Abstract
Background
To assess women’s preference and intention to use postpartum contraceptives according to the Interaction Model of Client Health Behavior (IMCHB).
Method
The study was cross-sectional and conducted in the outpatient clinics of a university hospital between March and June 2023. The sample consisted of 951 women between the ages of 15 and 49, who had given birth at least once, and had no history of menopause. Descriptive Information Form, Family Planning Attitude Scale, Contraceptive Knowledge Assessment Scale, and Contraceptive Intent Questionnaire were used as data collection tools. Moreover, Cox’s IMCHB constitutes the study’s theoretical framework.
Results
In the present study, it was determined that the contraceptive method used before pregnancy, emergency contraceptive experience, access and provision of contraceptive methods, and continuation of contraceptive method had a significant effect on contraceptive method preferences in the postpartum period. It was determined that each unit increase in the continuation of the contraceptive method used before pregnancy in the postpartum period increased the intention to use by 0.244 points, each unit increase in contraceptive knowledge level increased by 0.202 points, and each unit increase in positive attitude toward family planning increased by 0.102 points. Each unit increase in the desire to become pregnant again decreased the intention to contraceptive use by 0.230 points.
Conclusion
To increase the use of modern and effective contraceptives in the postpartum period and prevent unwanted pregnancies, it is necessary to evaluate the factors affecting contraceptive method use, preferences, and intentions of women and their husbands together.
Keywords: Postpartum contraception, Preference, Intention, Interaction Model of Client Health Behavior
Introduction
The postpartum period provides an ideal opportunity for women to access contraceptive methods and start using the most appropriate method [1]. Despite this, unintended pregnancies occur when women fail to use contraception or opt for traditional methods over modern ones [2–5]. The American College of Obstetricians and Gynecologists recommends addressing contraceptive needs and promptly initiating postpartum contraception for all women, regardless of age or sexual history, to prevent unintended pregnancies and reduce maternal and neonatal risks [6]. The use of postpartum contraceptive methods by women is of great importance to avoid unwanted pregnancies and reduce the risk of maternal, fetal, and neonatal mortality and morbidity [7]. In a previous study, it was stated that the use of contraceptive methods could prevent more than two-fifths of maternal deaths [8]. The COVID-19 pandemic is estimated to have caused 1.4 million unplanned pregnancies in developing countries and 12 million women in 115 countries to lose access to contraceptive methods [9]. In Türkiye, the unmet need for family planning increased from 6 to 12% between 2013 and 2018, and it was observed that this rate was higher among women with lower levels of education and wealth in the Eastern Anatolia Region [10]. The impact of the COVID-19 pandemic on this situation is not yet known.
Factors such as significant anatomical, biological, and psychological changes, previous contraceptive method experience, social, cultural, and economic factors, personal and family history, and breastfeeding status may affect women’s choice, intention, and use of postpartum contraceptive methods [11, 12]. In contraceptive method use, besides being reliable, the process may be preferred because it is cheap and easily accessible, does not interfere with breastfeeding, provides long-term protection, and does not require monthly visits to pharmacies or health institutions [4, 13]. It was also observed that women can express their intention to use postpartum contraceptive methods during the antenatal period but are not able to act on this intention during the postpartum period [14]. Globally, unmet family planning needs are significant, particularly in regions with low education and income levels, like Eastern Anatolia in Türkiye. This study evaluates factors affecting postpartum contraceptive preferences and intentions among women in eastern Türkiye using the Interaction Model of Client Health Behavior (IMCHB).
Research Questions
Q1. What are the conditions that affect women’s postpartum contraceptive method preferences?
Q2. What are the conditions that affect women’s intention to use postpartum contraceptives?
Q3. What is the effect level of the variables predicting women’s intentions to use postpartum contraceptives?
Materials and Methods
Sample and Procedures
This cross-sectional study was conducted between March and June 2023 in the outpatient clinics of a university hospital. The study population consisted of 97,624 women aged 15 and 49 who applied to the outpatient clinics. The sample consisted of 1056 women with a 95% confidence interval and a 3% margin of error. Since it was impossible to list the applications, no sample selection was made in the study, and 1056 women who met the inclusion criteria were reached in the relevant date range. Thirteen questionnaires (1.23%) were not evaluated due to missing data. Moreover, 92 participants were excluded from the analysis due to abnormal responses (n = 25; 2.39%) and outliers (n = 67; 6.42%). A total of 951 women (90.05%) constituted the study sample. The study included women aged 15–49 who had given at least one birth, excluding those with a history of menopause.
Data Collection
Data were collected face-to-face during outpatient visits when the women were waiting for the appointment time using a questionnaire that included a descriptive information form, the Family Planning Attitude Scale, the Contraceptive Knowledge Assessment Scale, and the Contraceptive Intent Questionnaire.
Descriptive Information Form: The researchers prepared a questionnaire in line with the literature and consisted of 20 questions inquiring about the socio-demographic characteristics of women, information about marriage, and contraceptive method use.
Family Planning Attitude Scale: Developed by Örsal and Kubilay (2006), this scale consists of 34 items rated on a 5-point Likert scale (1 = Totally agree, 5 = Totally disagree), yielding scores between 34 and 170. Higher scores indicate more positive attitudes toward family planning. The Cronbach’s alpha reliability coefficient was 0.90 in the previous study [15] and 0.97 in the current study.
Contraceptive Knowledge Assessment Scale: The Turkish validity and reliability study of the scale developed by Saleh (2020) was conducted by Eryılmaz et al. (2022). This multiple-choice scale consists of 25 questions, each contributing equally to the total score. Correct answers score 1 point, and incorrect answers score 0, yielding a minimum score of 0 and a maximum of 25. There is no cutoff point; higher scores indicate more excellent knowledge. The Cronbach’s alpha reliability coefficient was 0.86 in the prior study [16] and 0.77 in the current study.
Contraceptive Intent Questionnaire: Developed by Bennet and Rocca in 2015, this scale assesses contraceptive intention, with its Turkish validity and reliability studied by Suid and Pasinlioğlu (2016). The 15-item scale uses a 4-point Likert format, yielding scores from 0 to 15. Higher scores indicate greater intention to use contraceptive methods. The Cronbach’s alpha reliability coefficient was 0.82 in the previous study [17] and 0.86 in the current study.
Theoretical Framework
This study uses Cox’s IMCHB, a nursing-based, individual-focused, holistic health behavior model. It examines the interplay of individual characteristics (age, gender, family structure, income, health history) and environmental factors in understanding health behaviors. IMCHB emphasizes that multiple factors influence health behavior rather than focusing on one aspect [18]. It advocates for maximum individual control over health decisions, considering internal and external environments. The model highlights the reduced decision-making role of professionals (guide, teacher, counselor) in promoting health [19]. The theoretical framework of the study is illustrated in Fig. 1.
Fig. 1.
Application of the Interaction Model of Client Health Behavior to research
Data Analysis
Data analysis was conducted using SPSS (25.0). Questionnaires with abnormal responses (n = 25) were excluded, and missing data (< 1‰, n = 6) were replaced with the dataset mean. Multivariate outliers (n = 67) were identified using Z scores and removed if greater than + 3 or less than − 3. The skewness and kurtosis coefficients of the scales were between − 1 and + 1, supporting the normality assumption. Pearson Chi-square test was used for tables larger than 2 × 2, with the Z test for significance sources and Cramer’s V for effect size. The independent sample t-test compared the means of two independent groups, while one-way ANOVA was used for three or more groups, with eta squared (ƞ2) for effect size. Multiple linear regression analysis with a stepwise method determined the effects of variables predicting postpartum contraceptive intention. The statistical significance level was set at p < 0.05.
Ethical Aspects of the Study
For the scales used in the study, permission was obtained by the researchers from the scale owners via e-mail. To conduct the study, the ethics committee permission of Ağrı İbrahim Çeçen University Scientific Research Ethics Committee dated 28.12.2022. It numbered 294, and the institutional permission of Ağrı Provincial Health Directorate dated 29.03.2023 and numbered 91 were obtained. Written and verbal consent was also obtained from the participants.
Results
The mean age of the women who participated in the study was 31.25 ± 7.06 (min. 16.00; max. 49.00) years, and the mean age at first marriage was 21.18 ± 3.57 (min. 10.00; max. 38.00). Moreover, 38.6% (n = 367) of the women had been married for 11 years or more.
The contraceptive method used before pregnancy, experience with emergency contraception, access and provision of contraceptive methods, and continuation of contraceptive methods had a significant effect on the contraceptive method preferences of the participants in the postpartum period (p < 0.05; Table 1).
Table 1.
Distribution of the rates of participants’ postpartum contraceptive method preferences according to their socio-demographic and obstetric characteristics
| Variables | Preference for postpartum contraceptive method | Statistical analysis | |||||||
|---|---|---|---|---|---|---|---|---|---|
| No | Hormonal methods | Intrauterine device | Barrier methods | Natural methods | Surgical methods | Total | χ2 / p / V | ||
| n (%)* | n (%)* | n (%)* | n (%)* | n (%)* | n (%)* | n (%)** | |||
| The contraceptive method used before pregnancy | No | 48(56.5)a | 6(7.1)b | 9(10.6)b | 8(9.4)b | 12(14.1)b | 2(2.4)b | 85(8.9) |
1479.572; .000 V = 0.558 |
| Hormonal methods | 13(4.6)a | 193(68.4)b | 28(9.9)a | 21(7.4)a | 21(7.4)a | 6(2.1)a | 282(29.7) | ||
| Intrauterine devices | 4(2.8)a | 5(3.5)a | 97(68.3)b | 10(7.0)a | 10(7.0)a | 16(11.3) c | 142(14.9) | ||
| Barrier methods | 6(2.9)a | 19(9.0)a | 26(12.4)a | 134(63.8)b | 20(9.5)a | 5(2.4)a | 210(22.1) | ||
| Natural methods | 8(3.7)a,b | 13(6.0)b | 24(11.2)a,b | 12(5.6)b | 146(67.9) c | 12(5.6)a | 215(22.6) | ||
| Surgical methods | 0(0.0)a | 2(11.8)a | 0(0.0)a | 0(0.0)a | 2 (11.8)a | 13(1.3)b | 17(1.8) | ||
| Emergency contraceptive experience | No | 59(6.4)a | 235(25.5)b | 184(20.0) | 184(20.0)b | 206(22.3)b | 53(5.7)b | 922(97.0) |
147.265; .000 V = 0.394 |
| Yes | 20(69.0)a | 3(10.3)b | 0(0.0)b | 0(0.0)b | 5(17.2)b | 1(3.4)b | 29(3.0) | ||
| Access and provision of contraceptive methods | Does not use | 79(100.0)a | 0(0.0)b | 0(0.0)b | 0(0.0)b | 0(0.0)b | 0(0.0)b | 79(8.3) |
1284.553; .000 V = 0.822 |
| Paid | 0(0.0)a | 168(44.2)b | 65(17.1) c | 133(35.0)b | 0(0.0)a | 14(3.7) c | 380(40.0) | ||
| Free of charge | 0(0.0)a | 70(14.2)b | 119(24.2) c | 52(10.6)b | 211(42.9) d | 40(8.1) c | 492(51.7) | ||
| Continuation of contraceptive method | Does not use | 79(100.0)a | 0(0.0)b | 0(0.0)b | 0(0.0)b | 0(0.0)b | 0(0.0)b | 79(8.3) |
1003.034; .000 V = 0.726 |
| Continues | 0(0.0)a | 154(29.1)b,c | 97(18.3) d | 134(25.3) c | 131(24.8)b,d | 13(2.5) e | 529(55.6) | ||
| Changed | 0(0.0)a | 84(24.5)b,c | 87(25.4) d | 51(14.9) c | 80(23.3)b,d | 41(12.0) e | 343(36.1) | ||
| Total | 79(8.3) | 238(25.0) | 184(19.3) | 185(19.5) | 211(22.2) | 54(5.7) | 951(100.0) | ||
* Row percentage, ** column percentage, χ2 = Pearson Chi-square, V = Cramer's V, a,b,c According to Z test results, Columns (groups) coded with the same letters do not differ from each other, The p-values marked in bold indicate statistically significant results (p < 0.05)
Desire to become pregnant again and postpartum contraceptive method preference had a medium effect on women’s contraceptive use intentions (p < 0.05; Table 2).
Table 2.
Distribution of participants' postpartum contraceptive use intention rates according to their socio-demographic and obstetric characteristics
| Variables | Contraceptive intention to use | Statistical analysis | |
|---|---|---|---|
| Mean ± SD | t / F; p | ||
| Age | < 35 | 4.20 ± 3.86 | − 2,776; .006 |
| ≥ 35 | 4.96 ± 4.07 | ƞ2 = 0.008 | |
| Education status | Illiterate (1) | 4.26 ± 3.87 |
3.142; .014 ƞ2 = 0.013 |
| Literate (2) | 4.32 ± 3.94 | ||
| Primary, middle, high school (3) | 4.16 ± 3.94 | ||
| Associate degree (4) | 5.56 ± 3.81 | ||
| Bachelor’s degree and above (5) | 4.91 ± 3.94 | ||
| Within-group comparison* | (4–3) | ||
| Family type | Nuclear family | 4.65 ± 3.98 |
3.007; .003 ƞ2 = 0.009 |
| Extended family | 3.79 ± 3.75 | ||
| Number of living children | 1 | 3.85 ± 3.48 |
5.100; .002 ƞ2 = 0.015 |
| 2 | 4.25 ± 3.86 | ||
| 3 | 5.19 ± 4.47 | ||
| 4 and above | 4.81 ± 4.04 | ||
| Within-group comparison* | (3–1) | ||
| Duration of marriage | 1–5 years (1) | 3.68 ± 3.53 |
14.682;.000 ƞ2 = 0.030 |
| 6–10 years (2) | 4.34 ± 4.10 | ||
| 11 years and above (3) | 5.24 ± 4.07 | ||
| Within-group comparison* | (3–1) (3–2) | ||
| Age at first marriage | < 18 | 5.40 ± 4.08 |
5.439; .004 ƞ2 = 0.011 |
| 18–24 | 4.31 ± 3.85 | ||
| ≥ 25 | 4.11 ± 4.03 | ||
| Within-group comparison* | (1–2) (1–3) | ||
| Profession | No | 4.16 ± 3.85 |
− 4.372; .000 ƞ2 = 0.019 |
| Yes | 5.52 ± 4.08 | ||
| Perception of monthly income level | Income less than expenditure (1) | 4.79 ± 4.01 |
8.258; .000 ƞ2 = 0.011 |
| Income equals expenses (2) | 4.02 ± 3.83 | ||
| Income more than expenditure (3) | 5.48 ± 3.99 | ||
| Within-group comparison* | (1–2) (3–2) | ||
| Place of residence | Province (1) | 4.98 ± 3.98 |
8.347; .000 ƞ2 = 0.017 |
| District (2) | 4.05 ± 3.92 | ||
| Village (3) | 3.66 ± 3.62 | ||
| Within-group comparison* | (1–2) (1-3) | ||
| Presence of chronic disease | No | 4.38 ± 3.94 | − 1.309; .193 |
| Yes | 4.90 ± 3.96 | ||
| Total number of pregnancies | 1 (1) | 4.05 ± 3.58 |
3.778; .010 ƞ2 = 0.011 |
| 2 (2) | 3.99 ± 3.67 | ||
| 3 (3) | 4.61 ± 4.37 | ||
| 4 and above (4) | 4.98 ± 4.08 | ||
| Within-group comparison* | (4–2) | ||
| Number of live births | 1 (1) | 3.88 ± 3.48 |
4.945; .002 ƞ2 = 0.015 |
| 2 (2) | 4.23 ± 3.84 | ||
| 3 (3) | 5.19 ± 4.48 | ||
| 4 and above (4) | 4.81 ± 4.06 | ||
| Within-group comparison* | (3–1) | ||
| Number of miscarriages/mortal births | 0 | 4.36 ± 3.99 | 1.035; .376 |
| 1 | 4.68 ± 3.94 | ||
| 2 | 4.07 ± 3.82 | ||
| 3 and above | 5.37 ± 2.93 | ||
| Age at first pregnancy | ≤ 18 | 5.29 ± 4.02 |
3.158; .002 ƞ2 = 0.010 |
| ≥ 19 | 4.25 ± 3.90 | ||
| Planned pregnancy status | No | 4.72 ± 4.03 | 1.079; .281 |
| Yes | 4.37 ± 3.92 | ||
| Desire to become pregnant again | No | 5.28 ± 4.15 |
10.121; .000 ƞ2 = 0.097 |
| Yes | 2.92 ± 2.98 | ||
| The contraceptive method used before pregnancy | None (1) | 3.01 ± 3.23 |
10.327; .000 ƞ2 = 0.051 |
| Hormonal methods (2) | 3.71 ± 3.66 | ||
| Intrauterine devices (3) | 5.81 ± 4.10 | ||
| Barrier methods (4) | 4.50 ± 4.03 | ||
| Natural methods (5) | 4.76 ± 3.92 | ||
| Surgical methods (6) | 7.41 ± 4.25 | ||
| Within-group comparison* | (3–1) (3–2) (5–1) (6–1)(6–2) | ||
| Emergency contraceptive experience | No | 4.48 ± 3.96 |
2.777; .009 ƞ2 = 0.008 |
| Yes | 3.03 ± 2.73 | ||
| Previous unsuccessful contraceptive method | No | 4.29 ± 3.88 |
− 2.167; .030 ƞ2 = 0.004 |
| Yes | 4.97 ± 4.10 | ||
| Receiving FP counseling after childbirth | No | 4.18 ± 3.83 |
− 4.047; .000 ƞ2 = 0.016 |
| Yes | 5.56 ± 4.20 | ||
| Partner involvement in the FP process | No | 5.05 ± 4.31 |
2.584; .010 ƞ2 = 0.006 |
| Yes | 4.24 ± 3.79 | ||
| Access and provision of contraceptive methods | Does not use (1) | 2.26 ± 2.60 |
15.110; .000 ƞ2 = 0.030 |
| Paid (2) | 4.37 ± 3.97 | ||
| Free (3) | 4.84 ± 3.98 | ||
| Within-group comparison* | (2-3) (3-1) | ||
| Continuation of contraceptive method | Does not use (1) | 2.26 ± 2.60 |
14.595; .000 ƞ2 = 0.029 |
| Continues (2) | 4.79 ± 4.00 | ||
| Changed (3) | 4.40 ± 3.95 | ||
| Within-group comparison* | (2–1) (3–1) | ||
| Postpartum modern contraceptive method using status | Does not use | 3.78 ± 3.53 |
-3.627; .000 ƞ2 = 0.013 |
| Uses | 4.73 ± 4.08 | ||
| Preference for postpartum contraceptive method | None (1) | 2.26 ± 2.60 |
20.189; .000 ƞ2 = 0.096 |
| Hormonal methods (2) | 3.22 ± 3.56 | ||
| Intrauterine devices (3) | 5.76 ± 4.16 | ||
| Barrier methods (4) | 5.03 ± 4.07 | ||
| Natural methods (5) | 4.35 ± 3.66 | ||
| Surgical methods (6) | 6.83 ± 3.79 | ||
| Within-group comparison* | (3–1)(3–2)(3–5)(4–1)(4–2)(5–1)(6–1)(6–2)(6–5) | ||
| Total | 4.44 ± 3.94 |
* Scheffe test, ƞ2 = Eta-square, The p-values marked in bold indicate statistically significant results (p < 0.05)
All variables that had a significant relationship with contraceptive use intention were included in the model. However, VIF values of the variables of the number of living children and the number of live births were determined to be greater than 10. Moreover, tolerance values were observed to be less than 0.2. This situation was considered an indicator of multicollinearity, and these variables were excluded from the model. While continuous variables were directly entered into the model, dummy variables were created for categorical variables equal to one less than the number of categories. The 13 variables in Table 3 explain 26% of the change in contraceptive use intention. According to the standardized regression coefficients, the first three predictor (independent) variables that are effective on the intention to use contraceptives are the continuation of the contraceptive method used before pregnancy in the postpartum period (β = 0.244), the desire to become pregnant again (β = − 0.230), and the level of contraceptive knowledge (β = 0.202).
Table 3.
Multiple linear regression analysis results for the prediction of intention to use postpartum contraceptives
| Variable | Unstandardized coefficients | Standardized coefficients | t | p | Collinearity statistics | ||
|---|---|---|---|---|---|---|---|
| β | Standard error | β | Tolerance | VIF | |||
| Constant | 1.364 | 0.631 | 2.162 | 0.031 | |||
| Level of contraceptive knowledge | 0.209 | 0.032 | 0.202 | 6.590 | 0.000 | 0.832 | 1.201 |
| Desire to become pregnant again | − 1.896 | 0.237 | − 0.230 | − 7.997 | 0.000 | 0.943 | 1.061 |
| Postpartum surgical contraceptive method use | 1.821 | 0.503 | 0.107 | 3.623 | 0.000 | 0.900 | 1.111 |
| Perceiving income as equivalent to expenses | − .976 | 0.224 | − 0.123 | − 4.356 | 0.000 | 0.983 | 1.017 |
| Continuation of the contraceptive method used before pregnancy in the postpartum period | 1.940 | 0.425 | 0.244 | 4.559 | 0.000 | 0.272 | 3.671 |
| Postpartum hormonal contraceptives method use | − 1.183 | 0.271 | − 0.130 | − 4.371 | 0.000 | 0.886 | 1.129 |
| Receiving postpartum FP counseling | 0.958 | 0.291 | 0.096 | 3.293 | 0.001 | 0.928 | 1.077 |
| Changing the contraceptive method used before pregnancy in the postpartum period | 1.448 | 0.442 | 0.176 | 3.273 | 0.001 | 0.270 | 3.707 |
| Attitudes toward family planning | 0.013 | 0.004 | 0.102 | 3.424 | 0.001 | 0.887 | 1.127 |
| First pregnancy under 18 years of age | 0.950 | 0.295 | 0.093 | 3.223 | 0.001 | 0.934 | 1.071 |
| Associate's degree | 0.958 | 0.388 | 0.071 | 2.468 | 0.014 | 0.952 | 1.050 |
| Partner's participation in the FP process | − 0.600 | 0.257 | -0.066 | -2.335 | 0.020 | 0.980 | 1.021 |
| Living in the city center | 0.517 | 0.226 | 0.066 | 2.288 | 0.022 | 0.952 | 1.050 |
Dependent variable: contraceptive intention
R = .516, adjusted R2 = .256, Durbin--Watson = 1.871, F(13,937) = 26.171, p = .000
Discussion
With a fertility rate of 2.51 in 2022, Ağrı is above Türkiye’s mean (1.62) and is the fifth province with the highest fertility rate [20]. In this context, the study conducted in Ağrı province evaluated the postpartum contraceptive method preferences of women aged 15–49 in the postpartum period according to the IMCHB and the conditions affecting their contraceptive use intentions.
Postpartum contraceptive choice allows women to reassess their family planning desires and make informed decisions [21]. Our study found that pre-pregnancy contraceptive use, emergency contraceptive experience, access to contraceptive methods, and method continuation had a significant effect on the participants’ postpartum contraceptive preferences (Table 1). Consistent with previous research, factors such as the availability of affordable contraceptives [4], method continuation [22], prior contraceptive use [23], contraceptive experience [21], educational status [1, 22, 24], and the number of living children also impacted postpartum choices. However, contrary to our findings, some studies noted antenatal counseling and income status as essential factors [21, 24–29]. In the present study, it is thought that women’s preferences for postpartum contraceptive use were influenced by their emergency contraceptive experiences due to the unmet need for family planning, and their desire to continue the method used was due to satisfaction, unwillingness to change habits, and the fact that the technique used was easily accessible and economical.
Women’s preferences and intentions regarding postpartum contraceptive methods are crucial for preventing unintended pregnancies [3]. Our study found that women who did not wish to become pregnant again had higher contraceptive use intentions, with a medium effect size. Specifically, each unit increase in a woman’s desire to become pregnant again decreased contraceptive use intention by 0.230 points. In contrast, Borges et al. [30] found no significant relationship between the desire to conceive and contraceptive intentions among women aged 15–44. In another study, similar to our findings, more than half (54.6%) of the women who did not want to get pregnant again had a low or medium effect on contraceptive use intentions [31]. The varying results in the literature may stem from differing levels of knowledge about postpartum contraceptive methods. Moreover, even if women do not wish to conceive again, disparities in their contraceptive intentions could lead to unintended pregnancies and an increased unmet need for family planning.
The reliability, accessibility, and long-term protection of contraceptive methods influence preferences and intentions to use them [4]. In this study, women using surgical methods or intrauterine devices (IUDs) as postpartum contraceptives exhibited higher use intentions with a medium effect size. A survey of factors affecting postpartum contraceptive use found that condoms and IUDs were the most preferred methods; additionally, advanced age and a higher number of births significantly influenced intentions to use postpartum contraceptives [32]. Another study noted a significant increase in IUD use following postpartum counseling, while surgical method use declined [27]. Research evaluating women’s fertility intentions and unmet family planning needs in five low-income countries found the highest unmet need for family planning among women under 20, those with two or fewer children, those with lower education levels, and those who gave birth at home [3]. It is thought that the presence of accurate and sufficient information about postpartum methods, the decreased desire to have children with advanced age and high fertility, the effectiveness of the technique, the high satisfaction with the method, and also the ease of use of the technique, are effective on the intention to use contraceptive methods.
Women do not want to continue the contraceptive methods they used before pregnancy in the postpartum period due to reasons such as causing unwanted pregnancy, side effects, disapproval of the partner, and not believing that the method is effective [3, 21, 33]. Our study observed that each unit increase in the continuation of the contraceptive method used before pregnancy in the postpartum period increased the intention to use contraceptives by 0.244 points. In a study conducted by Altınbaş et al. [4], it was determined that 76% of women with unintended pregnancies used traditional methods before conception, and this rate decreased to 12% in contraceptive preferences in the postpartum period. In another study, the intention to use postpartum contraceptives was determined to be higher among women who had at least secondary school education, received antenatal care, had knowledge about modern contraceptive use, and had their husband’s consent to use contraceptives [34]. Adequate knowledge of contraceptive methods increases the intention to use, which in turn increases the rate of use in the postpartum period [35]. In our study, each unit increase in contraceptive knowledge level increases the intention to use contraceptives by 0.202 points. In the literature, it was reported that women who know at least one of the modern contraceptive methods have a higher intention to use modern contraceptive methods in the postpartum period [33].
Furthermore, it has been determined that contraceptive counseling increased modern contraceptive use by 3.8% in the first year of the postpartum period [27], and women who received contraceptive counseling were significantly more likely to use effective contraceptive methods in the postpartum period [28]. Accurate and sufficient information about contraceptive methods decreases the use of traditional methods and increases the use of modern methods. Increased knowledge about contraceptive methods contributes to a positive attitude toward family planning [27]. In the present study, each one-point increase in a positive attitude toward family planning increases the intention to use contraceptives by 0.102 points. Similar to our research, it has been reported that previous use of any contraceptive method affects the attitude toward family planning [22], and women who received family planning counseling had a higher intention to use contraceptive methods in the postpartum period [34].
Conclusion
The study found that factors such as the contraceptive method used before pregnancy, emergency contraceptive experience, and access to contraceptive methods had a significant impact on postpartum contraceptive preferences. The continuation of previous contraceptive methods strongly influenced women’s intention to use contraception, their knowledge of contraceptives, and a positive attitude toward family planning. Conversely, the desire to become pregnant again reduced contraceptive intentions. These findings align with previous studies, suggesting that availability, satisfaction, and economic factors are crucial in contraceptive preferences.
Declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Ethical Approval
The study was approved by the Ağrı İbrahim Çeçen University Scientific Research Ethics Committee (Ref. No. 28.12.2022/294), and the institutional permission of the Ağrı Provincial Health Directorate (Ref. No. 29.03.2023/91) was obtained. The study followed the ethical standards laid down in the Declaration of Helsinki.
Informed Consent
Informed consent was obtained from all individual participants included in the study.
Footnotes
Fatma Başaran, PhD, Assistant Professor; Pınar Duru, PhD, Associate Professor; Elmin Eminov, PhD, Assistant Professor.
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
References
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