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Abstract Background For women living with the human immunodeficiency virus (WLHIV), preventing untimed pregnancies during the postpartum period reduces vertical transmission and improves other maternal and child health outcomes. In Kenya, Busia County’s HIV prevalence and mother-to-child transmission rate are higher than the national average yet uptake of postpartum family planning (PPFP) is generally low. This study examined health system factors influencing the consistent use of PP modern FP methods among WLHIV in Busia County. Methods A retrospective study involving 314 WLHIV with children aged 12–24 months who were chosen using systematic random sampling was conducted from February to March 2024 from outpatient clinics in Busia County. Additionally, 14 health providers were purposively sampled as key informants. Quantitative data was collected using a pretested questionnaire, while qualitative data was gathered through key informant interview guides. Quantitative data was analyzed using STATA 15 with descriptive statistics, logistic regression, and Chi-square tests, while a deductive thematic analysis was used for qualitative data. Results The mean age of the participants was 32.06 (± 6.00) with the majority (51.27) aged between 25 and 34 years, married (74.84%) and unemployed (77.39%). Overall, 73.25% had used postpartum (PP) modern family planning (FP) methods, but only 52.55% reported consistent use throughout the first year postpartum. The only factors found to increase the odds of PPFP use were being married (aOR 3.34, 95% CI 1.58–7.07, p = 0.002), being escorted by a preferred person during seeking maternal and child health services (aOR 2.29, 95% CI 1.36–3.83, p = 0.002), and perceiving that they were provided information on all types of FP (aOR 2.33, 95% CI 1.19–4.16, p = 0.012). Persistent stock-outs and inadequate counseling hindered consistent PPFP use. Conclusion The study identified gaps in the consistent use of PP modern FP methods among WLHIV in Busia County, influenced by the availability of FP information and health system factors. Addressing stock-outs and improving counseling during clinic visits and pregnancy are crucial for improving FP service delivery and reducing maternal and child health risks in high HIV-incidence areas like Busia County.

Abstract Background Postpartum family planning (PPFP) is important in helping couples to achieve their reproductive intentions. National surveys have consistently reported higher fertility, lower use of family planning (FP), and higher unmet needs for FP in Upper Egypt. This study aims to identify the factors associated with the use of PPFP in Assiut Governorate, Upper Egypt, and to assess the current status of integration of PPFP counseling in the existing maternal and child health services (MCH). Methods The study employed a cross-sectional study design, collecting data from 455 postpartum women aged 15 to 49 years in 4 primary health care (PHC) centers in Assiut Governorate, Upper Egypt. The women were interviewed using a structured questionnaire. The questionnaire consisted of 4 sections: the first section included the participants’ demographic characteristics; the second section included women’s obstetric history; the third section included questions about PPFP knowledge, attitude, past and current use of contraception; and the fourth section assessed the current status of integrating PPFP counseling within antenatal, natal, and postnatal services. Results In total, 54.5% of postpartum women were using a modern contraceptive method. The significant predictors of using PPFP methods were as follows: receiving information about PPFP from health care providers (AOR = 11.46, p

Background: Postpartum family planning (PPFP) is important in helping couples to achieve their reproductive intentions. National surveys have consistently reported higher fertility, lower use of family planning (FP), and higher unmet needs for FP in Upper Egypt. This study aims to identify the factors associated with the use of PPFP in Assiut Governorate, Upper Egypt, and to assess the current status of integration of PPFP counseling in the existing maternal and child health services (MCH). Methods: The study employed a cross-sectional study design, collecting data from 455 postpartum women aged 15 to 49 years in 4 primary health care (PHC) centers in Assiut Governorate, Upper Egypt. The women were interviewed using a structured questionnaire. The questionnaire consisted of 4 sections: the first section included the participants' demographic characteristics; the second section included women's obstetric history; the third section included questions about PPFP knowledge, attitude, past and current use of contraception; and the fourth section assessed the current status of integrating PPFP counseling within antenatal, natal, and postnatal services. Results: In total, 54.5% of postpartum women were using a modern contraceptive method. The significant predictors of using PPFP methods were as follows: receiving information about PPFP from health care providers (AOR = 11.46, p < 0.001), better attitude towards PPFP (AOR = 10.54, p < 0.001), using modern FP methods (AOR = 6.98, p < 0.001), resumption of menstruation (AOR = 4.11, p < 0.001), older age (AOR = 2.15, p < 0.05), and better PPFP knowledge (AOR = 1.72, p < 0.001). Only 5.3%, 1.3%, and 3.5% received PPFP counseling during antenatal care (ANC), delivery, and the postpartum period, respectively. Conclusions: Postpartum contraception use was associated with receiving PPFP counseling by health care providers and women's knowledge and attitude regarding PPFP. However, FP counseling was not integrated with other MCH services. Updating the components of MCH services to include PPFP counseling during ANC, at delivery, and during the postpartum period should be prioritized by program planners and policymakers. [ABSTRACT FROM AUTHOR]

Inequitable gender norms can contribute to rapid repeat pregnancies and adverse maternal health outcomes among adolescent girls and young women. This study examined associations between male partners' gender-equitable attitudes and behaviors and postpartum family planning (FP) and maternal and newborn health (MNH) outcomes among first-time mothers aged 15-24 in Kinshasa, Democratic Republic of the Congo. Participants were 1335 couples who were successfully interviewed in the Momentum project's 2018 baseline and 2020 endline surveys. Multivariable regression models were used to analyze predictors of postpartum FP discussion and use, shared MNH decision making, completion of the maternal health continuum of care, and exclusive breastfeeding. Male involvement in maternal health was significantly associated with FP discussion and shared decision making. Male partners' willingness to be involved in routine childcare and shared decision making were significant positive predictors of exclusive breastfeeding. Postpartum FP outcomes were shaped by the intersection of marital status and male partners' gender-equitable attitudes, intimate partner violence perpetration, and willingness to engage in routine childcare activities to constitute advantage for some outcomes and disadvantage for others. Interventions must use multiple measures to better understand how young mothers' health outcomes are shaped by their male partners' gender-related attitudes and behaviors.

Abstract Background The first twelve months after a woman has given birth is crucial for the use of contraceptives to prevent unintended pregnancy. Most women, especially in developing countries, do not realize that they are at risk for pregnancy during this period. Due to this, contraceptive use by women is ignored at this time. Objective This study assessed the associated factors of postpartum family planning (PPFP) service uptake in the Asosa zone. Methods A facility-based cross-sectional study was conducted among 396 postpartum women in the Asosa zone. An interviewer-administered, structured, and pre-tested questionnaire was used to collect data. Data entry and cleaning were done using Epi Info version 7.0 and analyzed using SPSS version 25 software. Multivariate logistic regression analysis was employed to identify factors associated with postpartum family planning uptake. Results The majority of the study participants, 384 (97.2%), had heard about at least one method of family planning. Nearly two-thirds of the study participants (64.1%) had resumed sexual intercourse. Only 53.5% of the participants started using PPFP. Injectable forms (54.7%) and implants (26.4%) were the most commonly used methods. More than one-fourth (27.4%) did not use their preferred methods. Family planning use before index pregnancy (AOR = 4.8, 95% CI: 2.65, 8.82), previous use of PPFP (AOR = 2.4, 95% CI: 1.33, 4.38)] and health facility delivery (AOR = 2.8, 95% CI: 1.46, 5.49)] were significantly associated with uptake of postpartum family planning. Conclusion and recommendation : Postpartum family planning uptake in the study area was low. Uptake of PPFP was correlated with prior family planning usage and delivery at a healthcare facility. Given these factors, we recommend all study area stakeholders to promote family planning use among women of reproductive age and to encourage deliveries at healthcare facilities. Designing a method to reach women who give birth at home for a variety of reasons is also advisable. Unavailability of different forms of FP also made the participants not use the preferred option. Therefore, we recommend the stakeholders in the study area to avail variety of FP methods.

Globally, there are considerable barriers to accessing safe and effective contraceptive methods. Increased awareness and utilization among obstetricians and gynecologists (OB/GYNs) and allied health professionals of the WHO's tools and guidelines on contraception is a possible avenue to changing this. A cascade‐training model, based on regional training‐of‐trainer workshops followed by national workshops, was used to share key WHO global family planning tools and guidelines among OB/GYNs in 29 countries across three regions—Anglophone Africa, Middle East and Mediterraean, and Francophone West Africa. Monitoring and evaluation was performed through pre‐ and post‐knowledge questionnaires as well as in‐depth interviews of key informants before and after the training was instituted. The training increased both participants' knowledge and understanding of the relevant guidelines, as well as their confidence in using them. Qualitative data suggested that this improved in‐country clinical practice and influenced national policy through dissemination and engagement with country leadership. The cascade‐training model was a practical, locally adaptable means of disseminating up‐to‐date WHO family planning guidelines and tools. It resulted in sustainable changes in many participating countries, including training curriculum updates, policy changes, and increased government engagement with family planning. Future iterations of the initiative would benefit from additional support for multidisciplinary training. Synopsis: Description of FIGO/WHO SRH collaboration and its impact in disseminating up‐to‐date global tools and guidelines in contraception through a cascade‐training model with national OB/GYN societies. [ABSTRACT FROM AUTHOR]

Low uptake of family planning among women is predominantly attributed to low participation of men in postpartum family planning. In order to improve maternal health, strengthening male participation in family planning is an important public health initiative. This study aimed to assess factors associated with participation of men in postpartum care at Kiswa Health Centre III, Nakawa division, Kampala. An analytical cross-sectional study design involving collection of quantitative data was used. Systematic random sampling was used to select study participants. Data was collected using semi-structured questionnaires. Data entry and cleaning was performed using EpiData version 12 and analysed using Stata version 14. 80.0% of respondents participated in postpartum family planning. Approval of family planning use, knowledge on family planning and information source were significantly associated with male involvement in postpartum family planning. Respondents who approved family planning use at home were 15.5 times more likely to get involved in family planning services as compared to those who didn't approve family planning. Conclusively, there was a generally high level of male involvement in postpartum family planning in comparison with the national levels. Approval of family planning at home increased the likelihood of men's participation in family planning. What is already known on this subject? Evidence has it that short birth intervals of less than 15 months have been found to be associated with adverse pregnancy outcomes including induced abortions, miscarriages, preterm births, neonatal and child mortalities, still births and maternal depletion syndrome. In Africa, generally, low family uptake among women is also attributed to low men participation in postpartum family planning. What do the results of this study add? Approval of family planning use, knowledge on family planning and information source were associated with male involvement in postpartum family planning. Respondents who approved family planning use at home were 15.5 times more likely to get involved in postpartum family planning services as compared to those who didn't approve family planning. What are the implications of these findings for clinical practice and/or further research? In this study, the involvement of men was relatively high, but more studies are needed in other locations to compare with this finding. Otherwise, consolidation of such high involvement is highly needed, as this can be a starting point for further improvement. [ABSTRACT FROM AUTHOR]

BackgroundLimited evidence exists on how women's experiences of care, specifically person-centered maternity care during childbirth, influence maternal and newborn health outcomes.ObjectiveThis study aimed to examine the associations between person-centered maternity care and maternal and newborn health outcomes.Study designLongitudinal data were collected with 1014 women who completed baseline at a health facility and followed up at 2 weeks and 10 weeks after birth. A validated 30-item person-centered maternity care scale was administered to postpartum women within 48 hours after childbirth. The person-centered maternity care scale has 3 subscales: dignity and respect, communication and autonomy, and supportive care. Bivariate and multivariable log Poisson regressions were used to examine the relationship between person-centered maternity care and reported maternal complications, newborn complications, postpartum depression, postpartum family planning uptake, exclusive breastfeeding, and newborn immunizations.ResultsControlling for demographic characteristics, women with high total person-centered maternity care score at baseline had significantly lower risk of reporting maternal complications (adjusted relative risk, 0.63; 95% confidence interval, 0.42-0.95), screening positive for depression (adjusted relative risk, 0.55; 95% confidence interval, 0.38-0.81), and reporting newborn complications (adjusted relative risk, 0.74; 95% confidence interval, 0.56-0.97), respectively, than women with low total person-centered maternity care scores. Women with high scores on the supportive care subscale had significantly lower risk of reporting maternal and newborn complications than women with low scores on these subscales (adjusted relative risk, 0.52 [95% confidence interval, 0.42-0.65] and 0.74 [95% confidence interval, 0.60-0.91], respectively). Significant associations were found between all 3 subscale scores and screening positive for depression. Women with high total person-centered maternity care scores were also more likely to adopt a family planning method than those with low scores (adjusted relative risk, 1.25; 95% confidence interval, 1.02-1.52). In particular, women with high scores on the communication and autonomy subscale had significantly higher odds of adopting a family planning method than women with low scores (risk ratio, 1.15; 95% confidence interval, 1.08-1.23).ConclusionImproving person-centered maternity care may improve maternal and newborn health outcomes. Specifically, improving supportive care may decrease the risk of maternal and newborn complications, whereas improving communication and autonomy may increase postpartum family planning uptake.

Abstract Background Effective family planning is associated with substantial benefits, including reductions in maternal and neonatal mortality due to the avoidance of unintended pregnancies, and contributions to spacing, timing, and limiting births. However, in Zanzibar, Tanzania, the utilization of modern contraceptive methods is low. This study therefore aimed to identify barriers to using postpartum family planning among women in Zanzibar. Methods Five focus group discussions were conducted with 24 women who gave birth in the maternity unit at a reference hospital in Zanzibar during the first quarter of 2022. The discussions took place in Swahili, were performed with the assistance of an interview guide, and were audio recorded, transcribed in Swahili, and translated to English. Data were analysed with qualitative content analysis using an inductive approach. Results Barriers to using postpartum family planning in Zanzibar could be summarized in three generic categories. Inadequate knowledge about postpartum family planning is expressed in the subcategories: inadequate knowledge about contraceptive methods and their mode of action, insufficient quality of family planning services, and belief in traditional and natural medicine for family planning. Perceived risks of modern contraceptive methods are described in the subcategories: fear of being harmed, and fear of irregular bleeding. Limited power in one’s own decision about contraceptive use consist of the subcategories: the need to involve the husband, and opposition and lack of interest from the husband. Conclusions The participants’ current knowledge of postpartum family planning was insufficient to either overcome the fear of side-effects or to understand which side-effects were real and likely to happen. The woman’s power in her own decision-making around her sexual reproductive rights is of critical importance. Given the barriers identified in this study, the findings call for increased knowledge about family planning methods and their mode of action, and involvement of the husband throughout pregnancy, childbirth, and the postpartum period in postpartum family planning education and counselling, in Zanzibar and in similar settings.

Plain Language Summary We use information from mothers with a child under the age of 18 months, who were interviewed in a national survey conducted in 2018. We examine risk of an unintended pregnancy, using data on factors that protect against risk, namely delayed resumption of sex and menses, breastfeeding and contraceptive use. Among mothers with an infant aged less than 6 months, very few were at risk mainly because they had not resumed sex. Among those with an infant aged 6–11 months, 26% had still not resumed sex and an equal proportion was partially protected by delayed resumption of menses. Only 17% were protected by use of a modern contraceptive method, leaving 24% fully at risk. Among those with a child aged 12–18 months, 30% were fully at risk. As expected, well educated, urban women were more likely to use contraception than less privileged women but less likely to be protected by delayed resumption of sex and menses, with the consequence that pregnancy-risk was similar. Though three-quarters of mothers had taken their child for vaccination on three or more occasions, only one-third had discussed family planning with a health provider at a visit to a facility in the previous 12 months. The need for improved contraceptive services for mothers with young children is clear. Short intervals between births are common in Cameroon and these threaten the health of mothers and children. It is equally clear that closer integration of family planning into mainstream health services is needed.

BackgroundThe utilization of an immediate postpartum intrauterine device (IPPIUD) during the postpartum period helps women to realize their desire for birth spacing and prevent unplanned pregnancies. However, many postpartum mothers do not undergo immediate postpartum family planning in developing countries, including Ethiopia, which consequently increases the risk of unplanned pregnancies and pregnancy-related complications.ObjectiveTo assess the utilization of an IPPIUD and its associated factors among women who gave birth in public hospitals in the West Wollega Zone in 2022.MethodsAn institutional-based cross-sectional study was conducted among 605 postpartum mothers who delivered their baby between 15 April and 15 May 2022 at public hospitals in the West Wollega Zone, Ethiopia. A systematic random sampling technique was used to select study subjects, and the data were collected using an interviewer-administered structured questionnaire, which was then entered into EpiData Entry version 4.6 and exported to the Statistical Package for Social Science version 26 for analysis. The variable with a p-value of ≤ 0.05 with an adjusted odds ratio and 95% confidence intervals was used to declare statistically significant association.ResultThe prevalence of the utilization of the IPPIUD among respondents who gave birth in West Wollega public hospitals within 48 h was 27.2% (95% CI, 23.7–30.9). Age ranging between 25 and 34 years (AOR = 4.27, 95%CI:1.68–10.85), early initiation of antenatal care (ANC; AOR = 1.91, 95%CI: 2.8–10.01), adequate knowledge of IPPIUD (AOR = 4.71, 95%CI: 2.63–6.63), favorable attitude toward family planning (AOR = 3.35, 95%CI: 2.07–5.44), planning of pregnancy (AOR = 2.21, 95%CI: 1.37–4.11), and counseling (AOR = 4.14, 95%CI: 2.60–6.68) were factors that were significantly associated with the utilization of IPPIUD.ConclusionAccording to the 2019 Ethiopia Mini Demographic and Health Survey (mini EDHS 2019), the utilization of an immediate postpartum intrauterine device was low, that is, 35%. Age of respondents, early initiation of antenatal care, favorable attitude toward, planning of pregnancy, adequate knowledge of, and counseling on IPPIUD utilization were significantly associated with the mother’s utilization of immediate postpartum intrauterine device. Thus, the zonal health office and health professionals should work toward encouraging all the women who gave birth at public hospitals to the utilization of immediate postpartum intrauterine devices by improving awareness among the women in that specific zone through counseling to increase the uptake of IPPIUD.

Abstract 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.

Background: The postpartum period is a critical time to address the unmet family planning needs and reduce the risk of too-soon pregnancies, maternal and child morbidity, and mortality. The study was conducted to determine the factors influencing the uptake of postpartum family planning among postpartum mothers 0 to 6 weeks postpartum Method: The study was a cross-sectional study that employed quantitative methods for data collection. 56 postpartum mothers present at the study area at the time of data collection were counseled and interviewed using a semi-structured questionnaire. Result: There is a significant association between age and uptake of PPFP where mothers at a younger age are more likely to use PPFP within 6 weeks after delivery [x2(1) =6.222a; p

Background: Effective family planning is associated with substantial benefits, including reductions in maternal and neonatal mortality due to the avoidance of unintended pregnancies, and contributions to spacing, timing, and limiting births. However, in Zanzibar, Tanzania, the utilization of modern contraceptive methods is low. This study therefore aimed to identify barriers to using postpartum family planning among women in Zanzibar. Methods: Five focus group discussions were conducted with 24 women who gave birth in the maternity unit at a reference hospital in Zanzibar during the first quarter of 2022. The discussions took place in Swahili, were performed with the assistance of an interview guide, and were audio recorded, transcribed in Swahili, and translated to English. Data were analysed with qualitative content analysis using an inductive approach. Results: Barriers to using postpartum family planning in Zanzibar could be summarized in three generic categories. Inadequate knowledge about postpartum family planning is expressed in the subcategories: inadequate knowledge about contraceptive methods and their mode of action, insufficient quality of family planning services, and belief in traditional and natural medicine for family planning. Perceived risks of modern contraceptive methods are described in the subcategories: fear of being harmed, and fear of irregular bleeding. Limited power in one's own decision about contraceptive use consist of the subcategories: the need to involve the husband, and opposition and lack of interest from the husband. Conclusions: The participants' current knowledge of postpartum family planning was insufficient to either overcome the fear of side-effects or to understand which side-effects were real and likely to happen. The woman's power in her own decision-making around her sexual reproductive rights is of critical importance. Given the barriers identified in this study, the findings call for increased knowledge about family planning methods and their mode of action, and involvement of the husband throughout pregnancy, childbirth, and the postpartum period in postpartum family planning education and counselling, in Zanzibar and in similar settings. [ABSTRACT FROM AUTHOR]

Maternal Mortality Rate (MMR) is one of the national health indicators to achieve the success of maternal health efforts where the number of MMR in Indonesia reached 305 per 100,000 live births. Family planning services including Post Partum Family Planning/Keluarga Berencana Pascapersalinan (KBPP) can effectively reduce maternal mortality by reducing births and reducing high risk. The high number of KBPP users in DKI Jakarta can be caused by many things such as local government support, level of service by health workers, and others. Therefore, this study aims to analyze and find out the special causes that cause the number of KBPP participants in DKI Jakarta and as a lesson learned for other local governments. This research is a descriptive study to see the variety of data on the number of KBPP participants in DKI Jakarta. Univariate analysis was used to describe the number of KBPP participants and bivariate analysis to explain the characteristics of the variables studied based on time, namely in the form of a run chart. Based on four tests that have been carried out on the data on the number of KBPP participants in DKI Jakarta, it can be said that there is one test that meets the requirements as a variation of system data so that there is a special cause that causes the number of KBPP participants in 2019-2020. The existence of policy support from the DKI Jakarta Provincial Government, and various stakeholders has resulted in high coverage of the use of postpartum family planning.

This study assessed the relationships between emotional intimate partner violence (IPV) before, during, and after pregnancy and postpartum contraceptive use. We used 2016–2021 Pregnancy Risk Assessment Monitoring System data from seven sites (n = 30,125). We used multivariable logistic regression to assess indicators of emotional IPV and provider counseling associated with postpartum contraceptive use. Emotional IPV 12 months before, during, and after pregnancy were all significantly associated with reduced odds of postpartum contraceptive use. Strengthening postpartum contraceptive services by integrating IPV prevention into care is an opportunity to improve the health of postpartum people. [ABSTRACT FROM AUTHOR]

Background: The health hazards of short inter-birth intervals are severe in Cameroon. One-quarter of inter-birth intervals are less than 24 months and the probability of death before age 5 for children born after a short interval is double that associated with intervals of 36–47 months. We examine the risk of an unintended pregnancy in the 18 months following childbirth in Cameroon, taking into account the protective effects of lactational amenorrhea, delayed resumption of sex as well as contraceptive use. Methods: Data from 3007 postpartum women in the nationally representative 2018 Cameroon Demographic and Health Survey were used. Risk of an unintended pregnancy was defined from current status information on resumption of sex and menses, contraceptive use, desire for another child within 12 months, and, for the minority of pregnant women, whether the conception was intended. Predictors of risk, and of modern method use, were assessed by bivariate and multivariate analysis. Results: In the first 6 postpartum months, only 8% of women were fully at risk (i.e., sex and menses resumed but no contraceptive use), rising to 24% at 6–11 postpartum months, and further to 30% at months 12–17. Though 89% wanted to delay the next birth by at least 1 year, only 17% were currently using a modern method. Menstruating women were much more likely to be users than amenorrheic women: 27% versus 15% at months 12–17 postpartum. Urban and better educated women recorded higher contraceptive use but lower protection from other factors than rural, less educated women, with the net result that risk differed little across these population strata. Uptake of maternal and child health (MCH) services was high but only one-third of women had discussed family planning at a facility visit during the preceding 12 months. Conclusions: These results underscore the need for improved postpartum family planning services by means of closer integration with mainstream health services. In view of evidence from other sources of heavy workload and weak motivation of health staff, this will require strong leadership. A related priority is to increase the number of staff trained in provision of long-acting methods, such as implants. Plain Language Summary: We use information from mothers with a child under the age of 18 months, who were interviewed in a national survey conducted in 2018. We examine risk of an unintended pregnancy, using data on factors that protect against risk, namely delayed resumption of sex and menses, breastfeeding and contraceptive use. Among mothers with an infant aged less than 6 months, very few were at risk mainly because they had not resumed sex. Among those with an infant aged 6–11 months, 26% had still not resumed sex and an equal proportion was partially protected by delayed resumption of menses. Only 17% were protected by use of a modern contraceptive method, leaving 24% fully at risk. Among those with a child aged 12–18 months, 30% were fully at risk. As expected, well educated, urban women were more likely to use contraception than less privileged women but less likely to be protected by delayed resumption of sex and menses, with the consequence that pregnancy-risk was similar. Though three-quarters of mothers had taken their child for vaccination on three or more occasions, only one-third had discussed family planning with a health provider at a visit to a facility in the previous 12 months. The need for improved contraceptive services for mothers with young children is clear. Short intervals between births are common in Cameroon and these threaten the health of mothers and children. It is equally clear that closer integration of family planning into mainstream health services is needed. [ABSTRACT FROM AUTHOR]

Abstract Background Postpartum family planning (PPFP) helps women space childbirths, increase exclusive breastfeeding and prevent unintended pregnancies, leading to reduction in maternal, infant and child morbidities and mortality. Unmet need of family planning is highest among women in the postpartum period due to lack of knowledge, cultural and religious barriers, access barriers and low antenatal care service utilization. However, in spite of low prevalence of postpartum family planning practices, birth-to-birth interval is reportedly high in Delhi, India. This study explores the postpartum contraception practices and the relationship between use of postpartum contraception and subsequent child linear growth. Methods This is a mixed method cohort study on PPFP and is nested within an ongoing “Women and Infants Integrated Interventions for Growth Study” (WINGS). Married women aged 18–30 years who have delivered a live baby are recruited for quantitative interviews at 6 weeks, 6, 12, and 24 months postpartum. In-depth interviews are conducted with a randomly selected sub-sample of women at each of the four time points, 35 husbands and 20 local service providers to understand their perspectives on PPFP practices. Discussion The findings from the study will provide useful insights into couples’ contraception preferences and choice of contraception, modern and traditional, initiation time and the effect of birth spacing and contraception use on subsequent linear growth of the child. This knowledge will be of significant public health relevance and will help in designing appropriate interventions for appropriate postpartum contraception use and delivery strategies. The study aims to work address the Sexual and Reproductive Health and Rights goal of promoting reproductive health, voluntary and safe sexual and reproductive choices for women. Trial registration Trial registration number: CTRI/2020/03/023954 .

BackgroundIn Ethiopia, different fragmented studies have been conducted to assess the determinants and uptake of postpartum modern family planning services. There is discrepancy and inconsistency among reported studies on postpartum modern family planning service uptake. The scoping review aimed to collect evidence on postnatal birth control service use and supply a chance to spot key ideas and gaps to research, policy revision, and changes in strategies.MethodsThere were different process steps in this scoping review which included analysis questions, distinctive relevant studies, study choice, charting the information, and eventually collating, summarizing, and reporting the results. A search was conducted through scientific databases like PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Hinari, and Google Scholar. The first outcome of this scoping review was postpartum family planning service uptake after childbirth in Ethiopia. The Preferable Reporting Information in Systematic Review and Meta-Analysis (PRISMA) flow diagram was used to select and summarize the selection procedure of the articles. The information of the chosen studies was sorted using the subsequent categories: authors, year of publication, study location, main study objective, and method employed for information analyses.ResultsA total of 1,607 records were reclaimed from the database searches and reference list review. A total of 596 articles were identified in PubMed, 375 in CINAHL, 576 in Hinari, and 60 records in Google Scholar. A total of 1,607 literature studies were checked for replication, and 840 records were excluded. The bulk of articles (n = 420) were excluded because they did not focus on postpartum family planning service, and 322 articles were excluded due to study setting discrepancy. The remaining 28 full-text articles were read in full using the preidentified inclusion criteria and included in the scoping review for analysis.ConclusionGenerally, this scoping review identified different fragmented and inconsistent research findings on the uptake of postpartum modern family planning in Ethiopia. Almost all studies were observational studies that lack interventional study designs to provide evidence-based interventions to improve postpartum family planning uptake. There is a definite need for further interventional and qualitative research to improve early postpartum family planning service uptake that improves maternal and child health.

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. [ABSTRACT FROM AUTHOR]

Plain Language Summary This study assessed the practicality, usefulness, and acceptability of the decision aid we developed for pregnant adolescents in Tanzania. The study was conducted at Amana District Hospital in Dar es Salaam, Tanzania. For the study participants, six nurses/midwives with three or more years of experience in family planning services and 12 pregnant adolescents aged 15–19 years were recruited for in-depth interviews using a semi-structured interview guide with five questions. Study participants felt that the decision aid written in the Kiswahili language included important information that women wanted to know during counseling about long-acting reversible contraception options. The amount of information presented was just right, with the time of reading the data ranging from 20 min to 1 h. Study participants recommended that nurses/midwives implement the decision aid to ensure comprehension of the presented information and pictures. The decision aid was perceived to help improve knowledge and address several myths and misconceptions and the benefits and side effects of each long-acting reversible contraception option. Study participants recommended several changes: the flow of information needed reorganization, and some Kiswahili words needed rephrasing to reduce ambiguity. Notably, the study participants accepted the decision aid for use in clinical settings. It contained evidence-based information useful for complimenting the family planning counseling offered, particularly for long-acting reversible contraception methods. The decision aid helped improve the objectivity of counseling regarding long-acting reversible contraception methods. It imparted valuable knowledge to pregnant adolescents in Tanzania about the contraception methods (i.e., the use of intrauterine copper devices and implants) that are immediately available after childbirth. Additional studies are needed to examine the effects of the decision aid on pregnant adolescents in Tanzania to uptake long-acting reversible contraception methods after childbirth.

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Abstract Background Strengthened efforts in postpartum family planning (PPFP) is a key priority to accelerate progress in reproductive, maternal, newborn, and child health outcomes. This secondary data analysis explores factors associated with PPFP uptake in Rwanda. The purpose of this study was to explore variables that may influence PPFP use for postpartum women in Rwanda including health facility type, respectful maternity care, locus of control, and mental health status. Methods This secondary analysis of data from a cluster randomized control trial used information abstracted from questionnaires administered to women (≥ 15 years of age) at two time points—one during pregnancy (baseline) and one after delivery of the baby (follow-up). The dependent variable, PPFP uptake, was evaluated against the independent variables: respectful care, locus of control, and mental health status. These data were abstracted from linked questionnaires completed from January 2017 to February 2019. The sample size provided 97% power to detect a change at a 95% significance level with a sample size of 640 at a 15% effect size. Chi-square testing was applied for the bivariate analyses. A logistic regression model using the generalized linear model function was performed; odds ratio and adjusted (by age group and education group) odds ratio with 95% confidence interval were reported. Results Of the 646 respondents, although 92% reported not wanting another pregnancy within the next year, 72% used PPFP. Antenatal care wait time (p =

Benyam Seifu,1 Delelegn Yilma,1 Workinesh Daba2 1College of Medicine and Health Sciences, Ambo University, Ambo, Oromia Regional State, Ethiopia; 2School of Nursing and Midwifery, Addis Ababa University, Addis Ababa, EthiopiaCorrespondence: Benyam SeifuCollege of Medicine and Health Sciences, Ambo University, P.O. Box: 19, Ambo, EthiopiaTel +251 910 45 11 84Email benyamseifu77@gmail.comBackground: Globally, 95% of women wants to avoid pregnancy for at least two years after giving birth, but 70% of them are not using contraception; majority of them were from developing countries. Postpartum family planning (PPFP) enables families to avoid unplanned pregnancies following 12 months after childbirth. Different studies in Ethiopia showed that the majority of postpartum women do not use PPFP. Moreover, the level of PPFP knowledge and utilization in West Shewa, Oromia region of Ethiopia is unclear.Purpose: This study aimed to assess the knowledge, utilization and associated factors of postpartum family planning (PPFP) Oromia regional state, Ethiopia.Methods: A community-based cross-sectional study was conducted in Ambo town, West Shewa Zone of Oromia regional state from April 01 to July 30, 2019. A sample of 367 postnatal women participated in the study. An interview administered questionnaire was used to collect the data and the collected data were entered into Epi Info version 7.1 and analyzed with SPSS version 23. Study participants’ characteristics were described using frequency and percentage. Bivariate and multivariate logistic regression was carried out to identify the associated factors with the outcome variables.Results: A total of 354 women were participated in the study making a response rate of 96.4%. About 249 (70.3%) of the respondents had good knowledge about PPFP and 144 (40.7%) had utilized PPFP services. Higher education level [AOR= 3.4, 95% CI: 1.3– 6.9], history of family planning utilization [AOR= 2.8, 95% CI: 2.1– 4.4] and having ANC follow-up [AOR=2.1, 95% CI: 1.1– 4.0] had showed a positive association with knowledge of PPFP. Meanwhile, knowledge of PPFP [AOR=2.1, 95% CI: 1.6– 3.1], a grand multi-para women [AOR=1.7, 95% CI (1.3– 3.6)] and received routine PNC service [AOR=2.5, 95% CI: 1.3– 5.9] were associated with the utilization of PPFP.Conclusion and Recommendation: Although the majority of the women knew about PPFP, more than half of them did not utilize PPFP. Due emphasis should be given to improve the utilization of PPFP.Keywords: postpartum family planning, knowledge, utilization and associated factors

Postpartum family planning coverage in Central Java is below the national standard, or it only reached 26.8%. Postpartum mothers are at risk of getting pregnant if they do not use contraception. Modern contraceptives prevent 3.2 million of 5.6 million under-five deaths and 109,000 of 155,000 (70%) maternal deaths. Continuity of Midwifery Care during the extended postpartum period encourages mothers to use modern contraception to manage the pregnancy gap. This study aimed to explore midwifery services for Family Planning Postpartum from the perspective of providers and clients in three health facilities: hospitals (RS), Public Health Centers, and Independent Midwifery Practice (PMB). The research was implemented through a qualitative descriptive, a case study approach design in 2021. informants were ten postpartum mothers, nine midwives, two heads of Puskesmas, head division of Family Planning, Women and Children Empowerment (KBPPA) conducted an in-depth interview. The interviews were digitally recorded, transcribed, and analyzed using the Miles and Huberman method. Providers and clients identified several benefits of Postpartum Family Planning (KBPP). Midwives stated several obstacles in providing services, such as limited counseling time during labor and lack of support from hospital management. The competence of midwives constrained KBPP services at the Puskesmas. There were still few midwives at the Puskesmas certified to provide Long Term Contraception Method services. Midwives were also overloaded with work during the pandemic. Obstacles in the Independent Midwifery Practice were the lack of IMP with clinical networks and the limited authority of the midwife. Meanwhile, postpartum mothers' barriers included lack of knowledge about fertility and KBPP, worry about side effects, and the husband's lack of support. Therefore, optimizing the referral mechanism for long-term contraception in advanced health facilities is necessary. Continuity of care midwives and integration of services will increase coverage of postpartum contraception.

Background: Postpartum family planning (PPFP) helps women space childbirths, increase exclusive breastfeeding and prevent unintended pregnancies, leading to reduction in maternal, infant and child morbidities and mortality. Unmet need of family planning is highest among women in the postpartum period due to lack of knowledge, cultural and religious barriers, access barriers and low antenatal care service utilization. However, in spite of low prevalence of postpartum family planning practices, birth-to-birth interval is reportedly high in Delhi, India. This study explores the postpartum contraception practices and the relationship between use of postpartum contraception and subsequent child linear growth.Methods: This is a mixed method cohort study on PPFP and is nested within an ongoing "Women and Infants Integrated Interventions for Growth Study" (WINGS). Married women aged 18-30 years who have delivered a live baby are recruited for quantitative interviews at 6 weeks, 6, 12, and 24 months postpartum. In-depth interviews are conducted with a randomly selected sub-sample of women at each of the four time points, 35 husbands and 20 local service providers to understand their perspectives on PPFP practices.Discussion: The findings from the study will provide useful insights into couples' contraception preferences and choice of contraception, modern and traditional, initiation time and the effect of birth spacing and contraception use on subsequent linear growth of the child. This knowledge will be of significant public health relevance and will help in designing appropriate interventions for appropriate postpartum contraception use and delivery strategies. The study aims to work address the Sexual and Reproductive Health and Rights goal of promoting reproductive health, voluntary and safe sexual and reproductive choices for women.Trial Registration: Trial registration number: CTRI/2020/03/023954 . [ABSTRACT FROM AUTHOR]

Abstract Background Very few postpartum women want to become pregnant within the next 2 years, but approximately 60% of postpartum women in low- and middle-income countries are not using contraceptive methods. The World Health Organization recommends that women receive postpartum family planning (PPFP) counseling during antenatal, immediate postpartum, and postnatal services. Our objective was to establish whether PPFP counseling is being provided in antenatal and postnatal care services in SNNPR, Ethiopia and whether receipt of PPFP counseling improved uptake of postpartum family planning use by 6 months postpartum. Methods Longitudinal data from the Performance Monitoring for Accountability 2020 – Maternal and Newborn Health study were used. At screening, 329 women were identified as six or more months pregnant; 307 completed the survey at 6 months postpartum. We used weighted parametric survival analysis with Weibull distribution to assess the effect of receipt of postpartum counseling in antenatal and/or postnatal care by 6 weeks postpartum on contraceptive uptake, after adjusting for intention to use family planning, wantedness of the index pregnancy, delivery location, amenorrhea, exclusive breastfeeding, residence, parity, and education. Results Coverage of PPFP counseling is low; by six-weeks postpartum only 20% of women had received counseling. Women who received counseling in postnatal care only and postnatal care and antenatal care took up contraception at significantly higher rates than women who did not receive any counseling (HR: 3.4, p

Abstract Objective The aim of this study was to assess the prevalence of postpartum modern family planning utilization and associated factors among postpartum mothers in Debre Tabor town, North West Ethiopia, 2018. Result The proportion of postpartum modern contraceptive utilization in Debre Tabor town was 63% (95% CI 59%, 67.4%). In multivariable logistic regression analysis; age of the mother (25–29) [AOR: 2.004 (95% CI 1.079, 3.722)], married women [AOR 4.804 (95% CI 1.843, 12.521)], return of menses [AOR: 3.639 (95% CI 2.454, 5.396)] and previous history of family planning [AOR: 2.409 (95% CI 1.474, 3.937)] were the factors positively associated with utilization of postpartum modern contraceptive.

Abstract Background Improved training approaches have the potential to overcome barriers to the use of postpartum intrauterine devices (PPIUDs) in Pakistan, including a shortage of female providers who are able to insert the device. This study assessed the effectiveness and acceptability of a competency-based onsite training approach that employed a newly developed anatomic model (the Mama-U) to train doctors and midwives on postpartum family planning (PPFP) and the insertion of PPIUDs. Methods An observational, mixed methods study conducted training evaluations and knowledge and skills assessments with 11 trainers and 88 doctors and midwives who participated in eight PPIUD training sessions. Two months later, follow-up interviews and clinical assessments were conducted with 20 providers, and interviews and a focus group discussion were conducted with 85 married women who received a PPIUD from a trained provider. Results The training significantly improved provider knowledge (p

Background: The use of a decision aid in clinical settings has been beneficial. It informs and educates patients about the available treatment options that can help them reduce decision-making conflicts related to feeling uninformed compared with routine care. There is a scarcity of published data about using a decision aid during family planning counseling with postpartum women focusing on long-acting reversible contraception in Tanzania. Therefore, we developed a "postpartum Green Star family planning decision aid" and assessed its feasibility. The study outcomes were practicality, usefulness, and acceptability perceived by pregnant adolescents and nurses/midwives. Methods: We used an exploratory qualitative in-depth interview involving six nurses/midwives with three or more years of experience in family planning services and 12 pregnant adolescents aged 15–19 years. Purposive sampling was used to select the participants, and selection relied on the saturation principle of data collection. We used a semi-structured interview guide translated into the Kiswahili language. Data were transcribed and analyzed following inductive content analysis. Results: The amount of information presented was just right, with the time of reading the data ranging from 20 min to 1 h. The study participants perceived the flow of information to be good, with small significant changes suggested. Kiswahili language was used and reported to be appropriate and well elaborated. However, a few words were told to be rephrased to reduce ambiguity. The nurses/midwives said that the decision aid included most of the vital information the participants wanted to know during their family planning counseling. Pregnant adolescents stated that the decision aid improved their knowledge and provided new details on the long-acting reversible contraception methods (intrauterine copper devices and implants) offered immediately after childbirth. The participants stated that the decision aid addressed long-acting reversible contraception methods' benefits and side effects and dispelled myths and misconceptions. The study participants considered the decision aid helpful in complementing the family planning counseling offered and improving pregnant adolescents' knowledge. Conclusion: The postpartum Green Star family planning decision aid was practical, useful, and acceptable in enhancing the objectivity of counseling about long-acting reversible contraception methods. It improved the knowledge of pregnant adolescents in Tanzania about the available contraception methods (i.e., the use of intrauterine copper devices and implants), which can be immediately used postpartum. Further research is needed to assess the effects of the decision aid on long-acting reversible contraception postpartum uptake among pregnant adolescents in Tanzania. Plain Language Summary: This study assessed the practicality, usefulness, and acceptability of the decision aid we developed for pregnant adolescents in Tanzania. The study was conducted at Amana District Hospital in Dar es Salaam, Tanzania. For the study participants, six nurses/midwives with three or more years of experience in family planning services and 12 pregnant adolescents aged 15–19 years were recruited for in-depth interviews using a semi-structured interview guide with five questions. Study participants felt that the decision aid written in the Kiswahili language included important information that women wanted to know during counseling about long-acting reversible contraception options. The amount of information presented was just right, with the time of reading the data ranging from 20 min to 1 h. Study participants recommended that nurses/midwives implement the decision aid to ensure comprehension of the presented information and pictures. The decision aid was perceived to help improve knowledge and address several myths and misconceptions and the benefits and side effects of each long-acting reversible contraception option. Study participants recommended several changes: the flow of information needed reorganization, and some Kiswahili words needed rephrasing to reduce ambiguity. Notably, the study participants accepted the decision aid for use in clinical settings. It contained evidence-based information useful for complimenting the family planning counseling offered, particularly for long-acting reversible contraception methods. The decision aid helped improve the objectivity of counseling regarding long-acting reversible contraception methods. It imparted valuable knowledge to pregnant adolescents in Tanzania about the contraception methods (i.e., the use of intrauterine copper devices and implants) that are immediately available after childbirth. Additional studies are needed to examine the effects of the decision aid on pregnant adolescents in Tanzania to uptake long-acting reversible contraception methods after childbirth. [ABSTRACT FROM AUTHOR]

Background: Strengthened efforts in postpartum family planning (PPFP) is a key priority to accelerate progress in reproductive, maternal, newborn, and child health outcomes. This secondary data analysis explores factors associated with PPFP uptake in Rwanda. The purpose of this study was to explore variables that may influence PPFP use for postpartum women in Rwanda including health facility type, respectful maternity care, locus of control, and mental health status.Methods: This secondary analysis of data from a cluster randomized control trial used information abstracted from questionnaires administered to women (≥ 15 years of age) at two time points-one during pregnancy (baseline) and one after delivery of the baby (follow-up). The dependent variable, PPFP uptake, was evaluated against the independent variables: respectful care, locus of control, and mental health status. These data were abstracted from linked questionnaires completed from January 2017 to February 2019. The sample size provided 97% power to detect a change at a 95% significance level with a sample size of 640 at a 15% effect size. Chi-square testing was applied for the bivariate analyses. A logistic regression model using the generalized linear model function was performed; odds ratio and adjusted (by age group and education group) odds ratio with 95% confidence interval were reported.Results: Of the 646 respondents, although 92% reported not wanting another pregnancy within the next year, 72% used PPFP. Antenatal care wait time (p =  < 0.01; Adj OR (Adj 95% CI) 21-40 min: 2.35 (1.46,3.79); 41-60 min: 1.50 (0.84,2.69); 61-450 min: 5.42 (2.86,10.75) and reporting joint healthcare decision-making between the woman and her partner (male) (p = 0.04; Adj OR (Adj 95% CI) husband/partner: 0.59 (0.35,0.97); mother and partner jointly: 1.06 (0.66,1.72) were associated with PPFP uptake.Conclusions: These results illustrate that partner (male) involvement and improved quality of maternal health services may improve PPFP utilization in Rwanda. [ABSTRACT FROM AUTHOR]

Background: Postpartum family planning (PPFP) is associated with health, social and economic benefits to a woman and her family. Its uptake, particularly of the more effective, long-acting reversible contraceptives (LARCs), is low. The role of parity in PPFP uptake is inconclusive. The aim of this study was to compare the uptake of PPFP and LARCs between primiparous and multiparous women accompanying their children for the first measles vaccine, which is at 9 months after delivery, in Webuye County Hospital, Kenya. Methods: This was a cross-sectional study. Study participants were recruited using a systematic random sampling method and data were collected using a pretested, structured, interviewer-administered questionnaire. The collected data were analysed using an independent t-test to compare PPFP uptake between primiparous and multiparous women, whereas chi-square tests (for categorical data) and independent t-tests (for numerical data) were used to compare the various socio-demographic characteristics and occurrence of various predictors of PPFP uptake between the two groups of postpartum women. Factors that were significantly different between the two groups were controlled for using logistic regression. Results: There was a significant difference on PPFP uptake (22.0%; 95% CI: 11.8–32.3; p 0.001), but none on LARC use (OR = 0.88; 95% CI: 0.46–1.66) between the two groups of women. The unadjusted and adjusted OR for the effect of parity on FP uptake was 3.48 (95% CI: 1.88–6.42) and 2.32 (95% CI: 1.15–4.67), respectively. Conclusion: There is a significant difference in the uptake of PPFP, but not LARCs, between primiparous women and multiparous women accompanying their children for the 9-month measles vaccine in Webuye County Hospital. Primiparous women are less likely to initiate the use of PPFP compared to their multiparous counterparts.

Abstract Background Health service providers play a key role in addressing women’s need for pregnancy prevention, especially during the postpartum period. Yet, in Nepal, little is known about their views on providing postpartum family planning (PPFP) services and postpartum contraceptive methods such as immediate postpartum intra-uterine devices (PPIUD). This paper explores the perspectives of different types of providers on PPFP including PPIUD, their confidence in providing PPFP services, and their willingness to share their knowledge and skills with colleagues after receiving PPFP and PPIUD training. Methods In-depth interviews were conducted with 14 obstetricians/gynecologists and nurses from six tertiary level public hospitals in Nepal after they received PPFP and PPIUD training as part of an intervention aimed at integrating PPFP counseling and insertion into routine maternity care services. The interviews were audio recorded, transcribed, and analyzed using a thematic approach. Results Providers identified several advantages of PPFP, supported the provision of such services, and were willing to transfer their newly acquired skills to colleagues in other facilities who had not received PPFP and PPIUD training. However, many providers identified several supply-side and training-related barriers to providing high quality PPFP services, such as, (i) lack of adequate human resources, particularly a FP counselor; (ii) work overload; (iii) lack of private space for counseling; (iv) lack of IUDs and information, education and counseling materials; and (v) lack of support from hospital management. Conclusions Providers appeared to be motivated to deliver quality PPFP services and transfer their knowledge to colleagues but identified several barriers which prevented them from doing so. Future efforts to improve provision of quality PPFP services should address the barriers identified by providers.

Abstract Background The postpartum intrauterine contraceptive devices (PPIUCD) is the only family planning method for couples requesting highly effective, reliable, inexpensive, non-hormonal, immediately reversible, and long-acting contraceptive that can be initiated during the immediate postpartum period and it has no a negative effect on lactation. Despite these benefit, the acceptance and utilization of immediate PPIUCD were very low and the reasons for rejecting immediate PPIUCD usage have not been characterized in Southeast Ethiopia. Therefore, this study determined the level of acceptability and factors associated with immediate PPIUCD use among women who gave birth at Bale zone health facilities, Southeast Ethiopia. Methods A facility based cross-sectional study was conducted from March to July 2017 in Bale zone health facilities. Four hundred twenty-nine women were successfully interviewed using structured and pre-tested questionnaire. Health facilities were selected by lottery method. Study participants were selected systematically. Data were entered into Epi data version 3.1 and exported into SPSS version 21 for analysis. Logistic regression analyses were done. A significant association was declared at a p-value less than 0.05. Results The acceptance of immediate PPIUCD usage was 12.4%. Non-acceptors reported their reasons for rejecting PPIUCD use; concern and fears of complications (24.8%), religious beliefs (19.8%), and husband refusal (17.7%). Respondents who had completed secondary education were more likely to accept PPIUCD usage than those who had no formal education (AOR = 3, CI = 11.81, 53.91). In addition, the odds of accepting PPIUCD insertion was higher among women who attended 3 antenatal care visits than those who did not attend antenatal care visits for the current birth (AOR = 1.81, CI = 0.34, 0.85). Conclusions The acceptance of immediate PPIUCD usage was still low. This might be attributed to the low achievement of education, perceived concern and fears of complications towards IUCD insertion. The male partner’s refusal and religious beliefs also have a role in the usage of postpartum IUCD. Due attention should be given to enhancing educational level of women and effective IUCDs counseling should be given during antenatal care visits to correct misconceptions and fears of complication about PPIUCD insertion.

Abstract Background The YAM DAABO study (“your choice” in Mooré) takes place in Burkina Faso and the Democratic Republic of Congo. It has the objective to identify a package of postpartum family planning (PPFP) interventions to strengthen primary healthcare services and determine its effectiveness on contraceptive uptake during the first year postpartum. This article presents the process of identifying the PPFP interventions and its detailed contents. Methods Based on participatory action research principles, we adopted an inclusive process with two complementary approaches: a bottom-up formative approach and a circular reflective approach, both of which involved a wide range of stakeholders. For the bottom-up component, we worked in each country in three formative sites and used qualitative methods to identify barriers and catalysts to PPFP uptake. The results informed the package design which occurred during the circular reflective approach – a research workshop gathering service providers, members of both country research teams, and the WHO coordination team. Results As barriers and catalysts were found to be similar in both countries and with the view to scaling up our strategy to other comparable settings, we identified a common package of six low-cost, low-technology, and easily-scalable interventions that addressed the main service delivery obstacles related to PPFP: (1) refresher training of service providers, (2) regularly scheduled and strengthened supportive supervision of service providers, (3) enhanced availability of services 7 days a week, (4) a counseling tool, (5) appointment cards for women, and (6) invitation letters for partners. Conclusions Our research strategy assumes that postpartum contraceptive uptake can be increased by supporting providers, enhancing the availability of services, and engaging women and their partners. The package does not promote any modern contraceptive method over another but prioritizes the importance of women’s right to information and choice regarding postpartum fertility options. The effectiveness of the package will be studied in the experimental phase. If found to be effective, this intervention package may be relevant to and scalable in other parts of Burkina Faso and the DRC, and possibly other Sub-Saharan countries. Trial registration Retrospectively registered in the Pan African Clinical Trials Registry (PACTR201609001784334, 27 September 2016).

Abstract Background Postpartum family planning (PPFP) information and services can prevent maternal and child morbidity and mortality in low-resource countries, where high unmet need for PPFP remains despite opportunities offered by routine postnatal care visits. This study aims to identify a package of PPFP interventions and determine its effectiveness on the uptake of contraceptive methods during the first year postpartum. We hypothesize that implementing a PPFP intervention package that is designed to strengthen existing antenatal and postnatal care services will result in an increase in contraceptive use. Methods This is an operational research project using a complex intervention design with three interacting phases. The pre-formative phase aims to map study sites to establish a sampling frame. The formative phase employs a participatory approach using qualitative methodology to identify barriers and catalysts to PPFP uptake to inform the design of a PPFP intervention package. The intervention phase applies a cluster randomized-controlled trial design based at the primary healthcare level, with the experimental group implementing the PPFP package, and the control group implementing usual care. The primary outcome is modern contraceptive method uptake at twelve months postpartum. Qualitative research is embedded in the intervention phase to understand the operational reasons for success or failure of PPFP services. Discussion Designing, testing, and scaling-up effective, affordable, and sustainable health interventions in low-resource countries is critical to address the high unmet need for PPFP. Due to socio-cultural complexities surrounding contraceptive use, this research assumes that this is more effectively accomplished by engaging key stakeholders, including adolescents, women, men, key community members, service providers, and policy-makers. At the individual level, knowledge, attitudes, and behaviors of women and couples toward PPFP will likely be influenced by a set of low-cost interventions. At the health service delivery level, the implementation of this trial will probably require a shift in behavior and accountability of providers regarding the systematic integration of PPFP into their clinical practice, as well as the optimization of health service organization to ensure the availability of competent staff and contraceptive supplies. Trial registration Retrospectively registered in the Pan African Clinical Trials Registry (PACTR201609001784334, 27 September 2016).

Background: Health service providers play a key role in addressing women's need for postpartum pregnancy prevention. Yet, in Nepal, little is known about providers' knowledge, attitudes, and practice (KAP) on providing postpartum family planning (PPFP), particularly the immediate postpartum intrauterine device (PPIUD). This paper assesses providers KAP towards the provision of PPIUDs in Nepal prior to a PPIUD intervention to gain a baseline insight and analyzes whether their KAP changes both 6 and 24 months after the start of the intervention. Methods: Data come from a randomized trial assessing the impact of a PPIUD intervention in Nepal between 2015 and 2017. We interviewed 96 providers working in six study hospitals who completed a baseline interview and follow-up interviews at 6 and 24 months. We used descriptive analysis, McNemar's test and the Wilcoxon signed-rank test to assess KAP of providers over 2 years. Results: The PPIUD KAP scores improved significantly between the baseline and 6-month follow-up. Knowledge scores increased from 2.9 out of 4 to 3.5, attitude scores increased from 4 out of 7 to 5.3, and practice scores increased from 0.9 out of 3 to 2.8. There was a significant increase in positive attitude and practice between 6 and 24 months. Knowledge on a women's chance of getting pregnant while using an IUD was poor. Attitudes on recommending a PPIUD to different women significantly improved, however, attitudes towards recommending a PPIUD to unmarried women and women who have had an ectopic pregnancy improved the least. Practice of PPIUD counseling and insertion improved significantly from baseline to 24 months, from 10.4 and 9.4% to 99% respectively. Conclusions: Although KAP improved significantly among providers during the PPIUD intervention, providers' knowledge on a women's chance of getting pregnant while using an IUD and attitudes towards recommending a PPIUD to unmarried women and women who have had an ectopic pregnancy improved the least. Provider KAP could be improved further through ongoing and more in-depth training to maintain providers' knowledge, reduce provider bias and misconceptions about PPIUD eligibility, and to ensure providers understand the importance of birth spacing. [ABSTRACT FROM AUTHOR]

Objectives: To compare the coverage of immediate and early postpartum family planning to extended postpartum family planning. To analyze the socio demographic barriers for adopting immediate and early postpartum family planning methods. To identify the missed opportunities for immediate and early postpartum family planning. Study Design: Community Based Comparative Cross Sectional study. Setting: Tando Jam and Hali Road Hyderabad, Sindh. Period: Three months from 01-07-2017 to 30-09-2017. Material & Methods: Three Hundred females of reproductive age (15 to 49 years) during immediate, early and extended postpartum period residing in study area were selected through Purposive Sampling Technique. A pre-designed questionnaire was used as a data collection tool. The data was analyzed using SPSS version 16. The participants were inquired about the usage and concerns towards immediate and early post-partum family planning methods. Barriers and opportunities were identified. The association between various socio-demographic variables and family planning method was determined by applying Chi-square test at ≤0.05 level of significance. Results: Highest number of the study participants were practicing extended method of post-partum family planning i.e. 223(74.33%), only 65(21.67%) had adopted early PPFP and 12 (4%) were practicing immediate post-partum family planning. Low socio-economic status, low literacy rate of both partner, young age of women, and permission from husband, fear of health problem due to contraception and previous bad experience with contraceptive methods were identified barriers towards family planning adoption. Deliveries in homes or in maternity home, facilitated by Dais, not going through ante-natal checkups and not bringing the last born for vaccination were reported with non-adoption of immediate post-partum family planning. Conclusion: The coverage of immediate and early postpartum family planning is very low in the community so the barriers and opportunities identified should be addressed to overcome the hindrances. [ABSTRACT FROM AUTHOR]

Background: Postpartum family planning (PPFP) is associated with health, social and economic benefits to a woman and her family. Its uptake, particularly of the more effective, long-acting reversible contraceptives (LARCs), is low. The role of parity in PPFP uptake is inconclusive. The aim of this study was to compare the uptake of PPFP and LARCs between primiparous and multiparous women accompanying their children for the first measles vaccine, which is at 9 months after delivery, in Webuye County Hospital, Kenya. Methods: This was a cross-sectional study. Study participants were recruited using a systematic random sampling method and data were collected using a pretested, structured, interviewer-administered questionnaire. The collected data were analysed using an independent t-test to compare PPFP uptake between primiparous and multiparous women, whereas chi-square tests (for categorical data) and independent t-tests (for numerical data) were used to compare the various socio-demographic characteristics and occurrence of various predictors of PPFP uptake between the two groups of postpartum women. Factors that were significantly different between the two groups were controlled for using logistic regression. Results: There was a significant difference on PPFP uptake (22.0%; 95% CI: 11.8-32.3; p < 0.001), but none on LARC use (OR = 0.88; 95% CI: 0.46-1.66) between the two groups of women. The unadjusted and adjusted OR for the effect of parity on FP uptake was 3.48 (95% CI: 1.88-6.42) and 2.32 (95% CI: 1.15-4.67), respectively. Conclusion: There is a significant difference in the uptake of PPFP, but not LARCs, between primiparous women and multiparous women accompanying their children for the 9-month measles vaccine in Webuye County Hospital. Primiparous women are less likely to initiate the use of PPFP compared to their multiparous counterparts. [ABSTRACT FROM AUTHOR]

Objective: There is high unmet need for family planning in the postpartum period in Nepal. The current study assessed the effects of a contraceptive counseling and postpartum intrauterine device (PPIUD) insertion intervention on use of contraception in the postpartum period.Study Design: We utilized a cluster, stepped-wedge design to randomly assign two hospital clusters (compromised of six hospitals) to begin the intervention at time one or time two. From 2015 to 2017, women completed surveys after delivery but before discharge (n = 75,893), and then at one year and two years postpartum. We estimated the intent-to-treat effect of the intervention using weighted, linear probability models and the adherence-adjusted effect (antenatal counseling) using an instrumental variable approach. Outcomes included modern contraceptive use and method mix measured at one and two years postpartum in a sample of 19,298 women (year I follow-up sample) and a sample of 19,248 women (year II follow-up sample). We used inverse probability weights to adjust for incomplete follow-up and bootstrap methods to give correct causal inference with the small number of six clusters.Results: The intervention increased use of modern contraceptives by 3.8 percentage points [95% CI: -0.1, 9.5] at one-year postpartum, but only 0.3 percentage points [95% CI: -3.7, 4.1] at two years. The intervention significantly increased the use of PPIUDs at one year and two years postpartum, but there was less use of sterilization. Only 42% of women were counseled during the intervention period. The adherence-adjusted effects (antenatal counseling) were four times larger than the intent-to-treat effects.Conclusions: Providing counseling during the antenatal period and PPIUD services in hospitals increased use of PPIUDs in the one- and two-year postpartum period and shifted the contraceptive method mix.Implications: In order for antenatal counseling to increase postpartum contraceptive use, counseling may need to be provided in a wider range of prenatal care settings and at multiple time points. Healthcare providers should be trained on contraceptive counseling and PPIUD insertion, with the goal of expanding the available method mix and meeting postpartum women's contraceptive needs. [ABSTRACT FROM AUTHOR]

Unintended pregnancy is a global issue, with approximately 85,000,000 women around the world having unintended pregnancy annually. The contents of clinical application of women's contraceptive methods are very wide, involving multiple areas. This consensus deeply discusses the specific contraceptive needs at different statuses, combined with gynecological diseases, postabortion contraception, and postpartum family planning, ensuring the correct use of contraceptive methods under the corresponding status. The top priority of the consensus is the specific contraception consensus section for women combined with gynecological diseases because medical treatment effect as well as side effects should be weighed carefully. The consensus is to make high-efficiency and individual contraceptive strategy for different groups based on multidisciplinary (gynecology, obstetrics, and family planning) and multidimensional aspects, which can provide uniform guidance for medical and health organizations under the condition as relevant global guidance or consensus is still lacking.

Postpartum contraception has some ambiguities in terms of its definition and period. The purpose of this concept analysis is to clarify postpartum contraception in terms of its attributes, antecedents, consequences and empirical referents. This can be used in the development of a model for care that promotes the use of postpartum contraception Walker and Avant's (2011) traditional method of concept analysis was used here. A theoretical definition of postpartum contraception was formulated and six defining attributes of postpartum contraception were identified through the process of induction. The antecedents and consequences of postpartum contraception are presented Defining postpartum contraception helps highlight important elements that can be applied in client care in order to improve maternal and neonatal outcomes. Further insights to this concept are required for the development of a model, which can be used to improve midwifery practice and maternal and neonatal health. [ABSTRACT FROM AUTHOR]

Objective: To explore the perceptions of key stakeholders on different modalities of training and mentoring activities for healthcare providers of postpartum family planning and postpartum intrauterine devices (PPFP/PPIUD).Methods: In this qualitative study, data were collected from 40 participants in December 2017 via focus group discussions (FGD) and in-depth interviews (IDI) in three hospitals implementing PPFP/PPIUD services and government line agencies in Nepal. Data were analyzed through content analysis and grouped into themes and categories.Results: The majority of participants reported that PPFP/PPIUD training and mentoring was useful and contributed to their professional development. Most found that on-the-job training (OJT) was more effective than group-based training (GBT).Conclusion: Training and mentoring activities were perceived to be useful by health providers and OJT was the approach preferred by the majority. Further studies are necessary to explore the existing challenges and long-term effects of each modality of training and mentoring on health providers' competency and attitudes and on the uptake of PPIUD by postpartum mothers. [ABSTRACT FROM AUTHOR]

Objectives: Postpartum family planning (PPFP) is essential for maternal and newborn health but is often not systematically addressed before or after childbirth. This article describes the development and field-testing of a PPFP counseling tool to support providers and women.Methods: Participatory action research involving women, men, providers, policymakers, researchers, and contraceptive experts from Burkina Faso and the Democratic Republic of Congo.Results: The tool consists of an A4-size flipchart with illustrations on the client side and clinical information and counseling tips on the provider side, and can be used during visits of the antenatal-delivery-postnatal care continuum. Qualitative results suggest that the tool is easily understandable, user-friendly, relevant, and useful with regard to providing PPFP information to clients, and respectful of clients' rights and choices. It may have a positive influence on clients' attitudes towards PPFP and their decision to use contraception.Conclusions: The tool holds promise in guiding a systematic discussion on birth spacing options among providers and clients. Its impact on contraceptive uptake requires further research.Practice Implications: If proven effective, the tool could be disseminated to Ministries of Health and local, regional, and global partners to strengthen national family planning and maternal and child health strategies in low-resource countries. [ABSTRACT FROM AUTHOR]