Barriers and determinants of postpartum family planning uptake among postpartum women in Western Ethiopia: a facility-based cross-sectional study

Abstract

Background Despite Ethiopia’s efforts to avail postpartum family planning (PPFP) services, the unmet need for family planning among postpartum women remains high. Therefore, this study is aimed to assess barriers and determinants of postpartum family-planning uptake among women visiting Maternal, Neonatal, and Child Health (MNCH) services in public health facilities of western Ethiopia. Methods A facility-based cross-sectional study design with a quantitative method was conducted on 989 postpartum women in Western Ethiopia from September 1 to October 30, 2020. Data were collected through face-to-face interviews using pretested structured questionnaires, entered using EPI-INFO version 7.0, and analyzed by SPSS version 25. Descriptive analysis and logistic regressions were performed. The adjusted odds ratio with a 95% confidence interval was used and statistical significance was declared at P-value < 0.05. Result In this study, 56.1% of participants had used PPFP in the last year. The most commonly used method was injectable (51.7%). Family planning use before the index pregnancy (AOR = 2.09;95%CI:1.29,3,41),counselling on PPFP during antenatal care and delivery (AOR = 4.89;95%CI:2.31,10.37),health facility delivery (AOR = 7.61;95%CI:4.36,13.28), skilled birth attendance (AOR = 4.99;95%CI:2.88,8.64),COVID-19 restrictions (AOR = 0.59;95%CI:0.39,0.90) were factors associated with PPFP utilization. Being breastfeeding and amenorrhea were major reasons for not using postpartum family planning. Conclusion Post-partum family planning utilization among study participants was low. Given the associated factors, it is recommended that health facilities should make postpartum family planning one of their top priorities and focus on these factors to improve its utilization.

The role of family planning counselling during maternal and child health services in postpartum modern contraceptive uptake in Ethiopia: A national longitudinal study

“…On the other hand, it could also be because most women have resumed their sexual activity and menses and feel they are at risk of unintended pregnancy [28,29]. Our findings may support previous studies indicating that the return of sexual activity and menstrual cycle following childbirth were the strongest predictors for adopting modern contraceptives in Ethiopia [19,30,31]. These findings underscore the importance of improving the integration of family planning counselling into relevant MCH services.…”

“…This is consistent with studies conducted in South Ethiopia [19] and Kenya [32]. However, other studies evaluating the effect of family planning counselling during ANC on postpartum modern contraceptive uptake have reported a positive association [18,30,31,33]. For example, a study conducted in Northern West Ethiopia indicated that family planning counselling during ANC was associated with increasing modern contraceptive uptake by six weeks postpartum [18].…”

“…Although it is not well investigated why health care workers in Ethiopia do not provide integrated family planning counselling services, low awareness among health care workers of the National Guideline for Family Planning Services, lack of motivation, patient overload, and other infrastructural barriers might contribute to these high rates of missed opportunity [39]. Along with this, lack of transportation due to the travel restrictions implemented in the country as a consequence of the COVID-19 pandemic and fear of acquiring the infection might have contributed to the low family planning counselling coverage reported in this study [30]. Studies in Ethiopia indicated that women faced challenges in accessing family planning services because of COVID-19 [30,40].…”

“…Along with this, lack of transportation due to the travel restrictions implemented in the country as a consequence of the COVID-19 pandemic and fear of acquiring the infection might have contributed to the low family planning counselling coverage reported in this study [30]. Studies in Ethiopia indicated that women faced challenges in accessing family planning services because of COVID-19 [30,40].…”

Effect of Package of Interventions on the Use and Quality of Postpartum Family Planning Services at Yekatit 12 Hospital Medical College (Y12HMC), Addis Ababa, Ethiopia

“…[12][13][14] In addition to insufficient numbers of skilled care providers, poor organization of care processes, fragmented delivery of FP, routine maternal care, and a lack of a private counseling space for PPFP counseling are often barriers for postpartum women. [15][16][17] The aim of this study was to assess the combined effect of a package of interventions (creating a private counseling space near the postpartum ward and providing training for health care providers on the WHO decision tool kit and LACM) on the uptake and quality of PPFP services at Y12HMC, Addis Ababa, Ethiopia. the study used WHO decision tool kit for counseling clients.…”