Missed Opportunities for Family Planning Counseling Among Postpartum Women in Eleven Counties in Kenya | BMC Public Health

From 2014 to 2018, a total of 34,832 women aged 15 to 49 were interviewed. The response rate was between 97.0 and 99.0% for all streams. Table 1 presents the socio-demographic characteristics of all the women who took part in the PMA surveys as well as the women 0-11 and 12-23 months after childbirth. Overall, the majority (58.4%) of respondents were between the ages of 15 and 29. About a third (31.9%) had never been married, 64.6% came from rural areas while 4.3% had no formal education. About a third of respondents had one to two children (33.6%) and the majority were sexually active (58.0%). About one-third of respondents belonged to the top (top/top) wealth quintile (37.9%) (Table 1). Of the 34,832 women who participated in the seven rounds of PMA2020 data collection, 3,803 (10.9%) and 3,746 (10.8%) were 0-11 months and 12-23 months post-treatment, respectively. childbirth. Among women 0-11 months and 12-23 months postpartum, the majority were between 20 and 24 years old, married or in union, came from a rural residence, had a primary education, belonged to the lowest wealth quintile, had one or two previous births, were sexually active and resided in Nairobi County.

Table 1 Socio-demographic characteristics of all women, women 0-11 and 12-23 months after childbirth

Among women 0-11 months and 12-23 months postpartum, 0.5% and 4.6%, respectively, were pregnant at the time of the survey (Table 2). Among women within 2 years of giving birth, 69.1% were sexually active at the time of the survey (Table 2). Of all pregnancies at the time of the survey, 23.8 and 57.4% among women 0–11 months and 12–23 months postpartum, respectively, were unintended (intended later or not at all). Among sexually active women, 38.8 and 39.6% of those who had between 0 and 11 months postpartum and between 12 and 23 months postpartum respectively had a previous unwanted pregnancy. About 2.1% of sexually active women in the 12-month postpartum period and 3.8% of sexually active women 12-23 months postpartum expressed a desire to have another pregnancy within 2 years (Table 2).

Table 2 Pregnancy risk and fertility desire among 24,968 women who have already given birth

Figure 1 and Supplementary Materials Table 1 presents missed opportunities for FP/C counseling, contraceptive use, and unmet need for family planning among women over the period 0-11 months and 12-23 months after childbirth. Missed opportunities for FP/C counseling increased with increasing time after delivery, from 46.8% between 0 and 5 months to 53.2% between 12 and 23 months after delivery (at both at the facility level and at the community level). The overall missed opportunity for FP/C counseling among women 12 to 23 months postpartum (53.2%) was significantly higher than among women in the extended postpartum period (47.7%). p = 0.001. At health facilities, approximately 37.0, 41.4, and 44.7 percent of women 0-5 months, 6-11 months, and 12-23 months postpartum, respectively, had missed an opportunity for FP/ vs. Missed opportunities for FP/C counseling at health facilities among women 12–23 months postpartum (44.7%) were significantly higher than among women in the prolonged postpartum period (39.2 %). p= 0.003. Family planning/contraception use increases with increasing time after childbirth, while unmet need for FP/C decreases with increasing time after childbirth. Total demand for FP/C also increased with increasing postpartum duration, Fig. 1.

Fig. 1

Missed opportunity, family planning/modern contraceptive (FP/C) use and unmet need for family planning

Table 3 shows a bivariate analysis of current FP/C use and intention of last pregnancy among sexually active women. There is no significant association between overall missed opportunity for FP/C counseling and modern contraceptive use among sexually active women during the prolonged postpartum period. P> 0.05. In contrast, among women in the 12 to 23 month postpartum period, there was a significant association between overall missed opportunity for FP/C counseling and modern contraceptive use among sexually active women. , p= 0.007. Missed opportunities for FP/E counseling were not significantly associated with unplanned last delivery among women in the extended postpartum period (p= 0.753) and in women 12 to 23 months postpartum (p= 0.179). Similarly, unmet need for FP/C counseling was not significantly associated with missed opportunity for FP/C counseling among women in the prolonged postpartum period (p= 0.411) and in women 12 to 23 months postpartum (p= 0.120).

Table 3 Association between missed opportunity, FP/C use, intention of last pregnancy and unmet need

The results of the univariate and multivariate analysis of the correlates of overall missed opportunity for FP/C counseling among women 0 to 11 and 12 to 23 months postpartum are presented in Table 4. Bivariate analysis showed that rural/urban residence, education, wealth, parity, data collection cycle, and country of residence were all significant predictors of overall missed opportunity for FP/C counseling among women during the prolonged postpartum period, pp= 0.032. Those with some level of formal education were less likely to have a missed opportunity for FP/C counseling, compared to the control group of uneducated women. Women from the highest wealth quintiles were less likely to have a missed opportunity for FP/C counseling compared to the comparison group of women from the lowest wealth quintile. Those with 3 to 4 previous births were less likely to have missed an opportunity for FP/C consultation compared to the reference group of women with one or two previous births. Women in Kericho, Nandi, and West Pokot counties were more likely to have a missed opportunity for FP/C counseling compared to women in Bungoma County, Table 4.

Table 4 Bivariate and multivariate analysis of all missed FP/C opportunities (facility and community health worker) among women in postpartum periods from 0 to 11 months and from 12 to 23 months

As in the bivariate analysis, age, marital status, and sexual activity remained non-significant predictors of missed opportunity for FP/C counseling in the adjusted analysis. After controlling for all statistically significant variables in the bivariate analysis in Table 4, rural/urban residence and education were no longer significant predictors of missed opportunities for FM/C counseling. The likelihood of having a missed opportunity for FP/C counseling was almost twice among those with no education compared to those with tertiary education (AOR = 1.96, p= 0.006). Within wealth quintile categories, the only significant result was that women in the bottom quintile were less likely (AOR = 0.72, p= 0.005) of having a missed opportunity for FP/C counseling compared to women in the lowest wealth quintile. Women with three to four previous births were less likely to have missed a FP/C consultation opportunity (ORA: 0.73, 95% CI: 0.58, 0.92, p= 0.009) compared to the reference group of women who had one or two previous deliveries. By county of residence, women in Kericho, Nandi, and West Pokot counties were more likely to have a missed opportunity for FP/C counseling compared to women in Bungoma County, pp

The results of bivariate and multivariate analyzes for missed FP/C opportunities at the facility are shown in Table 5. Parity, data collection cycle, and county of residence were the significant covariates for missed FP counseling opportunities. /C in the establishment among the women of the establishment. prolonged postpartum period. Women with three to four previous births (adjusted OR: 0.71, p= 0.009) were less likely to have missed an opportunity for FP/C consultation at the facility than women with one or two previous deliveries. By county of residence, women in Kericho, Nandi, and West Pokot counties were 2–3 times more likely to have a missed opportunity for FP/C counseling at the facility than women in Bungoma County, ppp

Table 5 Bivariate and multivariate analysis of missed opportunities for FP/C in the facility among women in the postpartum periods of 0 to 11 months and 12 to 23 months

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