Effect of integrating maternal health services and family planning services on postpartum family planning behavior in Ethiopia: results from a longitudinal survey.

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 < .01 and HR: 2.5, p = .01, respectively). There was no difference between women who received PPFP counseling only in ANC and women who did not receive counseling at all. Women who did not want the child at all took up contraception at significantly lower rates than women who wanted the child at that time (HR: 0.3, p = .04). Women who had four or more children took up contraception at significantly lower rates than woman with 1-3 children (HR: 0.3, p = .01). There were no significant differences by delivery location, exclusive breastfeeding, residence, or education. CONCLUSION: Integration of postpartum family planning counseling into postnatal care services is an effective means to increase postpartum contraceptive uptake, but significant gaps in coverage, particularly in the delivery and postnatal period, remain.

INSTITUTIONAL DELIVERY SERVICES UTILIZATION BY WOMEN OF CHILDBEARING AGE IN SOUTH WEST SHOWA ZONE, OROMIA REGION.

Introduction: Institutional delivery is very low in Ethiopia, particularly in Oromia where less than one-third of antenatal care attendees utilize the services. This study assessed the magnitude of institutional delivery and associated factors in South West Showa Zone of Oromia. Methods: A cross-sectional community based study was conducted in 2010. A stratified cluster sampling technique used to select study districts, villages and households. Four hundred thirty childbearing women with at least one birth in the past 5 years preceding the survey were interviewed. Qualitative study method was employed to supplement the quantitative data. Data analyses were done using SPSS v15. Frequency tables and percentages were used to describe study population. Association of independent variables with outcome variable was measured using odds ratio with 95% confidence interval. Multivariate logistic regression analysis was run to control for confounding variables. Results: Eighty percent (344) respondents were from rural. Mean age of the women was 28.8 (±6.6). Most (70.5%) respondents and 39% of their husbands were uneducated. A quarter of them delivered at health institutions over five years preceding the survey. In a regression model with maternal age, residence, maternal and paternal education, all were significantly associated with use of institutional delivery services. Obstetric factors have also showed a statistically significant association. The qualitative findings revealed that trust in traditional birth attendants and health workers' negative attitude were among the reasons for not delivering at health institutions. Conclusion: Institutional delivery service utilization in the zone is affected by maternal and paternal education, ANC attendance and duration of labor. Traditional beliefs and health workers' negative attitude were among the identified barriers. Multiple interventions involving community, service providers and health system are recommended.

Institutional delivery services utilization by women of childbearing age in south west Showa zone, Oromia region

Introduction: Institutional delivery is very low in Ethiopia, particularly in Oromia where less than one-third of antenatal care attendees utilize the services. This study assessed the magnitude of institutional delivery and associated factors in South West Showa Zone of Oromia.Methods: A cross-sectional community based study was conducted in 2010. A stratified cluster sampling technique used to select study districts, villages and households. Four hundred thirty childbearing women with at least one birth in the past 5 years preceding the survey were interviewed. Qualitative study method was employed to supplement the quantitative data. Data analyses were done using SPSS v15. Frequency tables and percentages were used to describe study population. Association of independent variables with outcome variable was measured using odds ratio with 95% confidence interval. Multivariate logistic regression analysis was run to control for confounding variables. Results: Eighty percent (344) respondents were from rural. Mean age of the women was 28.8 (±6.6). Most (70.5%) respondents and 39% of their husbands were uneducated. A quarter of them delivered at health institutions over five years preceding the survey. In a regression model with maternal age, residence, maternal and paternal education, all were significantly associated with use of institutional delivery services. Obstetric factors have also showed a statistically significant association. The qualitative findings revealed that trust in traditional birth attendants and health workers' negative attitude were among the reasons for not delivering at health institutions. Conclusion: Institutional delivery service utilization in the zone is affected by maternal and paternal education, ANC attendance and duration of labor. Traditional beliefs and health workers' negative attitude were among the identified barriers. Multiple interventions involving community, service providers and health system are recommended