Determinants of postpartum family planning uptake among women in the Kumasi Metropolis, Ghana

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A high fertility rate leads to rapid population growth and hinders development. Over the past few decades, countries the world over have put in place policies to improve the health and well-being of their people by encouraging family planning uptake, especially in postpartum women. This is because though there has been an overall increase in family planning in developing countries, many women end up with unintended pregnancies before resumption of their first menses. In Sub-Saharan Africa, almost one- third of postpartum women are at risk of getting pregnant within 2 years of delivery as they are having sex without any form of contraception. Several factors have been proposed as being the reasons for the low uptake of family planning among women in the postpartum period. This cross-sectional study sought to determine the demographic, social and provider-related factors associated with postpartum family planning uptake among women within the Kumasi metropolis. A total of 550 women, in the reproductive age (up to1 year postpartum) were selected via multi-stage sampling, to participate in the study in five (5) private health facilities. Analysis of data obtained from 223 users and 327 non- users of postpartum family planning revealed an average postpartum family planning prevalence rate of 40.5%. Of the socio-demographic variables analyzed, age of women significantly influenced uptake at both the bi-variate and multivariate levels. Though there was a general awareness of family planning, women had inadequate information about return to fertility after delivery and the methods that could be adopted for postpartum use. In terms of service accessibility, variables such as location of family planning services (in relation to health facilities), means of transport to services, distance to services iii from place of residence, payment for the use of family planning services and the availability of contraceptive methods of a client's choice were shown to have some relationship with postpartum family planning uptake. The quality of family planning services had some relationship with postpartum uptake. Service delivery was generally good however, a third of users were uninformed about side-effects and a third were unwilling to return to service providers, Communicating with one's partner about family planning and receiving financial assistance from one's partner significantly influenced postpartum family planning uptake. Interventions should be directed at utilizing all missed opportunities to properly educate women about postpartum contraception and its benefits. Providers should be regularly updated on their level of information and motivated to give off their best in the provision of service. Policies should be formulated to increase male-involvement, as this will go a long way to improve patronage of family planning in women as soon as they deliver.
A thesis submitted to the School of Graduate Studies, Kwame Nkrumah University of Science and Technology in partial fulfillment of the requirements for the award of the Degree of Master of Public Health in Population and Reproductive Health, 2015