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Unintended pregnancy and subsequent postpartum long-acting reversible contraceptive use in Zimbabwe

Nance, Nerissa, Ralph, Lauren, Padian, Nancy, Cowan, Frances ORCID:, Buzdugan, Raluca, Mushavi, Angela, Mahomva, Agnes and McCoy, Sandra I (2018) 'Unintended pregnancy and subsequent postpartum long-acting reversible contraceptive use in Zimbabwe'. BMC Women's Health, Vol 18, Issue 1, e193.

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Background: The postpartum period is an opportune time for contraception adoption, as women have extended interaction with the reproductive healthcare system and therefore more opportunity to learn about and adopt contraceptive methods. This may be especially true for women who experience unintended pregnancy, a key target population for contraceptive programs and programs to eliminate mother-to-child HIV transmission. Among women in Zimbabwe surveyed in 2014, we examined the relationship between pregnancy intention associated with a woman’s most recent pregnancy, and her subsequent postpartum contraceptive use.

Methods: In our analysis we utilized a dataset from a random selection of catchment areas in Zimbabwe to examine the association between pregnancy intention of most recent pregnancy and subsequent postpartum contraceptive use using multinomial logistic regression models. We also explored whether this association differed by women’s HIV status. Finally, we examined the association between pregnancy intention and changes in contraception from the
pre- to postpartum periods.

Results: Findings suggest that women who reported that their pregnancy was unintended adopted less modern (all non-traditional) contraceptive methods overall, but adopted long-acting reversible contraception (LARC) more frequently than women reporting an intended pregnancy (OR 1.41; CI 1.18, 1.68). Among HIVpositive
women, this relationship was particularly strong (OR 3.12; CI 1.96, 4.97). However, when examining changes in contraceptive use from the pre-pregnancy to the postpartum period, women who had an unintended pregnancy had lower odds of changing to a more effective method postpartum overall (OR 0.71; CI 0.64, 0.79).

Conclusions: We did not find evidence of higher modern method adoption in the postpartum period among women with an unintended pregnancy. However, women who were already on a method in the pre-pregnancy period were catalyzed to move to more effective methods (such as LARC) postpartum. This study provides evidence of low modern (non-traditional) method adoption in general in the postpartum period among a vulnerable sub-population in Zimbabwe (women who experience unintended pregnancy). Simultaneously, however, it shows a relatively greater portion specifically of LARC use among women with an unintended pregnancy. Further research is needed to more closely examine the motivations behind these contraceptive decisions in order to better inform distribution and counseling programs.

Item Type: Article
Subjects: WA Public Health > WA 30 Socioeconomic factors in public health (General)
WA Public Health > Health Problems of Special Population Groups > WA 309 Women's health
WP Gynecology > Contraception > WP 630 Contraception
WQ Obstetrics > Pregnancy > WQ 200 General works
Faculty: Department: Clinical Sciences & International Health > International Public Health Department
Digital Object Identifer (DOI):
Depositing User: Rachel Dominguez
Date Deposited: 14 Dec 2018 09:48
Last Modified: 14 Dec 2018 09:48


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