Elsevier

Contraception

Volume 89, Issue 6, June 2014, Pages 516-520
Contraception

Original research article
Postpartum contraception utilization among low-income women seeking immunization for infants in Mumbai, India

https://doi.org/10.1016/j.contraception.2014.01.001Get rights and content

Abstract

Objective

The objective was to examine postpartum contraception utilization among Indian women seeking immunization for their infants in three low-income communities in Mumbai, India.

Study design

We conducted a cross-sectional questionnaire of low-income postpartum women seeking immunization for their infants at three large urban health centers in Mumbai. Contraceptive utilization data were collected as part of a larger study focused on the impact of postpartum domestic violence on maternal and infant health. Descriptive, bivariate and multivariate analyses were conducted to describe and identify predictors of postpartum contraceptive utilization.

Results

Postpartum women aged 17–45 years (N= 1049) completed the survey; 44.5% (n= 467) reported resuming sexual relations with their husbands. Among these women, the majority (65.3%; n= 305) reported not currently using contraception. In multivariate analyses, women who did not discuss postpartum family planning with their husbands, had not used contraception previous to the recent birth, and had experienced physical violence or forced sex were more likely to not use postpartum contraception (adjusted odds ratios=1.47–1.77). Among the 162 women using contraception, the most common time to initiation of contraception was 5 weeks postpartum, and the most common method used was condoms 77.8% (n= 126).

Conclusion

Contraception nonuse was common among urban, low-income postpartum women in India. This study highlights the importance of developing interventions to increase use of highly effective contraceptive methods postpartum, and that spousal violence and lack of marital communication may present barriers to postpartum contraception utilization. Infant immunization may represent an opportunity for provision of contraceptives and contraceptive counseling.

Implications

This original research study is a unique contribution to the literature because it presents data regarding the nonuse of postpartum contraception among women seeking immunizations for their infants in urban centers in a developing country. It also reveals barriers to not using postpartum contraception and provides data for future interventions.

Introduction

Several factors influence a woman’s decision on when to have another child. These factors may include her age, fertility, child care support, and economic and social circumstances. Another important factor that should be considered in timing of another pregnancy is the potential health implications. In June 2005, the World Health Organization (WHO) conducted a technical consultation on birth spacing. Participating international experts recommended birth-to-pregnancy interval of 24 months to improve maternal and child health outcomes [1]. Birth-to-pregnancy interval is defined as the time period between a live birth and the start of another pregnancy. This group of experts noted that a birth-to-pregnancy interval of less than 6 months is associated with elevated risk of maternal morbidity and mortality [1]. A birth-to-pregnancy interval less than 18 months is associated with elevated risk of infant, neonatal and perinatal mortality; low birth weight; small for gestational age and preterm delivery [1].

A suggested area for future research from the WHO technical consultation was to investigate effective interventions to promote birth spacing. One possible strategy to promote birth spacing is to link maternal postpartum contraception education with infant immunization [2]. A woman typically stops seeking health care from an obstetrician 6 weeks after a delivery; however, women may continue to bring infants to health centers for immunizations up to 24 months after delivery. Infant immunizations therefore may provide an opportunity to educate and counsel postpartum women about birth spacing and contraception utilization.

Before programs linking postpartum contraception education and infant immunization can be implemented and evaluated, it is important to understand the nature and predictors of postpartum contraception utilization. South Asia is a region of high infant immunization coverage (84%) and is therefore an ideal region to study contraceptive utilization among women seeking infant immunization [3]. This study provides data in order to inform the design of interventions to promote postpartum contraception.

Section snippets

Materials and methods

This study utilizes data from the “Mechanism for Relations of Domestic Violence to Poor Maternal and Infant Health.” This project involved a cross-sectional in-depth interview (qualitative) and survey (quantitative) data collection of women presenting for infant care at urban health centers (UHCs) in Mumbai, India. The goal of this study is to utilize the quantitative data from the larger project to specifically examine postpartum contraception utilization among Indian women seeking

Demographic profile

Among the total sample (N= 1049), the majority of women were aged between 20 and 29 years (76.9%), and the majority (83.7%) reported having formal education. Most women (67.8%) reported marrying either at 18 years or later, and most women (61.1%) reported living in a joint family structure. Almost the entire population (95.5%) reported that they were breastfeeding at the time of survey, and the majority (70.3%) reported never using contraception prior to conceiving the current child.

Contraception Utilization

There were

Discussion

The findings from this study document the high level of contraception nonuse among postpartum women in slums in Mumbai, India. More than half the women in this study reported no contraception use up to 6 months postpartum, which puts these women at risk for short birth-to-pregnancy intervals. Maternal visits for infant immunization may present an opportunity to educate and counsel women regarding risks related to short birth-to-pregnancy intervals and the need to utilize postpartum

Acknowledgments

We would like to acknowledge the Municipal Corporation of Greater Mumbai for allowing us to conduct our study within their health posts. Analyses for this study and development of this paper were funded by the US National Institutes of Health and the Indian Council on Medical Research Indo-US Program on Maternal and Child Health and Human Development (grant number 1 R03 HD055120-01). Dr. Mody was supported by the Women's Reproductive Health Research grant K12 HD001259. The authors have no

References (8)

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