Menstrual Pattern, Sexual Behaviors, and Contraceptive Use among Postpartum Women in Nairobi Urban Slums

Abstract

Postpartum months provide a challenging period for poor women. This study examined patterns of menstrual resumption, sexual behaviors and contraceptive use among urban poor postpartum women. Women were eligible for this study if they had a birth after the period September 2006 and were residents of two Nairobi slums of Korogocho and Viwandani. The two communities are under continuous demographic surveillance. A monthly calendar type questionnaire was administered retrospectively to cover the period since birth to the interview date and data on sexual behavior, menstrual resumption, breastfeeding patterns, and contraception were collected. The results show that sexual resumption occurs earlier than menses and postpartum contraceptive use. Out of all postpartum months where women were exposed to the risk of another pregnancy, about 28% were months where no contraceptive method was used. Menstrual resumption acts as a trigger for initiating contraceptive use with a peak of contraceptive initiation occurring shortly after the first month when menses are reported. There was no variation in contraceptive method choice between women who initiate use before and after menstrual resumption. Overall, poor postpartum women in marginalized areas such as slums experience an appreciable risk of unintended pregnancy. Postnatal visits and other subsequent health system contacts provide opportunities for reaching postpartum women with a need for family planning services.

Contraceptive use and lengthening birth intervals in rural and urban Eastern Africa

“…The intensity of suckling in parts of the continent is falling and levels of infant supplementary feeding have increased. As a result the duration of lactational amenorrhea is declining, with the shortest periods being found in Eastern and Southern Africa (Ndugwa et al 2011). This change has been accompanied by a decline in postpartum abstinence, particularly in urban areas (Egbuonu et al 2005;Ndugwa et al 2011).…”

“…As a result the duration of lactational amenorrhea is declining, with the shortest periods being found in Eastern and Southern Africa (Ndugwa et al 2011). This change has been accompanied by a decline in postpartum abstinence, particularly in urban areas (Egbuonu et al 2005;Ndugwa et al 2011). Anthropologists have described how in Eastern Africa the post-partum period of abstinence was "eroded from within" by coitus interruptus (Schoenmackers et al 1981).…”

Missed opportunities for family planning: an analysis of pregnancy risk and contraceptive method use among postpartum women in 21 low- and middle-income countries

“…Postpartum women are also often perceived as having less need for contraception based on the belief that they are protected by postpartum abstinence. However, several studies [17][18][19] have found rapid resumption of sexual activity after birth, and cross-sectional DHS data further illustrate sexual activity during distinct intervals after birth. Consolidating available data on the unique reproductive health needs of postpartum women in LMICs has a strong bearing on the public health interest in longer birth intervals.…”

Predictors of Time-to-Contraceptive Use from Resumption of Sexual Intercourse after Birth among Women in Uganda

“…Worth noting is the fact that abstinence following a birth is widely practiced in most communities of the world, yet with varying and/or unpredictable durations [4,5]. A recent study among postpartum women in Nairobi revealed that women resume sexual activity well before their menstruation [6]. Use of contraceptives, however, is delayed in most instances.…”

“…Recent studies provide insights into factors that determine contraceptive use among (i) women in the postpartum period [3,6,23,24], (ii) sexually active women in the reproductive age [20,25,26], and (iii) sexually active males [27]. However, studies are limited in providing an understanding of the factors among women particularly after resumption of sexual intercourse following a birth.…”