Immediate postpartum family planning utilization and its associated factors among postpartum women in Ethiopia: a systematic review and meta-analysis

Immediate postpartum modern family planning utilization and associated factors among postpartum women in Gurage Zone, Southern Ethiopia 2022: community-based cross-sectional study

Background

The period immediately following delivery is crucial for addressing the many requirements women have in terms of reproductive health, including the need for family planning after delivery and for lowering the risks associated with closely spaced pregnancies. However, contraception during the immediate postpartum period has not received enough attention in Ethiopia. Information on the use of modern family planning in the immediate postpartum period is also sparse in this study area. Therefore, the current study aimed to assess the level of immediate postpartum modern family planning utilization and associated factors among mothers who had given birth within the past twelve months in Gurage Zone, Southwest Ethiopia.

Methods

The present study was conducted from May 1 to July 1, 2022, involving 844 mothers who had given birth in the previous year in the Gurage Zone of Southern Ethiopia. A community-based cross-sectional study design was utilized, with participants selected through a multistage sampling method. Data collection was performed via face-to-face interviews using a structured questionnaire. After data entry, which was done using EpiData version 3.1, analysis was carried out using the Statistical Package for Social Science (SPSS) version 26. To investigate the relationships between dependent and independent variables, both binary and multivariable logistic regressions with 95% confidence intervals were applied. In the multivariable logistic regression analysis, variables with P-values below 5% were considered statistically significant.

Result

Altogether, a total of 836 postpartum women participated in the current study. The overall prevalence of immediate postpartum modern family planning utilization (IPPFP) was (42.9%) with 95% CI (39.6-46.3%). Attending secondary school [AOR = 1.966(1.028-3.761)], postpartum women from wealthier families [AOR = 2.57 (95% CI: 1.44-4.58)], giving birth in health facility [AOR = 2.06 t (95% CI: 1.26-3.38)], reporting higher women empowerment [AOR = 4.365 (2.436-7.824)], having favorable attitude [AOR = 2.65 (95% CI: 1.86-3.78)], getting counseling during ANC [AOR = 1.93 (95% CI: 1.36-2.76)] and immediate postpartum period [AOR = 2.51 (95% CI: 1.77-3.56)] were significant associated factors of IPPFP utilization.

Conclusion

This study concluded that approximately two in five postpartum women utilized immediate postpartum family planning this study area. Socio-economic and informational factors significantly influence the adoption of these methods. To enhance the uptake of immediate postpartum family planning, it is essential to improve the quality of counseling provided during antenatal care visits and at the time of delivery, thereby empowering women with the knowledge needed for informed decision-making. Additionally, efforts to change attitudes toward immediate postpartum family planning through community education and awareness campaigns are vital for increasing acceptance and utilization of these services.

Magnitude and associated factors of postpartum family planning uptake among postpartum women in Ethiopia: an umbrella review

Background

The World Health Organization indicates that despite advancements, the rates of maternal and neonatal mortality and morbidity during the postpartum period continue to be alarmingly high. Furthermore, untapped opportunities to enhance maternal health and promote effective newborn care, including family planning services, have not been fully leveraged. Earlier meta-analyses and systematic reviews have addressed this subject; however, a thorough evidence synthesis has not been provided. Therefore, the objective of this study was to compile the existing systematic reviews (SRs) concerning postpartum family planning uptake among postpartum women in Ethiopia.

Method

This review used an umbrella review method, incorporating numerous systematic reviews. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and the Meta-analysis of Observational Studies guideline (MOOSE). A comprehensive literature review was conducted across prominent four electronic databases (including MEDLINE/PubMed, Cochrane, Web of Science and Science Direct) from June 15, to July 15, 2024. This review encompassed investigations carried out within the uptake of family planning among post-partum women and its determinants in Ethiopia were the primary outcome. A set of inclusion criteria was established to identify all pertinent systematic reviews, including studies, with no restrictions on data collection and publication year. The quality of the methods was evaluated using the Assessment of Multiple Systematic Reviews tool, (AMSTAR) tool. Statistical analysis was conducted using STATA version 17 software, and the 95% confidence interval was utilized to establish statistical significance. I-squared statistics were employed to evaluate the heterogeneity of the studies by using a random-effects meta-analysis model.

Results

The umbrella review includes five studies with a total of 44,276 postpartum women. The pooled prevalence of postpartum family planning utilization was 36.41% (95% CI: 24.78, 48.03). Family planning counseling (AOR: 4.12, 95% CI: 2.89, 4.71), couple discussion (AOR: 3.06, 95% CI: 1.42, 5.60), and postnatal follow-up (AOR: 3.48, 95% CI: 2.60, 4.83) were significantly associated with postpartum family planning uptake.

Conclusion

The study results indicate that the adoption of postpartum family planning in Ethiopia requires focused intervention. This can be achieved by identifying and enhancing community frameworks to involve men in reproductive health initiatives and by providing comprehensive family planning information and services during postnatal care. Addressing the aforementioned factors is crucial to mitigate the risks associated with unintended pregnancies and to manage the swift increase in population.

Systematic Review Registration

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024568435, PROSPERO (CRD42024568435).

Family planning utilization among postpartum women in the Bule Hora District, southern Ethiopia

Background

Contraception use remains low in Ethiopia, particularly within the first year after childbirth. While some women might have medical conditions that limit their contraceptive options, the primary obstacle to wider family planning adoption is not a specific health problem. Instead, it is the lack of equitable access to high-quality family planning services. This barrier significantly hinders women's ability to make informed decisions about their reproductive health. This study examines postpartum family planning utilization and its associated factors among postpartum mothers in the Bule Hora District.

Methods

We conducted a community-based cross-sectional study. A multistage sampling technique was employed to recruit a total of 630 women who had given birth. To collect the data, structured, standardized, and pretested questionnaires were used, and the collected data were coded and entered into Epi-data version 4.6. The data were analyzed using SPSS version 25. Both bivariable and multivariable logistic regressions were used to identify factors associated with postpartum family planning utilization.

Results

The study found that 71.3% of women utilized postpartum family planning. Significant associations were found between postpartum family planning utilization and various factors, including counseling on family planning during pregnancy [adjusted odds ratio (AOR) = 1.79, 95% confidence interval (CI) 1.61-2.82], delivery (AOR = 2.62, 95% CI 1.56-4.38), and the postpartum period (AOR = 2.71, 95% CI 1.75-4.21). Women who resumed sexual activity after birth (AOR = 1.92, 95% CI 1.25-2.96), and who had at least four antenatal care visits (AOR = 3.09, 95% CI 1.61-5.92) were also more likely to use postpartum family planning. Women with grand multiparity were 69% less likely to use family planning methods than primiparous women (AOR = 0.31, 95% CI 0.13-0.73).

Conclusion

Postpartum family planning use in this study was higher than the national average. Factors such as parity; counseling during the pregnancy, delivery, and postpartum periods; and early resumption of sexual activity were linked to increased contraceptive use. These findings suggest that enhanced counseling during antenatal, delivery, and postnatal care could significantly increase contraceptive use.

Level of immediate postpartum family planning utilization and the associated factors among postpartum mothers, Bole Sub-city, Addis Ababa, Ethiopia: institution based cross-sectional study

BACKGROUND

The occurrence of pregnancy in the postpartum period poses a risk to women and their infants, and it also has increased risks of adverse health outcomes if a pregnancy happens less than two years after the preceding birth. Utilization of immediate postpartum family planning is a possible and simple way to reduce these unfavourable outcomes. However, only a small proportion of mothers use the service; but the reasons appear unclear. Thus, this study aimed to determine the level and factors associated with the utilization of immediate postpartum family planning in Bole sub-city, Addis Ababa, Ethiopia.

METHODS

A facility-based cross-sectional study was carried out from August 15 to September 15, 2022, among mothers who gave birth one year before the data collection period. A total of 425 mothers were selected with a systematic random sampling technique. A pretested and structured questionnaire was administered to collect data. Data entry and analysis were done by Statistical Package for Social Sciences 25. Chi-square, multicollinearity and Hosmer-Lemshaw model fitness tests were tested. The level of utilization was determined by descriptive statistics and the associated factors were determined by a binary logistic regression model, and presented with the adjusted odds ratios (AOR) with their respective 95% confidence intervals (95%CI). All statistical tests were conducted at a 5% level of significance.

RESULTS

Utilization of family planning method immediately after birth was 12.9% (95% CI = 11.3-14.5%), and it was statistically significantly associated with ages between 25 and 34 years (AOR = 5; 95% CI [1.38-18.41]) and 35 years and above (AOR = 6[1.47-25.70]), unfavourable attitude (AOR = 0.2[0.11-0.31]) and no counselling about immediate postpartum family planning during antenatal care visit (AOR = 0.43[0.20-0.89]).

CONCLUSION AND RECOMMENDATIONS

The level of utilization of immediate postpartum family planning is low in the study area. To improve it, dealing with younger women, working to achieve a positive attitude amongst women towards immediate postpartum family planning, and incorporating counselling about postpartum family planning methods during antenatal care visits are all recommended.