Dunstan Achwoka1, Jillian Pintye2, Christine J McGrath3, John Kinuthia4, Jennifer A Unger5, Norah Obudho6, Agnes Langat7, Grace John-Stewart8, Alison L Drake9. 1. US Centers for Disease Control and Prevention (CDC), Division of Global HIV & TB (DGHT), Nairobi, Kenya. Electronic address: yof4@cdc.gov. 2. Department of Global Health, University of Washington, Seattle, WA, USA; Department of Nursing, University of Washington, Seattle, WA, USA. 3. Department of Global Health, University of Washington, Seattle, WA, USA; Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, TX, USA. 4. Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya. 5. Department of Global Health, University of Washington, Seattle, WA, USA; Department of Obstetrics and Gynecology, University of WA, Seattle. 6. Afya Bora Consortium Fellow in Global Health Leadership, University of Nairobi, Nairobi, Kenya. 7. US Centers for Disease Control and Prevention (CDC), Division of Global HIV & TB (DGHT), Nairobi, Kenya. 8. Department of Global Health, University of Washington, Seattle, WA, USA; Department of Epidemiology, University of Washington, Seattle, WA, USA; Department of Medicine, University of Washington, Seattle, WA, USA. 9. Department of Global Health, University of Washington, Seattle, WA, USA.
Abstract
OBJECTIVE: The objective was to characterize uptake and correlates of effective contraceptive use postpartum. STUDY DESIGN: We analyzed data from a national, cross-sectional evaluation of prevention of mother-to-child HIV transmission programs that enrolled women attending 6-week or 9-month infant immunization visits at 120 Kenyan maternal and child health clinics. We classified women who resumed sexual activity postpartum and did not desire a child within 2 years as having a need for family planning (FP). RESULTS: We included 955 (94%) of 1012 women 8-10 months postpartum in the analysis. Mean age was 25.8 years and 36% were primigravidas. By 9 months postpartum, 62% of all women used contraception and 59% used effective contraception [injectables, implants, intrauterine devices [IUDs], oral contraceptives [OCs] and tubal ligations]. Most contraceptive users (61%) used injectables, followed by implants (10%), OCs (6%), IUDs (4%) and condoms alone (2%). The majority (n=733, 77%) had a need for FP, and 67% of 733 women with FP need used effective contraception. Among women with a need for FP, effective contraception use was higher among those who discussed FP in postnatal care (PNC) than who did not discuss FP in PNC [prevalence ratio (PR) for PNC alone: 1.35, 95% confidence interval (CI): 1.16-1.58; PR for PNC and antenatal care (ANC): 1.42, 95% CI: 1.21-1.67; p=.001 for both]. CONCLUSIONS: Two thirds of postpartum women with a need for FP used effective contraception at 9 months postpartum, and use was associated with discussing FP during PNC. IMPLICATIONS: Integrating FP counseling in ANC/PNC could be an effective strategy to increase effective contraception use. Published by Elsevier Inc.
OBJECTIVE: The objective was to characterize uptake and correlates of effective contraceptive use postpartum. STUDY DESIGN: We analyzed data from a national, cross-sectional evaluation of prevention of mother-to-child HIV transmission programs that enrolled women attending 6-week or 9-month infant immunization visits at 120 Kenyan maternal and child health clinics. We classified women who resumed sexual activity postpartum and did not desire a child within 2 years as having a need for family planning (FP). RESULTS: We included 955 (94%) of 1012 women 8-10 months postpartum in the analysis. Mean age was 25.8 years and 36% were primigravidas. By 9 months postpartum, 62% of all women used contraception and 59% used effective contraception [injectables, implants, intrauterine devices [IUDs], oral contraceptives [OCs] and tubal ligations]. Most contraceptive users (61%) used injectables, followed by implants (10%), OCs (6%), IUDs (4%) and condoms alone (2%). The majority (n=733, 77%) had a need for FP, and 67% of 733 women with FP need used effective contraception. Among women with a need for FP, effective contraception use was higher among those who discussed FP in postnatal care (PNC) than who did not discuss FP in PNC [prevalence ratio (PR) for PNC alone: 1.35, 95% confidence interval (CI): 1.16-1.58; PR for PNC and antenatal care (ANC): 1.42, 95% CI: 1.21-1.67; p=.001 for both]. CONCLUSIONS: Two thirds of postpartum women with a need for FP used effective contraception at 9 months postpartum, and use was associated with discussing FP during PNC. IMPLICATIONS: Integrating FP counseling in ANC/PNC could be an effective strategy to increase effective contraception use. Published by Elsevier Inc.
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