Abstract
Globally, there is extant literature on patterns and dynamics of postpartum contraceptive use with hardly any evidence examining time-to-contraceptive use from resumption of sexual intercourse after birth among women in Uganda. Methods. The analysis was based on data from 2011 Uganda Demographic and Health Survey on a sample of 2983 married women with a birth in the past three years preceding the survey and had resumed sexual intercourse. A time-to-contraceptive use was adopted in the analysis using life tables based on the Kaplan-Meier estimates, while the Log-Rank Chi-square tests assessed the variables to be included in regression analysis. Cox-Proportional Hazard regression was run to identify the predictors of time-to-contraceptive use among postpartum women in Uganda. Sampling weights were applied in the analysis to ensure representativeness. Results. The median time-to-contraceptive use was 19 months (range 0–24). Time to adoption of modern contraceptive use was significantly longer among women with no formal education, residing in northern region, who (HR=0.56, CI: 0.40–0.78) had delivered at home/traditional birth attendant (HR=0.75, CI: 0.60–0.93), had 1–3 antenatal care visits (HR=0.83, CI: 0.70–0.98), and were in poorest wealth quintile. Conclusions. Measures for enhancing modern contraceptive use during and after the postpartum period should focus on (i) addressing hindrances in accessing family planning, particularly among poor and noneducated women; (ii) integration of family planning service delivery into routine ANC through counseling; and (iii) promoting deliveries in health facilities.
Highlights
A considerable proportion of women especially in the developing countries engage in sexual relationships after childbirth without using any contraception [1]
The study was based on data from the 2011 Uganda Demographic and Health Survey (UDHS) (Uganda Bureau of Statistics (UBOS) and ICF International, 2012)
The assessment was based on married women who had resumed sexual intercourse after birth
Summary
A considerable proportion of women especially in the developing countries engage in sexual relationships after childbirth without using any contraception [1]. Resumption of sexual intercourse occurs earlier than the six-week period of postpartum abstinence recommended by health workers [2, 3]. A study of postpartum women in 17 developing countries showed that only women who had resumed menstruation used family planning [3] This evidence demonstrates that these women are at a higher risk of unplanned or unwanted pregnancies compared with their counterparts who use contraception before resumption of menstruation. Breastfeeding as an alternative to contraceptive use would not offer some of these women protection against unwanted pregnancies due to varying levels and intensity of breastfeeding [4, 7,8,9,10] It is debatable whether breastfeeding can substitute for the use of modern family planning methods during the postpartum period
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