Association Of Intended Birth To Pregnancy Interval And Uptake Of Immediate Postpartum Long Acting Reversible Contraceptive Methods At Thika Level 5 Hospital

Abstract

background Contraceptives reduce the number of high-risk pregnancies, high parity births and unintended pregnancies therefore playing a major role in reducing maternal and perinatal deaths. Globally, the unmet need for family planning during the postpartum period is high despite the available methods of immediate postpartum contraception and the prime opportunity to administer the contraceptives during this period. Rapid repeat pregnancy is associated with increased maternal and perinatal morbidity and mortality. Objective The study aimed to determine the association between women’s desire to achieve an inter-pregnancy interval of 2 years or more and uptake of immediate postpartum LARC in an urban public hospital. Methodology This was a prospective cohort study conducted at Thika level Five Hospital in Kiambu County, Kenya. A total of 1489 women in the latent phase of labor were recruited and segregated into two groups; those who intend to conceive in less than two years after delivery and those who intend to delay the next conception by two years or more. The women were followed up till they delivered and offered contraceptives within 24 hours. Data was collected for analysis. Summary statistics was performed on intent to delay pregnancy, reproductive and demographic characteristics and presented in charts and tables. Inferential statistics: association of inter-pregnancy interval, utilization of immediate post-partum LARC and other variables were compared. Relative risks have been calculated. A p-value of <0.05 is considered to be significant. Results Women who intend to delay their subsequent pregnancy by 2 years or more are likely to utilize long acting reversible contraceptive methods compared to those who intended to get pregnant in less than 2 years, OR 2.86 (95% CI 1.89 – 4.33) p-value <0.0001 The proportion of women taking up immediate post-partum long acting reversible contraceptives among those with intention to delay pregnancy by 2 years or more was 21.9% while those with no intention to delay their subsequent pregnancy by 2 years was 8.9%. xi Women with knowledge about the types of immediate post-partum contraceptives were more likely to accept it in the post-partum period than those with no knowledge. (OR 1.93) P value <0.0001. Conclusion The uptake of immediate postpartum long acting reversible contraceptives is higher in this study population compared to other low- and middle-income countries. The intention for an optimum interpregnancy interval of 2 years or more increases the odds of utilizing immediate postpartum long acting reversible contraceptives by up to three times. Knowledge about available contraceptive options in the immediate postpartum period increases utilization during this period Recommendation Policy and advocacy for reproductive planning with an optimum inter-pregnancy interval towards 2 years and more should be instituted as a crucial intervention in increasing uptake of immediate post-partum long acting reversible contraceptive. Institutionalizing provision of immediate post-partum long acting reversible contraceptives to increase contraceptive uptake should be encouraged. More studies should be done on the relationship between optimum inter pregnancy interval and utilization of immediate postpartum contraceptives with an aim of exploiting the relationship to increase family planning uptake