Contraceptive use among postpartum women in India

Association between history of abortion and current use of contraceptives among Mongolian Women

Background

Understanding the factors associated with the adoption of contraceptive methods among women of childbearing age is imperative to improving maternal health outcomes. This study aimed at exploring the association between history of abortion and contraceptive use among Mongolian women.

Materials and methods

We analyzed cross-sectional data of 8373 women aged 15–49 years from the 2018 Mongolian Social Indicator Sample Survey (MSISS). Binary logistic regression models were used to assess the association between abortion history and current contraceptive use while accounting for both individual- and community- level factors.

Results

A total of 4347 (51.92%) and 2525 (30.16%) reported current use of various contraceptive methods and a history of abortion in their lifetime, respectively. Women with a history of abortion were less likely to report current use of contraceptives (adjusted odds ratio (AOR) = 0.72, 95% confidence interval (CI) [0.58–0.89]). Specifically, women with a history of abortion were less likely to report use of IUD (AOR = 0.79, 95% CI [0.71–0.90)]) and injectables (AOR = 0.59, 95% CI [0.41–0.84]). History of abortion was associated with increased likelihood of using abstinence (OR = 1.82, 95% CI [1.31–2.53]) as a contraceptive method.

Conclusion

Our results demonstrated a significant association between history of abortion and contraceptive use. Public health interventions aiming to improve maternal health outcomes through contraceptive use should target women with a history of abortion to improve their uptake.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12905-022-01862-3.

A study on initiation of postpartum family planning in India based on NFHS-4: does urban poor differ significantly from rural?

OBJECTIVE

To explore the differentials of postpartum contraceptive adoption between rural and urban poor after adjusting for utilization of MCH services and other selected socioeconomic and demographic covariates.

METHODS

The data for this study is taken from the 4th round of NFHS survey conducted in India during 2015-16. The analysis is limited to 125,340 currently married women whose menses had returned at the time of survey. Discrete time complementary log-log multilevel model was applied.  RESULTS: The results clearly indicate that women from rural areas had a lower chance of early initiation of modern spacing methods after having recent birth as compare to that of Urban Poor and Urban non-poor areas. The contributions of several socioeconomic and demographic characteristics that were important for family planning practice were also highlighted in this study.

CONCLUSION

There is an urgent need of designing an intervention that will result in effective delivery of services to achieve the greatest impact. Policy planners must focus on targeted interventions for family planning use in the postpartum period than simply focusing on family planning.

Postpartum Family Planning Use and Its Determinants among Women of the Reproductive Age Group in Low-Income Countries of Sub-Saharan Africa: A Systematic Review and Meta-Analysis

Background

Postpartum family planning is the initiation and use of family planning services within the first 12 months following childbirth. Postpartum contraceptives reduce maternal and infant mortality by preventing unplanned and unwanted pregnancies and by spacing pregnancies at least two years after the previous birth. Thus, it is usually designed as an integral part of reproductive and maternal and child health programs. Therefore, the aim of this systematic review and meta-analysis is to estimate the pooled prevalence of postpartum modern contraceptive use and identify its determinants in low-income countries of sub-Saharan Africa.

Methods

A systematic review and meta-analysis of published and unpublished studies were used. PubMed, HINARI, ScienceDirect, Cochrane Library, Wiley Library, ETH Library, and Google Scholar were used to search all articles. STATA 14 software was used for data analysis. Funnel plots and Egger's test were used to examine the risk of publication bias. Heterogeneity was checked by using Cochran's Q test and I² test. A random effect model was computed to estimate the pooled prevalence.

Results

A total of 33 articles were included. The pooled prevalence of postpartum contraceptive use in low-income countries of sub-Saharan Africa was 37.41%, 95% CI: (31.35, 43.48%). Secondary and above level of education (AOR 2.09, 95% CI: (1.52, 2.86)), discussion with husband (AOR 3.68, 95% CI: (1.96, 6.89)), resumption of menses (AOR: 3.98, 95% CI: (2.62, 6.03)), ANC follow-up (AOR; 5.10, 95% CI: (3.57, 7.29)), knowledge of modern family planning (AOR: 5.65, 95% CI: 3.58, 8.93)), and family planning counseling during ANC (AOR =5.92, 95% CI: (2.54, 13.79)) were found to be determinants of postpartum contraceptive utilization.

Conclusion

In this systematic review and meta-analysis, the prevalence of postpartum modern contraceptive use was found to be low compared to the existing global recommendations. Therefore, empowering maternal education, delivering adequate counseling, and strengthening existing integrated maternal and child health services are highly recommended to increase postpartum contraceptive use. This trial is registered with CRD42020160612.

Knowledge and Associated Factors of Postpartum Contraceptive Use Among Women in the Extended Postpartum Period in Gondar City, Northwest Ethiopia

Background

The choice of a postpartum contraceptive method and the timing of its initiation depend on the woman’s knowledge regarding postpartum contraceptives use. Also, women’s perception towards family planning is reliant on good knowledge and has a great influence on their attitudes and practices. There is limited information on the knowledge and associated factors of postpartum contraceptive use among women. Therefore, the aim of this study was to assess the knowledge and associated factors of postpartum contraceptive use among women in the extended postpartum period.

Methods

An institutional-based cross-sectional study was conducted from November 5, 2018 to December 5, 2018 among postpartum women in six health institutions in Gondar city, northwest Ethiopia. A systematic random sampling technique was used to select the study participants. Data were analyzed using SPSS version 20. Bivariable and multivariable logistic regression models were fitted to identify the determinants of knowledge of postpartum contraceptive use. Adjusted odds ratio (AOR) with their 95% confidence intervals (CI) were calculated. P-values less than 0.05 were considered to indicate statistical significance.

Results

Out of 403 participants, 299 (74.2%) had good knowledge on postpartum contraceptive use. Being urban residents (AOR=2.95, 95% CI=1.34–6.48), previous modern contraceptives use (AOR=5.15, 95% CI=1.16–22.88), health facility delivery (AOR=4.10, 95% CI=1.20–13.98), and counseling about family planning during PNC (AOR=3.80; 95% CI=1.52–9.51) were significantly associated with good knowledge.

Conclusion

This study showed that the knowledge of women regarding postpartum contraceptives was relatively low. Therefore, increasing institutional delivery service and counseling about family planning during the postpartum period should get more focus to address the knowledge gap of postpartum mothers.

Progesterone vaginal ring as a new contraceptive option for lactating mothers: Evidence from a multicenter non-randomized comparative clinical trial in India

OBJECTIVES

Evaluate and compare contraceptive efficacy, safety, continuation rates and duration of lactational amenorrhea (LA) in married lactating women (20-35 years) using the progesterone vaginal ring (PVR) or Copper-T380A intrauterine device (IUD) during the first postpartum year.

STUDY DESIGN

We conducted a one-year multicenter, non-randomized, non-inferiority, open-label, comparative trial at 20 centers in India and compared efficacy, safety, continuation and LA plus feeding patterns and growth/well-being of participants' infants. Women used four 3-month PVRs consecutively (lost PVRs were not replaced) and were to breastfeed at least four times/day. We used Pearl Index (PI) and Kaplan Meier (K-M) rates to analyze pregnancy and K-M for continuation.

RESULTS

We enrolled 789 women (459 PVR, 330 IUD). Neither PI nor K-M one-year pregnancy rates differed significantly between groups (PI: PVR-0.62; IUD-0.35); (K-M: PVR-0.7; IUD-0.4, p = 0.58). Continuation rates at 12 months were 78.5% (IUD) vs. 56.9% (PVR) (p < 0.001). Ring expulsions and menorrhagia were the most common discontinuation among PVR/IUD users respectively. The median duration of LA among PVR vs. IUD users was 405 vs. 120 days (p < 0.001). Both groups reported similar adverse events (PVR: 24.2%; IUD: 23.0%); there were no serious adverse events among PVR users. Infants from both groups fed 12-7 times/day and grew at expected rates.

CONCLUSIONS

Efficacy and safety outcomes were comparable among women in both groups. Continuation rates for PVR, a woman-controlled method, were shorter than IUD rates while PVR users maintained LA significantly longer than IUD users. Infant breastfeeding and growth patterns/well-being were favorable in both groups.

IMPLICATIONS

PVR, a user-controlled device, offers an additional contraceptive choice for lactating women for one-year postpartum use and can help to address the unmet need for contraception among postpartum women while encouraging breastfeeding to enhance infant growth and well-being.

Knowledge, attitude and practice GAP in family planning usage: an analysis of selected cities of Uttar Pradesh

Background

The GAP between the knowledge of contraception and its actual practice is well recognized in the literature of family welfare studies. The present study assessed the relation between the level of knowledge and practice of contraception among the women and sought to explore the reasons behind the Knowledge, Attitude, and Practice - GAP (KAP GAP) regarding contraceptive users in six cities of Uttar Pradesh.

Method

Present analysis based on 17,643 currently married women aged 15 to 49. A Bivariate analysis (χ2 test) and a multivariable logistic regression were performed for the study.

Result

The highest percentages of respondents (women) were in the age group 35-49 (40-45 %) in all the districts considered. Knowledge of contraceptives was almost universal; tubal ligation and pill were the commonly known methods. Information about the contraceptive methods was mostly obtained through the husband. In the present study, there was a highly significant association (p < 0.01) of age group, educational status of respondents, the number of living children, the wealth of the respondent, media exposure and husband's education with the variable KAP GAP for all six cities. Health concern issues in all the districts were the most prominent reason for not using contraception.

Conclusion

There differences in the socioeconomic and demographic factors exist, which lead to KAP GAP in the family planning (FP) usages. Therefore, in designing effective family planning programme, there is a need to understand the various factors which influence the practice of contraception.

ROLE OF COMMUNITY AND CONTEXT IN CONTRACEPTIVE BEHAVIOUR IN RURAL WEST BENGAL, INDIA: A MULTILEVEL MULTINOMIAL APPROACH

Studies examining the influence of community-level interactions and contextual/supply-side factors in determining contraceptive choices have yielded mixed results in the context of rural India. Using small-scale survey data of 1348 women from rural West Bengal and by employing multilevel multinomial logit models, this study tested the influence of these factors after controlling for various socio-demographic and individual-level socioeconomic factors. The study reveals that supply-side intervention strategies, i.e. addressing outreach and advocacy activities and socio-religious needs at the community level, are essential prerequisites to breaking away from the predominance of sterilization in the contraceptive method-mix and enhancing the adoption of modern reversible contraceptives for improved spacing of births - a crucial factor in maternal and child health outcomes.

Contraceptive use before first pregnancy by women in India (2005-2006): determinants and differentials

Background

There exist ample of research literature investigating the various facet of contraceptive use behaviors in India but the use of contraception by married Indian women, prior to having their first pregnancy has been neglected so far. This study attempts to identify the socio demographic determinants and differentials of contraceptive use or non use by a woman in India, before she proceeds to have her first child. The analysis was done using data from the third National Family Health Survey (2005–2006), India.

Methods

This study utilized information from 54,918 women who ever have been married and whose current age at the time of NFHS-3 survey was 15–34 years. To identify the crucial socio-demographic determinants governing this pioneering behavior, logistic regression technique has been used. Hosmer Lemeshow test and ROC curve analysis was also performed in order to check the fitting of logistic regression model to the data under consideration.

Results

Of all the considered explanatory variables religion, caste, education, current age, age at marriage, media exposure and zonal classifications were found to be significantly affecting the study behavior. Place of residence i.e. urban - rural locality came to be insignificant in multivariable logistic regression.

Conclusions

In the light of sufficient evidences confirming the presence of early marriages and child bearing practices in India, conjunct efforts are required to address the socio demographic differentials in contraceptive use by the young married women prior to their first pregnancy. Encouraging women to opt for higher education, ensuring marriages only after legal minimum age at marriage and promoting the family planning programs via print and electronic media may address the existing socio economic barriers. Also, the family planning programs should be oriented to take care of the geographical variations in the study behavior.