Postpartum family planning uptake in Uganda: findings from the lot quality assurance sampling survey.

BACKGROUND: The initiation and use of family planning (FP) services within the first 12 months following childbirth, postpartum family planning (PPFP), promotes safe motherhood by reducing unintended pregnancies and ensuring appropriate pregnancy spacing. However, there is a paucity of information on PPFP uptake from community surveys. This study aimed to quantify the reported use of PPFP and identify predictors and barriers to PPFP uptake from a large community survey. METHODS: We analysed data collected from the 2021 Lot Quality Assurance Sampling (LQAS) survey, a cross-sectional community and household survey that covered 68 districts in Uganda. The survey uses small sample sizes to designate health or administrative geographical areas which are assessed to determine whether they achieved the pre-determined target for defined indicators of interest. We abstracted and analysed data collected from mothers of children aged 12 months or younger on reproductive health and FP. PPFP use was defined as the reported use of modern FP by the mother or their partner. Associations were measured using Pearson's chi-square test at 5% significance. Multivariate logistic regression was performed for variables that were significantly associated with PPFP use to identify the predictors of PPFP. RESULTS: Overall, 8103 mothers of children aged less than 12 years were included in the analysis; the majority of mothers, 55.8% (4521/8103) were above 24 years while 11.7% (950/8103) were 19 years and under. 98% (7942/8103) of the mothers attended at least one antenatal care (ANC) visit and 86.3% (6997/8103) delivered at a health facility. Only 10% (814/8103) of mothers who participated in the survey reported PPFP use at the time of the survey. Reporting of PPFP use was 5 times higher among mothers of children aged 7-12 months (AOR 4.9; 95%CI 4.1-5.8), 50% higher among mothers with secondary education (AOR 1.5; 95%CI 1.0-2.3), 80% higher among breastfeeding mothers (AOR 1.8; 95%CI 1.3-2.4) and 30% lower among those that didn't receive a health worker visit within 3 months preceding the survey (AOR 0.7; 95% CI 0.5-0.8). Among 4.6% (372/8103) who stated a reason for non-use of PPFP, the most cited reasons for not using were breastfeeding 43% (161/372), fear of side effects 26.9% (100/372), respondent/partner opposition 17.6% (48/372) and infrequent sex 12.1% (48/372). CONCLUSION: The analysis showed a low proportion of PPFP uptake among mothers of children under 12 years. Possible barriers included child age, education, a health worker visit, and side effects and perceived benefits of possibly improperly implementing lactation amenorrhea method. Integration of social, community and health services could provide a more holistic approach to improving PPFP uptake.

Family planning since ICPD--how far have we progressed?

The 1994 International Conference on Population and Development (ICPD) was a pivotal global event. It established voluntary family planning as a fundamental human right. We describe the progress made and challenges faced by the family planning field in the 20 years since ICPD. We present case studies from three African countries to highlight factors affecting the evolution of family planning during the past 2 decades. Measurable progress has been made in the key family planning indicators over this interval. However, improvement has slowed in recent years, and demographic forecasts predict a greater unmet need for effective contraception in the future. With a rights-based lens, we need to better understand the nuances of fertility intentions as we offer women and couples contraceptive choices pertinent to their stage of life. With a public-health lens, we need better metrics to reflect the realities of contraceptive effectiveness. Now is the time to build on two decades of family planning progress after ICPD.

Contraceptive implants in Kenya: current status and future prospects.

BACKGROUND: Since introducing Norplant over 20 years ago in Kenya, demand for contraceptive implants has remained high and implant costs are dropping substantially. METHODS: An assessment of the Kenyan experience with implants was conducted to understand level of demand, capacity to provide services and reproductive health impact of possible increased use. Interviews were conducted with 35 key Kenyan informants. By modeling increases in national implant use (at the expense of oral contraceptives), reductions in the annual number of unintended pregnancies were estimated. RESULTS: Kenya has an unmet need for implants and the current network of trained providers appears ready to increase the volume of services. If 100,000 users of oral contraceptives switch to implants, then an estimated 26,000 unintended pregnancies can be averted over a 5-year period. CONCLUSION: With increased purchases of implants by international donor agencies, Kenya can reduce reliance on short-term hormonal methods and reduce the 45% prevalence rate of unintended pregnancy.

Dual protection in sexually active women.

OBJECTIVE: To determine the prevalence and co-factors associated with the practice of dual protection against sexually transmitted infections (STIs) and unwanted pregnancy in a cross-sectional sample of South African women. DESIGN: Secondary analysis of cross-sectional household survey data. METHODS: Statistical analysis of responses by sexually active women to the question, 'Was a condom used on the last occasion you had sex?' were obtained from the women's questionnaire of the South African Demographic and Health Survey in relation to a number of other variables. RESULTS: (i) 10.5% of all sexually active women aged 15-49 years used a condom at last sex and 6.3% used a condom as well as another contraceptive method; (ii) condom use is more likely among younger, more educated, more affluent, and urban women, and among women who change partners more frequently; (iii) reasons for not using condoms are more likely to be associated with the personal attitudes of women or their partners than with poor knowledge of or lack of access to condoms; (iv) women who have no need or desire to prevent pregnancy are less likely to use condoms; and (v) there is a minority of sexually active women, characterised by social disadvantage, who have difficulty obtaining condoms. CONCLUSIONS: There is an urgent need for targeted programmes that increase dual protection with condoms.