The relationship of age & antenatal care with immediate uptake of postpartum contraception in poor populations of four Mesoamerican countries: Findings from the baseline evaluation of the Salud Mesoamerica Initiative

Thesis (Master's)--University of Washington, 2017-09Objective: To test the association of age and antenatal care (ANC) with immediate uptake of postpartum family planning methods in the poorest populations of Guatemala, Honduras, Mexico, and Nicaragua. Study Design: The Salud Mesoamerica Initiative is a results-based financing initiative targeting maternal and child health in the poorest quintile of the population. Using information collected during the household surveys for the baseline round of the evaluation, we ran a country-specific multivariable logit regression predicting immediate uptake of postpartum family planning methods after delivery, accounting for socioeconomic and household characteristics. Results: Our total sample size was 4,844 women, all of whom had delivered at least once in the last three years. Using the most recent birth, we found that the proportion of women that did not receive a modern method of family planning within one day after delivery ranged from 40% of women in Nicaragua to nearly 99% in Guatemala. After controlling for sociodemographic and household characteristics, age was not significantly associated with uptake of postpartum family planning methods, but receipt of four ANC visits was a significant predictor in Guatemala (Adjusted Odds Ratio [OR] = 5.81, 95% Confidence Interval [CI] = 1.40-24.12) and Mexico (OR = 2.33, CI = 1.45-3.74). Conclusions: Adolescents and older women are equally likely to receive postpartum family planning methods immediately, but the vast majority of women receive no method. Uptake of the WHO-recommended four ANC visits was positively associated with immediate postpartum family planning methods in Guatemala and Mexico, but receipt of fewer than four visits was not significant. Further research is needed to understand the interactions between quality and quantity of ANC, and whether educational tools are being properly utilized at every ANC visit. Keywords: Family planning, postpartum, poverty, Salud Mesoameric