Is maternal health services utilization predict the contraceptives adoption in extended postpartum period: A community-based cross-sectional study done in urban slums of Western Gujarat

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Abstract

Background:

Family planning (FP) programme has been integrated since long with MCH programme in order to reduce maternal and child mortality. The period of pregnancy, delivery, and postnatal period is very crucial to sensitize the women to adopt contraceptive practice because during this time they are in constant contact with health provider and more receptive to advice. The present study is designed in this context to see whether the utilization of maternal health services have any impact on adoption of modern contraceptives in extended postpartum period.

Materials and Methods:

Community-based cross-sectional study was done in urban slum of Jamnagar, Gujarat, for 1 year in 2016. Two-stage sampling methodology was used; in first stage, 30 Anganwadi centres (AWC) was chosen by systemic random sampling and in second stage from each AWC, 8 women in extended postpartum period were included. Study included total 240 women. Sampling was done at household level. Descriptive statistics for sociodemographic factors and reproductive characteristics were done. Chi-square test was used to find association between different variables.

Result:

Prevalence of using modern contraceptive was only 24.6%. The most preferred choice was barrier method (35.5%), followed by sterilization (27.1%), Intrauterine device (IUD) (25.04%), and OCP (12%). Around 57% women had taken ≥4 health center visit during their last pregnancy and 7.5% had never visited or consulted. 12% women were delivered at home. Majority of the participants (63.5%) were not paid visit by health worker, only 15% were provided with adequate postnatal visit and 21% had inadequate visit during their immediate postpartum period. A statistical association was found between usage of contraceptive with health center visit during ANC, postnatal visit by HW, parity and age of women in extended postpartum period.

Conclusion:

There is need to improve the quality of maternal health services to increase the utilization of FP services.

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Most cited references 12

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Postpartum contraceptive use and unmet need for family planning in five low-income countries

Omrana Pasha, Shivaprasad Goudar, Archana Patel … (2015)

Background During the post-partum period, most women wish to delay or prevent future pregnancies. Despite this, the unmet need for family planning up to a year after delivery is higher than at any other time. This study aims to assess fertility intention, contraceptive usage and unmet need for family planning amongst women who are six weeks postpartum, as well as to identify those at greatest risk of having an unmet need for family planning during this period. Methods Using the NICHD Global Network for Women’s and Children’s Health Research’s multi-site, prospective, ongoing, active surveillance system to track pregnancies and births in 100 rural geographic clusters in 5 countries (India, Pakistan, Zambia, Kenya and Guatemala), we assessed fertility intention and contraceptive usage at day 42 post-partum. Results We gathered data on 36,687 women in the post-partum period. Less than 5% of these women wished to have another pregnancy within the year. Despite this, rates of modern contraceptive usage varied widely and unmet need ranged from 25% to 96%. Even amongst users of modern contraceptives, the uptake of the most effective long-acting reversible contraceptives (intrauterine devices) was low. Women of age less than 20 years, parity of two or less, limited education and those who deliver at home were at highest risk for having unmet need. Conclusions Six weeks postpartum, almost all women wish to delay or prevent a future pregnancy. Even in sites where early contraceptive adoption is common, there is substantial unmet need for family planning. This is consistently highest amongst women below the age of 20 years. Interventions aimed at increasing the adoption of effective contraceptive methods are urgently needed in the majority of sites in order to reduce unmet need and to improve both maternal and infant outcomes, especially amongst young women. Study registration Clinicaltrials.gov (ID# NCT01073475)

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Interventions to Improve Postpartum Family Planning in Low- and Middle-Income Countries: Program Implications and Research Priorities.

John G.F. Cleland, Iqbal Shah, Marina Daniele (2015)

This article provides programmatic guidance and identifies future research priorities through a review of interventions to improve postpartum contraception. Thirty-five interventions in low- and middle-income countries were identified and classified according to timing and nature of administration: antenatal, postnatal, both ante- and postnatal, and integration with other services. With the exception of single, short antenatal interventions, the evidence of impact is positive but incomplete. A major gap in knowledge concerns demand for, and means of promoting, immediate postpartum family planning services in Asia and Africa. Counseling before discharge is likely to have an impact on subsequent contraceptive uptake. Integration of family planning into immunization and pediatric services is justified, but policy and program obstacles remain. A case for relaxing the strict conditions of the lactational amenorrhea method (LAM) is strong, but qualitative evidence on the perspectives of women on pregnancy risks is required. Despite the gaps in knowledge, the evidence provides useful guidance for strategies to promote postpartum family planning, in ways that take different contexts into account.

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Integration of family planning with maternal health services: an opportunity to increase postpartum modern contraceptive use in urban Uttar Pradesh, India

Pranita Achyut, Anurag Mishra, Livia Montana … (2015)

Background Maternal health (MH) services provide an invaluable opportunity to inform and educate women about family planning (FP). It is expected that this would enable women to choose an appropriate method and initiate contraception early in the postpartum period. In this study we examined interactions with health providers for MH services, and the effect of FP information provision during these interactions on the postpartum use of modern contraceptive methods. Methods This study used midline data collected from 990 women who had delivered a live birth between January 2010 and the date of the midline survey in 2012. These women were asked a series of questions about their last delivery, including interactions with health providers during pregnancy, delivery and the postpartum period, if they received FP information during these interactions, and their contraceptive use during the postpartum period. Results The study found that FP information provision as part of antenatal care in the third trimester, delivery and the postpartum period have a positive association with postpartum modern contraceptive use in urban Uttar Pradesh. However, health providers often miss these opportunities. Despite a high proportion of women coming into contact with health providers when utilising MH services, only a small proportion received FP information during these interactions. Conclusions Integration of FP with MH services can increase postpartum modern contraceptive use. With the launch of the National Urban Health Mission, there now exists appropriate policy and programmatic environments for integration of FP and MH services in urban settings in India. However, this will require a concentrated effort both to enhance the capacity of health providers and encourage supportive supervision.

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Author and article information

Journal

Journal ID (nlm-ta): J Family Med Prim Care

Journal ID (iso-abbrev): J Family Med Prim Care

Journal ID (publisher-id): JFMPC

Title: Journal of Family Medicine and Primary Care

Publisher: Wolters Kluwer - Medknow (India )

ISSN (Print): 2249-4863

ISSN (Electronic): 2278-7135

Publication date (Print): March 2019

Volume: 8

Issue: 3

Pages: 1164-1169

Affiliations

[1 ] Department of Community Medicine, All India Institute of Medical Science, Nagpur, Maharashtra, India

[2 ] Department of Community Medicine, M P Shah Government Medical College, Jamnagar, Gujarat, India

Author notes

Address for correspondence: Dr. Mubashshera Firdous Khan, 20, Teachers Colony, Jafar Nagar, Nagpur - 440 013, Maharashtra, India. E-mail: mubashshsera_khan@ 123456rediffmail.com

Article

Publisher ID: JFMPC-8-1164

DOI: 10.4103/jfmpc.jfmpc_122_19

PMC ID: 6482738

SO-VID: c865c603-477f-4f7d-96fe-fb030416a097

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This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

Is maternal health services utilization predict the contraceptives adoption in extended postpartum period: A community-based cross-sectional study done in urban slums of Western Gujarat

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Advocacy for Maternal and Women’s Health

Most cited references 12

Postpartum contraceptive use and unmet need for family planning in five low-income countries

Interventions to Improve Postpartum Family Planning in Low- and Middle-Income Countries: Program Implications and Research Priorities.

Integration of family planning with maternal health services: an opportunity to increase postpartum modern contraceptive use in urban Uttar Pradesh, India

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