Factors Influencing Contraceptive Utilisation Among Postpartum Adolescent Mothers: a Cross Sectional Study at China-uganda Friendship Hospital

doi:10.21203/rs.3.rs-3909375/v1

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Factors Influencing Contraceptive Utilisation Among Postpartum Adolescent Mothers: a Cross Sectional Study at China-uganda Friendship Hospital

https://doi.org/10.21203/rs.3.rs-3909375/v1

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published 30 Jul, 2024

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Background

Globally, modern contraceptives remain underutilized among postpartum mothers resulting in the rise of short interpregnancy intervals. This is even severe in low-income countries where health information access regarding such interventions is limited, undermining their uptake. While there are a range of other factors that can influence the uptake of such services, understanding of the significance of their influence is critical in public health programming. This study sought to analyze maternal and health facility factors influencing the utilization of contraceptives among postpartum mothers in urban areas of Uganda.

Methods

In the year 2023, we conducted a health facility-based survey in urban areas of Kampala, Uganda using cross sectional study design approaches. A total of 332 women aged between 15 and22 years were randomly selected for the interviews using semi-structured interview questionnaires. We used descriptive statistics, multivariable logistic and multinomial regression to compare age, occupation, women’s preferred contraceptive, distance from a health facility, service payment, as potential factors influencing uptake and utilization of family planning methods.

Results

An overall 28.3% utilization of contraceptives was realized in the current study. The majority of the respondents 98 (29.52) were within the age group of 17–18 years and unmarried 76.81%(255/332). Significantly associated factors were; income below UgX. 500,000 (p = 0.002), housewife and student (p = 0.006).

Conclusions

Basing on the low contraceptive utilization, understanding the attitudes and views of postpartum teenagers regarding contraception is crucial for creating effective intervention, given the negative effects of adolescent pregnancy. Adolescent mothers are a challenging demographic to interact with, therefore focus groups with them offer a forum for delving into this intricate problem.

Contraceptives

Naguru-China Uganda Friendship

Hospital

Postpartum Adolescent Mothers

The World Health Organization has indicated family planning to significantly contribute to improved health as well as save lives of children and their mothers [1]. Additionally, family planning methods have been associated to contribute to improved socioeconomic welfare of families and communities [2] [3]. Indeed, it has been argued that family planning is an important pathway to achieving development across different scales [2] [3]. While these benefits have been widely recognized across the globe, modern contraceptives remain underutilized among postpartum mothers [1]. This has been indicated to result on rise of short-birth pregnancies, and an estimated 20,000 deliveries occur daily among those under 24 years of age [4] [5]. Current contraceptive methods available include oral, injectable, and barrier methods, as well as emergency and postpartum contraception strategies [6].Condoms are one of the barrier contraceptive methods that are crucial for preventing sexually transmitted infections but should be used in conjunction with other forms of contraception due to their high failure rate [7] [8].

In countries like United Sates of America, access to postpartum contraception is a public health priority and over 40% of postpartum mothers always receive this service from the health facilities [9]. Despite this effort, statistics on contraceptive utilization in women of reproductive age in a marital or consensual relationship show that intrauterine device (IUD) use is low in many countries (1.8% in the United States (US) and 7% in the United Kingdom (UK)). However, there are some notable exceptions where the IUD is a commonly used contraceptive method (Cuba 43.5%, Vietnam 37.7%, Egypt 36.5%), and it is the most frequently opted way in China (44.9%) [10].

In the U.K, 69% of postpartum mothers use contraceptives compared to 12% of usage among adolescent mothers in Mali [9] [11]. It is said that, approximately 37% of single sexually active females aged 15–24 years in sub – Saharan Africa use contraceptives with 8% using a non-barrier method [12]. The utilization of contraceptives among adolescent mothers in Uganda remains low at 9.4% (Sserwanja et al., 2021) despite the fact that majority of them have indulged in sexual activities.

In low and middle-income countries, over 200 million women have the highest unfulfilled need for modern contraception as those who do not wish to conceive are not using any of these methods and adolescents are inclusive[14]. Moreover, contraceptives allow adolescent girls to exercise their right to decide whether to be pregnant, spacing and number of children and have pleasurable and safe sexual experiences without having unintended pregnancy risks [15]. Studies have revealed a number of barriers to contraceptive utilization among post-partum mothers in low and middle-income countries(LMICs) ranging from lack of or limited knowledge on the utilization, sexuality education and limited access to services, high risk of misperceptions, and harmful social norms surrounding premarital sexual activity and pregnancy [12] [13]. Further still, more than 80 percent of the Ugandan population lives in rural areas where access to clinical family planning services is inadequate [16].

In Sub-Saharan Africa, contraceptive use is affected by women’s misconceptions of contraceptive side effects, male partner disapproval, and social/cultural norms surrounding fertility [17] [18] ). Factors that can positively impact contraceptive utilization include education, employment, and communication with male partner[17] [18]. Increasing contraceptive use is a multi-faceted problem that will require community and systems wide interventions that aim to counteract negative perceptions and misinformation [17] (Nearly half of the 1.4 million annual pregnancies occurring in Uganda are unwanted [19] leading to the need for abortions. Studies have revealed 57% of all unsafe abortions in sub-Saharan Africa found in the age-group of 15–24 years [20].

Uganda has a liberal family planning policy that allows access to contraceptive services to every sexually active individual and couples irrespective of age [21], and in addition, contraceptives are free in public facilities such as China-Uganda Friendship Hospital and also private facilities charge low fees as a compensation for labor (human resource) and consumables [13]. Despite all the above favorable factors and a high level of awareness of at least one contraceptive method (98 percent), a large proportion of adolescents in Uganda have never used contraceptives [22] despite

Several organizations, including the Ministry of Health (MOH) and about 10 Non-Governmental Organizations (NGOs), have or still provide family planning services through Community Based Distribution (CBD) programs in Uganda. The former Family Health International, FHI360, an international organization with an office in Uganda, runs one of the largest CBD programs, established in 2006. Therefore, this study focused on the factors influencing the use of contraceptives with the study respondents being those at China-Uganda Friendship Hospital.

Study design and study site

This was a cross-sectional study employing quantitative data collection method where by data was collected once from postpartum adolescent mothers receiving care at Naguru China Uganda friendship regional referral hospital (NCUFH). The Hospital provides any array of health services including sexual and reproductive health that includes counselling and care during pregnancy as well as postnatal care, family planning and treatment of sexual transmitted diseases (STIs) and human immunodeficiency virus (HIV. There are two wings of antenatal care services, namely general mother child health and Teenage antenatal clinic. General mother child health operates five days week and according to records, it receives over eighty mothers per day. All the care is free of charge, attracting low-income earners especially young people (teenagers) most of whom are from the slum area of Kampala.

Study population

The population of this study included all the postpartum adolescent mothers receiving care at Teenage antenatal clinic China Uganda friendship regional referral hospital. The Teenage antenatal clinic operates four days a week and on average receives 30 mothers in a single day. during the study period.

Inclusion criteria

All the postpartum adolescent mothers receiving care at NCUFH facility and those who consented to participate in the study
Postpartum adolescent mothers who had given birth to live babies.

Exclusion criteria

Those who were unable to consent to participate in the study
Those who were above the age of 22 years at the time of the study
Postpartum adolescent mothers who were receiving emergency care.

Sampling Technique and procedure

Simple random sampling technique was used. to select adolescent mothers attending China Uganda Friendship Hospital as primary respondents in the study. Given the homogeneity of the respondents as adolescents. We used a freely online available random number generator (www.random.org?) to effect this exercise to give all respondents a chance to participate in this studyWhere by the maximum number of registered patient number of the day was entered in the online generator. The participants were picked in accordance to the registration numbers of the day and similar to the random number generated.

Data management

The data was collected, entered into excel, organized and stored in a protected way with locks and pass codes on computers and tabs. Data from the questionnaire was first entered in the research laboratory registers and then later double entered into the computer using EPI DATA package 2.1, and then subsequently exported to a statistical software program R version 4.1.2 for analysis. The duplicate or irrelevant observations were removed from the dataset before analysis.. The frequencies and proportions were determined. To determine the factors associated with contraceptive use, chi-square was used. The associations with p-values less than 0.05 were considered to be statistically significant and they were presented in Table 2. The factors that were significantly associated with contraceptive use were run in a logistic regression model. P values of below 0.05 were considered significant and confidence interval of 95% were used.

Ethical Consideration

This study was approved by Clarke International University Research and Ethics Committee (CLARKE-2023-639) An administrative clearance was sought from Kampala City Council Authority and later from China-Uganda Friendship Hospital to allow data collection process. The researcher obtained consent from the study respondents before collecting any data and privacy and confidentiality of the participants’ information were observed and maintained at all times. Furthermore, we also followed the Helsinki declaration guidance on ethical principles of having human participants in this study.

Prevalence of contraceptive utilization

Generally, 28.3% (94/332) of the respondents used contraceptives. About 56.9% (189/332) of the respondents visited health facilities with family planning services. The commonest contraceptive preferred was injection (37.35%) as presented in Table 2.

Demographic characteristics

The total number of respondents was 332 who were all postpartum adolescent mothers at China-Uganda Friendship Hospital, Naguru, Kampala district. Majority of the respondents (39.52%) were aged between 17 and 18 years. Additionally, most of these mothers (81.63%) were Christians whereas only 18.37% were Moslems. Two hundred fifty-five (255) of the 332 (76.81%) were unmarried and most of these mothers earned less than UgX. 500,000 per month.as presented in Table 1.

Table 1

Demographic characteristics
Variable	Category	Frequency (%)
Age	14 to 16	54(16.27)
	17 to 18	98(29.52)
	19 to 20	92(27.71)
	21 to 22	88(26.51)
Religion	Christian	271(81.63)
	Moslem	61(18.37)
Education	Non	50(15.06)
	primary	105(31.63)
	Secondary	145(43.67)
	Tertiary	32(9.64)
Occupation	Business	37(11.14)
	Housewife	89(26.81)
	Maid	39(11.75)
	Student	90(27.11)
	Other	77(23.19)
Marital	Married	77(23.19)
	Unmarried	255(76.81)
Husband education	Primary and below	127(38.25)
	Secondary and above	77(23.19)
	Secondary	128(38.55)
Income	Greater than 500000	63(18.98)
	Less than 500000	157(47.29)
	None	112(33.73)

Table 2

Use of contraceptives and associated factors
Variable	Category	Use contraceptives		N (%)	p-value
		No	Yes
Visit family planning	no	143(100)	0(0)	143(43.07)	0.485
	yes	21(11.11)	168(88.89)	189(56.93)
Maternal
Have preferred contraceptive	no	7(7.37)	88(92.63)	95(28.61)	0.027
Have preferred contraceptive	yes	14(14.89)	80(85.11)	94(28.31)
Type of contraceptive	inject	7(5.65)	117(94.35)	124(37.35)
	Iud	2(5.26)	36(94.74)	38(11.45)
	no	143(100)	0(0)	143(43.07)
Type of health Centre	private	10(15.4)	55(84.6)	65(19.58)	0.801
Type of health Centre	public	11(8.9)	113(91.1)	124(37.35)
Why prefer a specific type of contraceptive	Less side effects	7(11.67)	53(88.33)	60(18.07)	0.946
	No	143(100)	0(0)	143(43.07)
	Readily available	14(19.72)	57(80.28)	71(21.39)
	Works longer	0(0)	17(100)	17(5.12)
	Works well	0(0)	41(100)	41(12.35)
Health facility
Distance from the health unit	Less than 5 km	96(54.9)	79(45.1)	175(52.7)	0.039
Distance from the health unit	More than 5 km	68(43.3)	89(56.7)	157(47.3)
Ever failed to access contraceptives due to long distance	no	164(52.56)	148(47.44)	312(93.98)	0.727
Ever failed to access contraceptives due to long distance	yes	0(0)	20(100)	20(6.02)
Ever found family planning unit closed	I prefer not to mention	143(100)	0(0)	143(43.07)	0.110
	no	21(15.22)	117(84.78)	138(41.57)
	yes	0(0)	51(100)	51(15.36)
Which day of the week	I prefer not to mention	143(100)	0(0)	143(43.07)
	na	21(15.22)	117(84.78)	138(41.57)
	Public holiday	0(0)	26(100)	26(7.83)
	Weekend	0(0)	25(100)	25(7.53)
Always find the contraceptive of choice whenever in need of them	I am not sure	143(100)	0(0)	143(43.07)	0.046
	no	21(11.86)	156(88.14)	177(53.31)
	yes	0(0)	12(100)	12(3.61)
Are you required to pay for family planning services	I don’t know	143(100)	0(0)	143(43.07)	0.009
	no	21(13.55)	134(86.45)	155(46.69)
	yes	0(0)	34(100)	34(10.24)

Table 3

Maternal and health facility factors relating to contraceptive use
Variable (reference category)	p-value	Odds ratio	Confidence interval
Maternal factors
Preferred contraceptive (no)
Yes	0.028	2.62	[1.97,3.55]
Health facility factors
Distance from the health unit (More than 5 km)
Less than 5 km	0.033	2.10	[1.44,2.48]
Always find the contraceptive of choice whenever in need of them (no)	0.550	0.787	[0.02,5.113]
yes
Are you required to pay for family planning services (No)	0.001	4.69	[3.51,7.28]
yes

There was a significant association between distance from the health center and contraceptive use. There was also a significant association between whether the person was required to pay and contraceptive use.

The logistic regression model showed that respondents with specific contraceptives were significantly about twice as likely to use contraceptives as those with no specific preferred contraceptives. In addition, mothers who stay within 5 km distance from the health facility were significantly associated with increased odds (2.10) of using contraceptives compared to those who stay further than 5 km.

From Table 4, mothers whose income was below UgX. 500,000 were significantly associated (p = 0.002) with increased odds (4.546) of using contraceptives compared to those who do not have earnings. Housewives were also significantly associated (p = 0.006) with increased odds (3.526) of using contraceptives compared to those who do business as source of income.

Table 4

Relationship between contraceptive use and disposing factors (multivariate logistic model)
Variable (reference category)		p-value	OR [LCI, UCI]
Age (17to18)	17to18 years
	19to20 years	0.589	1.218[0.596,2.5]
	21to22 years	0.445	0.739[0.339,1.607]
Education (Non)
	Primary	0.403	0.654[0.232,1.731]
	Secondary	0.636	0.798[0.299,1.976]
	Tertiary	0.768	0.837[0.25,2.708]
Occupation (business)	Business
	Housewife	0.006	3.526[1.452,8.812]
	Maid	0.144	2.246[0.766,6.798]
	Other	0.131	2.195[0.795,6.165]
	Student	0.006	6.417[1.744,24.812]
Marital (married)
	Unmarried	0.612	0.853[0.458,1.568]
Husband education (primary and below)
	Secondary and above	0.323	1.43[0.706,2.927]
	Secondary	0.509	1.22[0.675,2.206]
Income (None)
	Greater than 500000	0.085	2.571[0.892,7.735]
	Less than 500000	0.002	4.546[1.785,12.193]

This study reports a 28.3%. prevalence of contraceptive use among adolescent postpartum mothers. This is a lower rate of contraceptive utilization by the postpartum adolescent mothers. This prevalence rate has been similarly reported by previous studies carried outside Uganda in Brazil among the same age group [23]. Though the prevalence suggests a substantial need for family planning services among postpartum adolescent mothers, it is lower than the 30.4% of postpartum mothers using contraception found in a study by Sidhu & Coonar [24]. The low utilization of contraceptive by adolescent mothers remains a global challenge as reported in the study by Kantorová et al [25].

The reason for low contraceptive use may be attributed to literacy level combined with limited awareness campaigns and counseling services in communities and schools for the use of modern contraceptive among adolescents[26]. It could also be attributed to women’s low level of income which makes them to desire to work hard in order to improve their earnings and view pregnancy as a barrier [27]

The likelihood of contraceptive use among the female adolescents increased significantly with the preference of specific method. Thus, female adolescents with preferred method were more likely to use contraceptives than their counterparts. A study carried out in Tanzanian female youths reported availability of a preferred method of contraceptive promoted uptake of modern contraceptives [28]. Another study in Malawi also found that the quality and cost of family-planning services, rather than their proximity, influenced contraceptive use among young women [29]. This implies the importance of taking mothers’ preference of specific contraceptives while placing orders for health facility stocks will increase contraceptive utilization.

This study reports a high association of occupation with contraceptive use where students were six times likely to use contraceptives. Our findings are in agreement with other studies carried out elsewhere [20] [21] [30]. This could be due to promotion of interventions in schools such as prevention of teenage pregnancy; the increased awareness and access to contraceptive methods among students, as well as the influence of social and behavioral factors on contraceptive [31] [32] .

Our findings reveal that health facilities within a distance of less 5 kilometers of the respondents was highly associated with the increased chances of contraceptive use and mothers in this proximity were 2 times likely to use contraceptives compared to their counterparts. In support of our findings, studies carried out elsewhere are in concordance with ours and they reported proximity to the health facility as a predictor to contraceptive use among the post-partum mothers [13] [22]. This could be due to easy access at convenient time and awareness of availability of the modern contraceptive services in the health facility.

Also, nonpayment of contraceptive services in health facilities promotes the use of contraceptives and clients in these settings were found to be 4 times more likely to consume the service compared to the paying facilities. A previous study in urban Pakistan also showed that nonpayment for contraceptive services in health facilities can significantly increase the likelihood of clients using these services[33].

Among the studied population, economic factors, particularly low income (as evidenced by mothers earning less than UgX 500,000) having significantly increased odds (4.55) of contraceptive use compared to those without such an economic advantage. As such, a study by [34] emphasized the need to improve services for marginalized groups in Mesoamerica, including those living in extreme poverty, indigenous populations, and adolescents. The use of contraceptives by housewives, compared to those who do business, is influenced by a variety of factors. Uddin and colleagues [35]found that a balance of power in the spousal relationship is important, with husband-only decision-making associated with lower odds of contraceptive use. This is further supported by Mon and Liabsuetrakul [36], who identified the wife's Health Belief Model perception, her income, spousal communication, and geographic barriers as significant predictors of contraceptive use. Uddin (2017) also highlighted the importance of couples' concordant joint decision-making in meeting the unmet demand for contraception. These studies collectively suggest that the use of contraceptives by housewives is influenced by a complex interplay of factors related to spousal dynamics, women's status, and communication.

The prevalence of contraceptive use among postpartum mothers Naguru-China friendship hospital Kampala Uganda was low (28.3%) with a higher preference for injectable contraceptives. Despite, the availability of the contraceptives at the health facility and other factors such as nonpayment and proximity to the health facility to the contraceptive utilization is low. Therefore, understanding the attitudes and views of postpartum teenagers regarding contraception is crucial for creating effective interventions, given the negative effects of adolescent pregnancy.

The study provides valuable insights into the prevalence and factors associated with contraceptive use among postpartum adolescent mothers in China – Uganda Friendship Hospital. The findings may contribute to the designing of targeted interventions for contraceptive utilization particularly for postpartum adolescent mothers and women with specific demographic characteristics.

Acknowledgement

The authors wish to thank Mr. Patrick Madrama Lulu, and the staffs of China-Uganda Friendship Hospital, Naguru, Kampala, Uganda for their assistance during execution of this study and also acknowledge the compliance of participants for their honest responses.

Author contributions

R.W and S.W contributed to the design, conception, and data collection, fieldwork, drafting and writing of the manuscript. R.W, I.I and S.A contributed to data analysis and drafting of the manuscript. C.M.C, N.D and M.H contributed to supervision and drafting of the manuscript. All authors have read and approved the final manuscript.

Competing interests

The authors declare no competing interests

Funding

This study received no specific funding to declare.

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No competing interests reported.

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published 30 Jul, 2024

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Factors Influencing Contraceptive Utilisation Among Postpartum Adolescent Mothers: a Cross Sectional Study at China-uganda Friendship Hospital

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Abstract

Background

Methods

Results

Conclusions

Introduction

MATERIALS AND METHODS

Study design and study site

Study population

Inclusion criteria

Exclusion criteria

Sampling Technique and procedure

Data management

Ethical Consideration

RESULTS

Prevalence of contraceptive utilization

Demographic characteristics

DISCUSSION

Conclusion

Declarations

References

Additional Declarations

Status:

Journal Publication

Version 1