Intention to use immediate postpartum contraception and associated factors amongst mothers delivering from Kisenyi and Kawaala HC IVs

Abstract

Background:. The global prevalence of unintended pregnancies is about 41%, and 40% in low and middle-income countries. A study in Yumbe district indicated the prevalence of short birth intervals of 52.4%, from which 12% had complications, and that in Uganda, up to 4% of infant mortalities are attributed to short birth intervals. Intention to use contraception has an overriding importance to better visualize the women’s future needs and is more likely to translate it to actual behavior. It is likely that perceived control, behavioural beliefs and intention may inform when to use IPPC among women in Uganda. Given the unpredictable time of the return of fertility after childbirth, postnatal women can get pregnant even before the return of their menstruation. The objective: To determine the intention to use immediate postpartum contraception and associated factors amongst mothers delivering from Kisenyi and Kawaala HC IVS. Methods: This was a cross-sectional study. The study was conducted as an exit interview among mothers who had reached their date of discharge from the postnatal wards of Kisenyi and Kawaala HC IVs. The interviews were conducted using a trained research assistant or principal investigator-administered questionnaire that included all variables of interest. Consecutive sampling was used to identify 403 participants.. 229 and 174 interviews were carried out in Kisenyi and Kawaala HC IVs respectively. Data was analyzed using Stata v20. Results: The proportion of intention to use IPPC was 22%. Among those with the intention to use IPPC, 62% actually received the service. Mothers aged 25 years and above were more likely to have intention to use IPPC. Higher education was associated with higher intention to use IPPC. Being married was associated with increased intention to use IPCC. Mothers with a history of contraceptive use were 2.6 times more likely to express intention to use IPPC than those who had never used any contraceptive method. The intention to use IPPC was twice as high among mothers who had received counseling on IPPC compared to those who had not. Mothers who delivered through operative delivery were 2.5 times more likely to intend to use IPPC compared to those who delivered via spontaneous vaginal delivery (SVD). Additionally, the number of ANC visits was positively associated with the intention to use IPPC, with mothers who attended 5–8 ANC visits had a 2.3-fold higher likelihood compared to mothers with 1–4 ANC visits. Conclusion: Less than 1/4 of the women had intention to use IPPC, and less than 2/3 of those with intention actually got the service indicating both a very low attitude towards IPPC among mothers and a big gap in actual utilization of the services by those with the intention. Maternal age, highest level of education, past use of contraception, being counselled about IPPC, mode of delivery, and number of antenatal visits attended are some of the factors that significantly influence intention to use IPPC. Recommendations: To improve the intention to use, and thus improve uptake of Immediate Postpartum Contraception (IPPC), it is crucial to implement a multi-faceted strategy that targets key determinants such as maternal age, education, marital status, and access to antenatal and postnatal care.