Magnitude and factors associated with utilization of Long Acting Reversible Contraceptive (LARC) methods in the Immediate Postpartum Period among mothers who gave birth in Addis Ababa Public Health Facilities, Ethiopia

Abstract

ABSTRACT Background: Maternal and child mortality is prevailing in SSA where Ethiopia is located. While it is revealed that promotion of contraception can avert 32% of all maternal deaths and 10% of childhood deaths; every year in SSA, about 14 million unintended pregnancies occurs and a sizable proportion is due to poor use of short-term hormonal methods. Delay in initiating contraception is common during the postpartum period, and a sizable number of women became pregnant before they return to health facilities to take modern FP methods and for this reason there is promotion of LARCs use in the immediate postpartum period. However, in Ethiopia, only 10% of currently married women uses LARC, and small proportion of them use it in immediate postpartum period. In Addis Ababa, only 22.6% of currently married women use LARCs. The main objective of this study was to measure the magnitude and to identify factors associated with LARC use in the immediate postpartum period in Addis Ababa, Ethiopia. Methods: Institution based cross sectional study was conducted in Addis Ababa public health facilities from Jan. 1, 2019 to April 30, 2019. Three public hospitals and 9 public health centers were selected using simple random sampling; and 693 women who gave birth in the selected health facilities in the past 48hr. before the survey and lived at least 1 year in the city prior to the survey were nominated with systematic random sampling and involved in the study. Data was entered and analyzed using Epi Info Version 7 and SPSS Version 20. Descriptive and bivariate analysis were done. Factors affecting use of LARC during the immediate postpartum period were determined using multivariate logistic regression. Result: A total of 17.5 % of women used LARC during immediate postpartum period. Attitude towards LARC use in the immediate postpartum period (AOR = 3.42, 95% CI: 1.96, 5.98); place of delivery (AOR = 3.29, 95% CU: 1.41, 7.66); knowing, before the recent delivery, that IUCD can be inserted within 48hr postpartum (AOR = 0.29, 95% CI: 0.11, 0.76); knowing, before the recent delivery, that implant can be inserted within 48hr postpartum (AOR = 0.31, 95% CI: 0.11, 0.89); and husband attitude towards LARC use (AOR= 3.26, 95 % CI: 1.46, 7.29) were found to have statistically significant association with LARC use during the immediate postpartum period. Conclusion: LARC use in immediate postpartum period is low in the study facilities. Attitude towards LARC use in immediate postpartum period found to be a very important factor associated with immediate postpartum LARC use among others. Integrating a high quality FP counseling service with ANC, focusing on building mothers knowledge and decision on immediate postpartum LARC use, besides counseling about LARC during labor and immediate postpartum period; and providing health education and BCC services to mothers, husbands and the community at large on importance of immediate postpartum LARC use, are some of the areas where much work is needed to improve immediate postpartum LARC use. Keywords: LARC, immediate postpartum period, public health facilities, Addis Ababa, Ethiopia