The Provision of Postnatal Contraceptive Advice in Uganda
Miss Claire Barnsley1, Dr JessicaTaylor1,2, Dr Joanne Moffatt1,2
Postpartum family planning (PPFP) aims to prevent closely spaced pregnancies, which in turn, reduces rates of premature labour, low birth weight babies, and infant mortality1. A United Nations report demonstrates that Uganda has low rates of contraceptive use (27.2%) and a high rate of unmet need for contraceptive advice (35.6%), compared to global figures of 63.3% and 12.3% respectively2. Achieving the optimal inter-pregnancy interval of greater than 2 years is the overall goal as this can reduce infant mortality of second children by up to 60%. The purpose of this study was to explore attitudes towards PPFP in rural Uganda.
A prospective qualitative study of postnatal women (n=20) was performed at Villa Maria Hospital in rural Uganda. Patients participated in a structured interview on family planning (FP) advice they had received up to that point. Interviews to establish the views of health care professionals on PPFP advice were also conducted. Quantitative data from 174 cases regarding the provision of FP advice and methods at discharge were obtained retrospectively from the Ministry of Health Integrated Maternity Register (MoHIMR).
None of the women were offered advice regarding PPFP methods, and 55% wanted more information. 25% of the women had previously used a form of contraception. Those who had not were mainly concerned about side effects. The MoHIMR indicated that 43% received PPFP advice, but none were provided with contraception. 75% of the health care professionals interviewed did not provide PPFP advice, as the hospital was Catholic faith-based.
Contraceptive use and provision of PPFP advice remains low at Villa Maria Hospital. This may be due to the faith-based nature of the hospital. Increasing provision of PPFP can decrease the inter-pregnancy interval and decrease maternal mortality rates. If personal or institutional beliefs do not allow discussion and provision of contraceptives, referral to another clinician should be made. Increasing availability of information in the local language would be beneficial, alongside community outreach programmes to provide more education in this field.
1. Cleland, J., et al., Contraception and health. Lancet, 2012. 380(9837): p. 149-56.
2. United Nations. Millennium Development Goals Indicators - Current contraceptive use among married women 15-49 years old, any method, percentage. 2015; Available from: http://unstats.un.org/unsd/mdg/SeriesDetail.aspx?srid=730&crid=800
3. Alkema L, Kantorova V, Menozzi C, Biddlecom A. National, regional, and global rates and trends in contraceptive prevalence and unmet need for family planning between 1990 and 2015: a systematic and comprehensive analysis. Lancet. 2013;381(9878):1642-52.