Contraceptive Practices Research Articles

Understanding how social norms affect modern contraceptive use

BackgroundAn aim of this study is to introduce a practitioner-friendly behavior model. Few theories of health behavior explicitly take the effect of social norms on behavior into account. Generally, theories that do take social norms into account assume that the effect of social norms on behavior operates through motivation. We use the Fogg Behavior Model (FBM), a behavior model that is new to public health, to explore whether social norms are associated with modern contraceptive use among Nigerian women, and whether they affect behavior through motivation or through ability. In other words, do social norms that discourage contraception lower women’s motivation to use contraception or do they lower women’s ability to use contraception.MethodsThis study uses data from a cross-sectional household survey of Nigerian women, ages 14–24. The survey collected data on socio-economic and demographic characteristics of women, whether they were sexually experienced, and whether they used contraception. Modern contraceptive use was the outcome of interest for the study. The survey also collected data on social norms around premarital sex and contraceptive use. Multivariate logistic regression was used for the analysis.ResultsAfter adjusting for a range of socio-economic and demographic variables, we found that social norms that discourage contraception had a statistically significant negative association with contraceptive use (aOR = 0.90, p < 0.001). The analysis found that the negative association between social norms and contraceptive use remained statistically significant after controlling for motivation but did not remain statistically significant after controlling for ability.ConclusionThese findings suggest that social norms may affect contraceptive use in Nigeria through ability rather than motivation. In terms of programmatic implications, these finding suggest that public health interventions may be able to counter the negative effects of social norms that discourage contraceptive use by increasing women’s ability to practice contraception.

Trends in contraceptive use: A thousand-year-old practice and two revolutions

The use of contraceptive methods seems so old that it is difficult to know precisely when human beings first wanted to control their fertility. However, two major changes have been observed over time. In the mid-18th century in France and during the 19th century in Europe, the "first contraceptive revolution" was characterized by the adoption of "withdrawal" by married couples. The "second contraceptive revolution" took place from the second half of the 20th century, with the gradual spread of the pill and the Intra-Uterine Device (IUD) among different social groups. Since then, contraceptive practices have been largely medicalized, and fertility control has become an exclusively female responsibility.

KNOWLEDGE, ATTITUDE AND PRACTICE OF EMERGENCY CONTRACEPTION AMONGST HEALTHCARE WORKERS IN IDP CAMPS AND HOST COMMUNITY CLINICS IN JERE AND MAIDUGURI METROPOLITAN LOCAL GOVERNMENT AREAS, BORNO STATE

Background: Emergency contraception (EC) offers women a second chance to avoid unintended pregnancy after unprotected sexual intercourse. Besides its availability, requisite knowledge and positive attitude of the healthcare works will encourage its utilization by the Internally Displaced Persons (IDP) and host community. Objectives To determine the knowledge, attitude and practice of EC by healthcare workers (HCWs) in IDP camps and host community clinics in Jere and Maiduguri metropolitan local government areas (LGAs) of Borno state, Nigeria. Methodology: Self-administered questionnaires were issued to HCWs attending a workshop on child spacing counselling and service organized by the Society of Gynaecology and Obstetrics of Nigeria, North-East sector (SOGON-NE). The questionnaire inquired about knowledge, attitudes and practice of emergency contraception. Results: Eighty-nine (89.0%) of the respondents were aware of EC and 88.0% have approved of its provision. The most common indication for the EC was unprotected sexual intercourse (91.0%), followed by rape, failed contraception and missed pills. Sixty-five (84.4%) of Nurse/Midwives and CHEWs were willing to provide EC for prospective clients and 59(76.6%) of them had provided EC in the past. The commonest form of EC known to the respondents was Levonorgestrel (Postinor 2), followed by oral contraceptive pills (OCP) and intrauterine device (IUCD). Mifepristone and ulipristal were known to only 23.6% and 11.2% of the respondents respectively. Majority (79.6%) will give EC immediately after intercourse. Only 46.1% of the respondent would institute EC within 7 days of unprotected intercourse and among them, 50% were Nurse/Midwives and 46.4% were CHEWs. Conclusion: Both the knowledge and approval of EC among the HCWs in the IDP camps and host community clinics in Jere and Maiduguri metropolitan LGAs of Borno state are high. This can be harnessed to encourage the wide utilization of the EC by adolescents and other vulnerable womenin the IDP camps and Host communities.

Impact of family planning on maternal and infant mortality in Cameroon: Protocol for a clustered non-randomized controlled trial

The study aimed to assess the impact of family planning on maternal and infant mortality in Tiko CDC plantation camp. This is a clustered non-randomized controlled trial with a predetermined intervention site (Tiko CDC plantation camp) and a control site (Pena Mboko camp). Four clusters were randomly selected in each group using simple ballot and the intervention administered in all clusters in the intervention site. Households/participants were then systematically sampled (250 in each site) for data collection and analysis. The intervention comprises a triad of health education, facilities strengthening and distribution of contraceptives in the intervention cohort. After baseline study, re-evaluation visits are scheduled for 3rd, 6th and 9th month of intervention and a post-intervention data collection at 12th months of intervention. The pre-intervention phase was conducted from December 2019 to February 2020; data was partially analysed and intervention was designed. Primary outcomes to be measured are contraceptive knowledge, perception and practice while secondary outcomes are maternal and infant morbi-mortality. Ethical clearance was obtained from the institutional ethics committee for research on human health at University of Douala. While the study adds to existing literature, its strengths and limits could be useful in informing similar interventions in the study area and beyond. Key words: Non-randomized clustered, Family planning, Health education, Maternal, Infant, mortality, Cameroon.

Women’s perspectives on long-acting reversible contraception: a critical scoping review of qualitative research

ABSTRACT Long-acting Reversible Contraception (LARC) has significant promise both from a public health outlook and a social justice perspective. However, if women’s empowerment is to be supported, then perspectives and experiences of LARC must be considered. This scoping review assesses research about contraceptive users’ perspectives and experiences of contraceptive decision-making and practices. A content analysis was conducted to identify research trends in qualitative studies of contraceptive-user perspectives (n = 54), located by means of a systematic search. Interpreting findings through a reproductive justice lens, three main limitations in the scholarship were identified, viz., (1) an instrumentalist, individual-level focus; (2) a lack of consideration for diverse perspectives; and (3) an uncritical focus on young women. While the small body of qualitative research on LARC offers some valuable insights, when viewed from a sexual and reproductive justice perspective, it is not sufficiently user-centered or grounded within the reproductive politics surrounding contraceptive care and provision. Research is needed that draws on appropriate social theory; widens its focus beyond dominant groups; and is cognizant of the multi-level power relations surrounding LARC. Such work provides a nuanced picture of the complex social and contextual factors at play and inform person-centered approaches in sexual and reproductive health policy and programming.

The interaction of sexual orientation and provider-patient communication on sexual and reproductive health in a sample of U.S. women of diverse sexual orientations

ObjectiveOur goal was to examine associations among provider-patient communication, past-year contraceptive use and lifetime sexually transmitted infection. MethodsData were analyzed cross-sectionally from 22,554 women in the Growing Up Today Study and Nurses’ Health Study 3 between the follow-up period of 1996–2020. We used multivariable Poisson regression models adjusted for race/ethnicity, age in years, study cohort, and region of residence to obtain risk ratio (RR) associations and 95% confidence intervals (CI). ResultsProvider-patient communication was associated with higher likelihood of using all methods of past-year contraceptive use (RRs ranging from 1.11 to 1.63) and lifetime STI diagnosis (RRs ranging from 1.18 to 1.96). Completely heterosexual women with no same-sex partners (referent) were 13% more likely than lesbians and 4% less likely than other groups to report a provider ever discussed their SRH. Significant interactions emerged between sexual minority status and provider-patient communication. Sexual minority women whose providers discussed their SRH were less likely to report contraceptive non-use in the past year (p < .0001). ConclusionProvider-patient communication may benefit sexual minority women’s contraceptive practices and engagement with STI testing. Practice implicationsDifferences in provider-patient SRH discussion by sexual orientation indicate lesbian women are not receiving the same attention in clinical encounters.

Knowledge, Attitude and Practice of Emergency Contraceptive among Undergraduate Female College Students: A Cross-Sectional Study

Background: Emergency contraceptive is a unique type of family planning methods, which has been available since 1970s and can prevent pregnancy, when used after unprotected sex around the time of ovulation. Objectives: The main purpose of the study was to investigate the knowledge level, attitude towards and practice of emergency contraceptive among female college students. Methods: A cross-sectional study design was used and data were collected by structured pre-tested questionnaire that 456 students were randomly selected. Logistic regression analysis was used and p &lt;0.05 was considered statistically significant. Results: About 53.3% of the study participant’s knowledge level were good and 56.1% of them showed a positive attitude towards emergency contraceptive. Field of study, year of study and awareness were associated with the knowledge level. Age, year of study and sexual behavior were associated with attitudes towards emergency contraceptive. Attitude towards emergency contraceptive and sexual behavior were associated with the utilization of emergency contraceptive. Conclusions: The knowledge level, attitude towards and practice of emergency contraceptives were affected by age, field of study, level of study, awareness and sexual behavior.

Exploring contraceptive care practices at Rural Health Clinics in the southern United States

ObjectiveWith declining numbers of obstetrician-gynecologists operating in rural areas across the United States, primary care providers have stepped in to fill contraceptive service gaps. Many of these providers operate in Rural Health Clinics; however, little is known about the provision of contraception in these clinics. MethodsThis exploratory qualitative descriptive study used a purposive sampling strategy to recruit South Carolina Rural Health Clinic providers from across regions and income levels. Eleven providers participated in semi-structured, in-person interviews. Contraceptive care practices were identified using a combination of inductive and deductive coding. ResultsParticipants described their typical contraceptive patient as a low-income woman under 22 years. While providers were open to providing contraception, their on-site services were limited. Each included clinic offered the oral contraceptive pill and the shot, but only one offered the implant, and none offered the intrauterine device. ConclusionRural Health Clinic providers have limited capacity to offer a full range of contraception due to financial, training, and staffing constraints. Despite these limitations, Rural Health Clinics remain a contact point that helps meet national recommendations for increasing access to reproductive health services for rural women. Efforts to increase access to contraceptive care for rural women must include resources for these providers.

KNOWLEDGE AND PRACTICE OF FAMILY PLANNING METHODS AMONG THE MARRIED WOMEN OF REPRODUCTIVE AGE GROUP ATTENDING SOS HOSPITAL IN MOGADISHU SOMALIA

Objectives: To assess the knowledge, and practice on family planning among the married women of reproductive age group attending At SOS Hospital Mogadishu Somalia. Methodology: It was descriptive, cross-sectional and facility -based study in SOS hospital in Mogadishu-Somalia State during six months (November 2017 – April 2018). A total of 150 women of child bearing age were interviewed regarding their awareness and practices of contraception. Results: The mean ± SD of age was 30.7 ± 7.2 years. The minority of women (40.0%) heard and had knowledge about family planning, while (60.0%) said did not know anything about family planning. Sixty five women (43.3%) practiced family planning, while eight five women (56.7%) did not. Conclusion: The present study concludes that a significant proportion of respondents have poor knowledge about family planning. And practice of contraception and compliance is low.

Family planning practices and prehospital care received by women seeking abortion services in a tertiary care hospital

Background: The study was carried out in the department of Gynaecology and Obstetrics at RG Kar Medical college and Hospital, among 114 attendees seeking induced or spontaneous abortion. The aim of the study was to assess their socio demographic characteristics, elicit their family planning knowledge, practices and prehospital care received by them before coming to this institute.Methods: An observational descriptive cross-sectional study was carried out using a predesigned, pretested schedule using systemic random sampling technique among women seeking abortion services at a tertiary care centre.Results: Out of the 114 interviewees, 53 (46.5%) underwent induced abortion and rest had spontaneous abortion. Statistically significant difference was found between the mean age of induced and spontaneous abortion seekers. Majority i.e. 28 (52.8%) of induced abortion seekers first sought help at illegal abortion service providers. Statistically significant difference was found in duration of marriage, gravidity and number of living children between induced and spontaneous abortion candidates. Contraceptive knowledge and practice were found to be higher among induced abortion seekers.Conclusions: This study clearly shows the need to focus on unmet need for family planning services including safe abortion services at pre-tertiary hospital level. The Government needs to stop advertisement and sale of over the counter abortifacients which is proving to be a menace to women’s health.

From training to implementation: Improving contraceptive practices in South Carolina

ObjectiveCapacity building and training to improve contraceptive care is essential for patient-centered care and reproductive autonomy. This study assessed the feasibility of translating the knowledge and skills gained from contraception trainings into improvements in practice. Study DesignParticipants completed surveys following contraceptive care trainings provided to family planning clinic and hospital obstetric providers and staff as a part of the Choose Well contraceptive access initiative in South Carolina. Surveys assessed participants’ intent to change their practice post-training and anticipated barriers to implementing change. A mixed-methods approach was utilized including descriptive analysis of Likert scale responses and thematic content analysis to synthesize open-ended, qualitative responses. ResultsData were collected from 160 contraceptive training sessions provided to 4814 clinical and administrative staff between 2017 and 2019. Post-training surveys were completed by 3464 participants (72%), and of these, 2978 answered questions related to the study outcomes. Most respondents (n = 2390; 80.7%) indicated intent to change their practice and 35.5% (n = 1044) anticipated barriers to implementing intended changes. Across all training categories, organizational factors (time constraints, policies and practices, infrastructure/resources) were the most frequently perceived barrier to improving contraceptive services. Structural factors related to cost for patients were also identified as barriers to IUD and implant provision. ConclusionThe trainings were successful in influencing family planning staff and providers’ intent to improve their contraceptive practices, yet some anticipated barriers in translating training into practice. Improvements in organizational and structural policies are critical to realizing the benefits of trainings in advancing quality contraceptive care. ImplicationsIn addition to training, coordinated efforts to address organizational practices and resources, coupled with system-level policy changes are essential to facilitate the delivery and sustainability of patient-centered contraceptive care.

The Sin of Onan and Contraception

Our thesis is that the story of Onan in Genesis chapter 38 offers scriptural and logical grounds for believing that contraceptive acts are sinful. We set out a five‐part modus ponens argument which considers the meaning and significance the story of Onan and, by showing that contraceptive acts are substantially similar to the act for which Onan is infamous, conclude that Christians ought not to practise contraception. We then respond to objections to this conclusion before finally and briefly touching upon some of the implications of our thesis for Christian ethics, namely with reference to the perverted faculty argument and natural law.

\u201cSince I\u2019m a little bit more mature\u201d: contraception and the arc of time for women in midlife

BackgroundContraceptive methods have rapidly evolved over the past several decades, but little research has explored how women interact with contraception over time. Exploring contraceptive beliefs, perceptions, and attitudes of women in midlife can reveal much about how lived experience affects contraceptive decisions and reproductive health choices.MethodsIndividual, semi-structured interviews were conducted with 20 women between the ages of 40 and 55 who had not reached menopause and did not have a permanent method of sterilization. Data were coded using qualitative descriptive methods.ResultsThree major themes were identified: 1) journey toward empowerment; 2) finding the right fit: evolution over time; and 3) anticipating a transition. Past experiences with or fear of side effects and hormones were common reasons to change or avoid certain contraceptive methods. Most participants were happy with their contraceptive method; however, those who were unhappy were more likely to vocalize fatigue at continuing to need contraception as menopause approached.ConclusionApproaching contraceptive counseling from a place that considers the journey with contraception over a reproductive life span will help identify how beliefs, perceptions, and attitudes of women affect their contraceptive practices and choices.

Determinants of Contraceptive Practice Among the Tribal Women in Rangamati Hill District

Determinants of Contraceptive Practice Among the Tribal Women in Rangamati Hill District

A study on assessment of unmet need and contraceptives practices adopted among currently married females residing at urban slums of Ahmedabad

Background: India is a country where population is rapidly growing, to slow down this growth rate family planning is necessary. Family planning services have the potential to improve the quality of the lives and economic welfare of people. Aim of the study was to assess prevalence of unmet need, knowledge, attitude regarding family planning methods and contraceptive practices, among study participants.Methods: A cross- sectional study was carried out among females of early reproductive age group 18-25 years, Group-1 and late reproductive age group 35-49 years, Group-2Results: Out of 200 women, majority respondents belonged to age group of 22-25 years (44.5%). Females of both age-groups had almost similar (54% and 53%) knowledge “partially correct” type for objectives of family planning and had similar positive attitude (78% and 85%) towards family planning practices. Total 45% of group 1 and 55% of other group females were currently using contraception. Most common method used by group 1 women was Intra Uterine Devices (35.5%), followed by Oral Contraceptive pills (31.2%) and in group 2 women was permanent sterilization (74.5%) followed by barrier and Intra Uterine Devices (9.1% each). Unmet need of family planning was 29% and 18% among early and late reproductive age groups, respectively.Conclusions: Unmet need of family planning was higher among early age group females. In both age groups, utilization of contraceptives were less because of lack of awareness and fear of side effect.

Can clinical vignettes administered by mobile phone call be used to measure quality of contraceptive care practices in Malawi?

Background Accurate and timely measures of quality of contraceptive care are required for program improvement but can be expensive and time-consuming to implement in low- and middle-income countries (LMICs). Clinical vignettes (CLVs) measure quality knowledge and have been shown to be a valid proxy of provider quality practice in the United States, and may be administered via mobile-phone, making them an attractive cost-savings alternative to field assessments. This cross-sectional study aims to validate mobile-phone CLVs for measuring quality of contraceptive service provision using simulated, “mystery” clients as the gold standard. Methods Researchers trained to simulate clients (SC) seeking contraceptive care visited 112 government-administered clinics in six districts of Malawi. The providers who saw the simulated clients were called via mobile phone approximately three weeks later for CLV administration. We calculated sensitivity, specificity, and area under the ROC receiver operating characteristic curve (AUC) and compared the proportion of quality behaviors measured from both methods. Results Overall, the quality measured by CLVs differed from quality measured with SCs. A higher proportion of providers reported clinical assessments and counseling on more topics during the CLV compared to the SCs, including counseling on what to do if the pill was not taken on time (59% vs. 26%; P&lt;0.01). During the SC, providers asked more questions when taking client history and recommended the preferred method of the case scenario more often (81% vs. 49%; P&lt;0.01). Conclusions The quality of care ascertained through mobile-phone CLV was not similar enough to quality ascertained through SCs to replace them. Mobile phone-based CLV also failed to capture all areas of quality performance. Continued efforts are needed to identify and test innovative methods to accurately and inexpensively measure quality of care to inform improvement of provider performance.

A rise in births following contraceptive failure in France between 2010 and 2016: results from the French national perinatal surveys

BackgroundIn France, while the prevalence of contraception is high, a significant proportion of pregnancies are unintended. Following the 2012 pill scare, the contraceptive method mix, which was mostly comprised of pills and intrauterine devices (IUD), has become more diversified. In this changing landscape, our objective was to describe trends in live births resulting from contraceptive failure and evaluate how patterns of contraceptive use have contributed to observed changes between 2010 and 2016.MethodsWe used data from the 2010 and the 2016 French National Perinatal surveys which included all births from all maternity units in France over a one-week period. Interviews collecting information about pre-conception contraceptive practices were conducted in the maternity ward post-delivery. Women were classified as having a contraceptive failure if they discontinued contraception because they were pregnant. Our study sample included adult women who had a live birth, had ever used contraception and did not undergo infertility treatment (n = 11,590 in 2010 and n = 9703 in 2016). We evaluated changes in contraceptive failure over time using multivariate Poisson regressions to adjust for sociodemographic characteristics and pre-pregnancy contraceptive methods.ResultsPre-pregnancy contraception evolved between 2010 and 2016 with a 12.3% point-drop in pill use, and conversely, 4.6%- and 3.2%-point increases in IUD and condom use, respectively. Use of other barrier or natural methods doubled between 2010 and 2016 but remained marginal (1.4% in 2010 vs 3.6% in 2016). Between 2010 and 2016, the proportion of live births resulting from contraceptive failure rose from 7.8 to 10.0%, with higher risks among younger, parous and socially disadvantaged mothers. The risk ratio of contraceptive failure in 2016 compared to 2010 remained higher after sociodemographic adjustments (aRR = 1.34; 95% CI; 1.23–1.47) and after adjusting for pre-pregnancy contraceptive method mix (aRR = 1.35; 95% CI; 1.25–1.49). Increases in contraceptive failures were concentrated among pill and condom users.ConclusionsRecent shifts in contraceptive behaviors in France following the 2012 pill scare may be associated with a subsequent increase in births resulting from short acting contraceptives failures.

A Study on role of socio demographic status of women in excessive vaginal discharge at teaching hospital

Introduction: The complaint of excessive vaginal discharge is very common in women attending the gynecology out-patient department. It is associated with considerable emotional stress, health seeking associated cost and has a substantial impact on female health and behavior. Objective: To find out socio-demographic variables associated with the complaint of vaginal discharge wherein no biomedical cause of leucorrhoea can be detected. Socio-cultural perspectives have an exaggerative effect on the normal vaginal discharge and in absence of pathological diagnosis, they create fear and anxiety in couples. The problem of vaginal discharge can be best understood not only in the biomedical perspective but also in the socio cultural perspective. Materials and Methods: This is a hospital based study, conducted in out-patient department of obstetrics and gynecology department, AIIMS, Udaipur (Raj). Women with complaint of vaginal discharge without any evident pathological or infectious causes were counted in the study. The women with vaginal discharge which is non-infected, non-blood stained, non-purulent, without pruritus vulvae were interviewed with a pretested questionnaire. Socio-demographic details, personal and menstrual hygiene, obstetric history and contraceptive practices were noted and tabulated. Conclusion: To mitigate the problem of vaginal discharge, socio-demographic status of women should be taken in consideration. Improvement of literacy rate, economic status and women’s empowerment are the key areas of interventions. Proper understanding of this problem helps in initiating appropriate medical education programs and framing health policies. Keywords: Excessive vaginal discharge, Socio-demographics, Somatic symptoms, Leucorrhoea, Pruritus tubectomy.

\u2018Every medicine is part poison\u2019: a qualitative inquiry into the perceptions and experiences of choosing contraceptive methods of migrant Chinese women living in Australia

BackgroundIn Australia, ethnic Chinese people are one of the largest, youngest and fastest growing overseas-born groups. Yet, little is known about their perceptions of contraceptive methods and their experiences with choosing one. Decisions about contraceptive methods are preference sensitive. Understanding the influencing factors of Chinese migrant women’s contraceptive method choice and practices will help cater to their decision-making needs in a culturally sensitive and responsive way.MethodsA qualitative study design underpinned by critical realism approach was used to explore Chinese migrant women’s perceptions and experiences of choosing contraceptive methods. Semi-structured interviews were conducted with 22 women who self-identified as being ethnically Chinese and had been living in Australia for no more than 10 years. The interview guide was adapted from the Ottawa Decision Support Framework. Majority of the interviews were conducted in Mandarin Chinese. Transcribed data was analysed using thematic analysis method.ResultsFour major themes were identified, including: ‘every medicine is part poison: hormonal contraceptives cause harm to the body’; ‘intrauterine device, a device used in the past for married women’; ‘it takes two (or one) to decide, depending on the relationship dynamics and contraception preferences’; and ‘it is not necessary to seek medical advice in choosing contraceptive methods’.ConclusionsOur findings suggest that Chinese migrant women’s perceptions and experiences of choosing contraceptive methods are influenced by complex personal, cultural, societal and inter-relational factors. Chinese migrant women were cautious of using hormonal methods due to fears of side-effects, including reduced or absent menstrual bleeding. Women were also reluctant to consider intrauterine devices as options due to associating them with past experiences of other women and themselves and also fears of potential complications. There was a reluctant attitude towards seeking medical advice regarding contraception due to beliefs that needing to use contraception is not an illness requiring treatment. Such findings are likely to be useful in increasing healthcare professionals’ and policy makers’ understanding of Chinese migrant women’s contraceptive method preferences, beliefs and behaviours. They also help to develop culturally and linguistically sensitive strategies, which goes beyond the provision of contraceptive counselling, in assisting Chinese migrant women’s decision-making needs.

A study of knowledge and practice of contraception in a rural area of Bareilly, Uttar Pradesh

Background: It is very critical to understand that awareness of family planning and proper utilization of contraceptives is an important indicator for reducing maternal and neonatal mortality and morbidity. It also plays an important role in promoting reproductive health of the women in an underdeveloped country. Objective was to assess knowledge and practice of modern contraception in rural area.Methods: A community based cross sectional study. A cross-sectional descriptive study was carried out in the in a rural area of Bareilly, Uttar Pradesh. 458 randomly selected eligible couples were included in the study. A pre-structured questionnaire was used to collect information about family planning methods knowledge, source of knowledge and current practices and reasons of nonuse. The appropriate statistical analysis was done to present the results.Results: 48.03% eligible couples had adopted one or the other current modern contraceptive measure. Female sterilization was the most common method used.Conclusions: Overall usage of postpartum contraception was low need to focus at every step to contact with health facility or health workers.