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Background: There is a high unmet need for limiting and spacing child births during the postpartum period. Given the consequences of closely spaced births, and the benefits of longer pregnancy intervals, targeted activities are needed to reach this population of postpartum women. Our objective was to establish the determinants of contraceptive uptake among postpartum women in a county referral hospital in rural Kenya. Methods: Sample was taken based on a mixed method approach that included both quantitative and qualitative methods of data collection. Postpartum women who had brought their children for the second dose of measles vaccine between 18 and 24 months were sampled Participants were interviewed using structured questionnaires, data was collected about their socio-demographic characteristics, fertility, knowledge, use, and access to contraceptives. Chi square tests were used to determine the relationship between uptake of postpartum family planning and: socio demographic characteristics, contraceptive knowledge, use access and fertility. Qualitative data collection included focus group discussions (FDGs) with mothers and in-depth interviews with service providers Information was obtained from mothers’ regarding their perceptions on family planning methods, use, availability, access and barriers to uptake and key informants’ views on family planning counseling practices and barriers to uptake of family planning Results: More than three quarters (86.3%) of women used contraceptives within 1 year of delivery, with government facilities being the most common source. There was a significant association (p ≤ 0.05) between uptake of postpartum family planning and lower age, being married, higher education level, being employed and getting contraceptives at a health facility. One third of women expressing no intention of having additional children were not on contraceptives. In focus group discussions women perceived that the quality of services offered at the public facilities was relatively good because they felt that they were adequately counseled, as opposed to local chemist shops where they perceived the staff was not experienced. Conclusion: Contraceptive uptake was high among postpartum women, who desired to procure contraceptives at health facilities. However, there was unmet need for contraceptives among women who desired no more children. Government health facility stock outs represent a missed opportunity to get family planning methods, especially long acting reversible contraceptives, to postpartum women.
This cross sectional study was conducted at maternal and child health clinics at Kisii level 5 hospital. This hospital is the largest government owned facility in the county of approximately 1.2 million population residing in the following 9 sub counties Kitutu Chache North, Kitutu Chache South, Nyaribari Masaba, Nyaribari Chache, Bomachoge Borabu, Bomachoge Chache, Bobasi, South Mugirango and Bonchari. The respondents were randomly selected from the clinic. Structured questionnaires were used to collect quantitative data and focus group discussions and in-depth interviews to gather qualitative data. Between April and May 2015, we recruited 365 mothers who had brought their children aged between 18 and 24 months for the second dose of measles vaccine at the maternal and child health clinics. Mothers whose children were aged below 12 months and more than 24 months were excluded from the study. Family planning clinic staff were also recruited for key informant interviews. At enrollment, we administered coded questionnaires to mothers, and collected information on maternal socio-demographic characteristics, knowledge (type of family planning known to the mothers), use (type of family planning used during postpartum period) and access (sources of contraceptives) to selected contraceptive methods (see Additional file 1). Mothers self-reported their contraceptive use. We defined postpartum family planning as being the uptake of modern contraceptives within a year of delivery. Research Assistants purposively recruited a subset of 20 participants who met the study criteria to participate in FGDs (see Additional file 2). We conducted two FGDs with each FGD having 10 mothers. Each FGD lasted between 45 and 60 min. Demographic characteristics of mothers who participated in the FGDs were captured. The FGD guide focused on mothers’ perceptions of FP methods, use, availability, access and barriers to uptake. Three KII were purposively recruited but one declined. The interviews were based on a discussion guide that covered availability of contraceptives, training and staffing of service providers, barrier and general uptake of family planning (see Additional file 3). Both key informant interviews (KII) and FGDs were moderated by the principal investigator, with the help of a research assistant who took notes and kept time. The KIIs were conducted in English while FDGs were conducted in both Swahili and English and the conversations were digitally recorded. Descriptive Statistics as percentages for the categorical variables are shown for selected predictors. (Table (Table1)1) Bivariate analysis were performed to examine the relationship between PPFP and the selected predictors. We used chi square tests to evaluate the relationship between the dependent variable (uptake of postpartum family planning) and the key independent variables (contraceptive knowledge, use, access and fertility). P value <0.05 was considered to be statistically significant. The tape recorded discussions and interviews were transcribed and translated into English. Manual content analysis was carried out and aligned to the main study themes. The relevant quotes have been highlighted in the text to illustrate the major findings. Socio-demographic characteristics of postpartum women
