. Am. J. Public Health Res. Jun. 2015;3(4):122–7. Idowu A, Deji SA, Ogunlaja O, Olajide SO. Determinants of Intention to Use Post Partum Family Planning among Women Attending Immunization Clinic of a Tertiary Hospital in Nigeria. Am. J. Public Health Res. Am. J. Public Health Res. Jun. 2015;3(4):122–7.
25.
go back to reference Mahmood SE, Srivastava A, Shrotriya VP, Shaifali I, Mishra P. POSTPARTUM CONTRACEPTIVE USE IN RURAL BAREILLY. Indian J. Community Health IJCH. 2012;23(2):56–7. Mahmood SE, Srivastava A, Shrotriya VP, Shaifali I, Mishra P. POSTPARTUM CONTRACEPTIVE USE IN RURAL BAREILLY. Indian J. Community Health IJCH. 2012;23(2):56–7.
Metadata
Title
Determinants of contraceptive use among postpartum women in a county hospital in rural KENYA
Authors
Rose Jalang’o
Faith Thuita
Sammy O. Barasa
Peter Njoroge
Publication date
01-12-2017
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2017
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-017-4510-6

Other articles of this Issue 1/2017

BMC Public Health 1/2017 Go to the issue