Factors associated with the intention to adopt postpartum family planning among pregnant women in Lagos State, Nigeria

Background/Objectives:

Postpartum women are often among those with the highest unmet need for family planning even though the period of pregnancy up till about 12 months after delivery is one of the times in a woman's life where she is in constant contact with health providers. Understanding the elements that encourage early postpartum family planning (PPFP) adoption is critical to making these opportunities with women worthwhile. To support the design of high-quality interventions that promote PPFP, this study identifies factors associated with the future intention of pregnant women in Lagos State to use modern contraception within three months after delivery.

Description Of Intervention And/or Methods/Design:

Data from the 2018 baseline survey of the Nigerian Urban Reproductive Health longitudinal study of 714 pregnant women in Lagos was used for this analysis. Multivariable logistic regression was used to predict variables associated with the intention to use a modern family planning (FP) method within three months after delivery. The framework for this analysis is the ideation model (Kincaid 2000:216). The following variables were included in the model: Socio-demographic characteristics: Age, educational level, religion, and parity; Ideational variables: Awareness of modern contraceptive methods, self-efficacy related to FP, rejection of misconceptions about FP, perceptions about FP providers and of contraceptive use, beliefs and attitudes related to FP, spousal discussions about and approval of FP, perceived norms related to PPFP, future fertility preferences, and perceived social support; Prior use of, and need for permission to use contraception; and exposure to FP information in the media and through health workers

Results/Lessons Learned:

Overall, about 78.3% of the 714 pregnant women interviewed cited the intention to use a method of contraception after delivery. However, only about a third (27.2%) of these women intended to start a modern form of contraception within three months after delivery. The other two-thirds either intended to adopt a modern method more than three months after delivery (32.4%) or intended to use non-modern methods of contraception (32.9%). High self-efficacy for contraceptive use (OR 2.04; p=0.001), belief in the safety of long-acting reversible contraceptives (LARC) in the immediate postpartum period (OR 2.03; p=0.001), rejection of misconceptions about contraceptive use (OR 1.74; p=0.008), prior use of a modern FP method (OR 1.75; p=0.014), and talking with health worker about modern contraceptive use within six weeks of delivery (OR 1.52; p=0.045) were the strongest predictors of the intention to adopt modern PPFP within three months after delivery

Discussion/Implications For The Field:

Early adoption of PPFP is a proven high impact practice that should be encouraged among pregnant women. This study, guided by the ideation model, expands the body of knowledge about factors that drive early adoption of PPFP. Results suggest that effective PPFP programming should prioritize social behavior change communication activities that promote women's contraceptive self-efficacy, knowledge about the safety LARCs in the immediate postpartum period, and dispel myths about family planning. Findings from this study also underscore the role of antenatal and postnatal care providers in demand generation for the early adoption of modern methods of PPFP

Abstract submitted by: 

Olamide Oyenubi - JHU

Stella Babalola - JHU