Contraceptive use during the postpartum period has been of considerable interest to both demographers and family planning managers. The risk of unwanted pregnancy is high during the year following the birth of a child, and many women have unmet need for contraception during this period.
This study examines the determinants of time to first use of a contraceptive method after a birth, duration of breastfeeding, and postpartum amenorrhea. We use data from month-to-month detailed retrospective histories of contraceptive use by women age 15-49. The data come from recent Demographic and Health Surveys (DHS) in Kenya, Indonesia, the Dominican Republic, and Peru. Using life-table methods, we report cumulative percentages of women who initiated contraceptive use by 2, 6, 9, and 12 months, and the median duration until first use of contraception after a birth. We then investigate the independent effects of selected social, economic, and demographic factors on the time to first use of contraception, on durations of breastfeeding, and on postpartum amenorrhea during the first 12 months after a birth.
Our bivariate analyses show that in all four countries the likelihood of adopting contraception during the first 12 months postpartum increases with the level of education of the mother, her exposure to the media, the wealth status of the household, and whether delivery was at a public or private health facility. Additionally, we find that between 20 percent and 40 percent of women in the countries studied did not initiate contraceptive use postpartum before they became at risk for another pregnancy.
Our multivariate analyses suggest that in all four countries education and wealth status have a significant positive association with the adoption of any contraceptive method during the first 12 months postpartum. Also, in three of the countries mother’s exposure to mass media has a significant positive association with adoption of a contraceptive method
The study also explores the determinants of adoption of hormonal contraception (specifically, the pill and injectables) and non-hormonal methods during the first 12 months postpartum. Mothers from wealthier households and with formal education are more likely to initiate use of non-hormonal and hormonal contraceptive methods, as well are mothers age 25 and older. Modernization (synonymous with urbanization and formal education) is linked to early termination of breastfeeding, our study shows. Older mothers (age 25 and above) are more likely than mothers age 15-24 to terminate breastfeeding early. In all four countries higher levels of maternal education and wealth are associated with a lower likelihood of remaining amenorrheic during the 12 months postpartum. Additionally, mothers with a preceding birth interval of 24-47 months are more likely to remain amenorrheic during this period.
Given that mothers delivering in a health service breastfeed for a shorter period and adopt contraception earlier and more, we recommend that prenatal programs include information on breastfeeding and on using contraception during the postpartum period, as well as the regular inclusion of a discussion of contraception during the postpartum check before discharge for mothers who deliver in health facilities and during postpartum home visits for all mothers.