Abstract
Women who report use of postpartum family planning may not continue their initial method or use it consistently. Understanding the patterns of method uptake, discontinuation, and switching among women after delivery is important to promote uptake and continuation of effective methods of contraception. This is a secondary analysis of 634 Malawian women enrolled into a prospective cohort study after delivery. They completed baseline surveys upon enrollment and follow-up telephone surveys 3, 6, and 12 months post-delivery. Women were included in this analysis if they had completed at least the 3- and 6-month post-delivery surveys. Descriptive statistics were used to assess contraceptive method mix and patterns of switching, whereas Pearson’s χ2 tests were used for bivariable analyses to compare characteristics of women who continued and discontinued their initial post-delivery contraceptive method. Among the 479 women included in this analysis, the use of abstinence/traditional methods decreased and the use of long-acting and permanent methods (LAPM) increased over time. Almost half (47%) discontinued the contraceptive method reported at 3-months post-delivery; women using injectables or LAPM at 3-months post-delivery were significantly more likely to continue their method than those using non-modern methods (p<0.001). Of the 216 women who switched methods, 82% switched to a more or equally effective method. The change in contraceptive method mix and high rate of contraceptive switching in the first 12 months postpartum highlights a need to assist women in accessing effective contraceptives soon after delivery.
Highlights
Postpartum family planning can help women achieve their fertility goals by allowing them to limit and space their pregnancies
All 480 women who had completed both the 3-month and 6-month surveys were included in the analysis, except for one woman was pregnant at the time of the 6-month survey
Most (n = 40, 67%) condom discontinuers started using a more effective method of contraception when condom use stopped. In this cohort of postpartum women, the contraceptive method mix changed with more women using long-acting and permanent methods (LAPM) as time from delivery increased
Summary
Postpartum family planning can help women achieve their fertility goals by allowing them to limit and space their pregnancies. Contraceptive Continuation and Switching after Delivery to publish, or preparation of the manuscript. (2) University of North Carolina Center for AIDS Research (National Institute of Health P30AI50410-14, http://unccfar.org/; PI: Ronald Swanstrom, JHT received this funding); The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Switch, or discontinue contraceptive methods at various times during the postpartum period. Understanding the patterns of method uptake, discontinuation, and switching among postpartum women is important to promote uptake and continuation of effective methods of contraception. The secondary objective is to compare characteristics of women who continued and discontinued their initial post-delivery contraceptive method. We sought to describe patterns of contraceptive switching among women who did not continue their initial post-delivery method
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