Determinants of Family Planning Service Uptake and Use of Contraceptives among Postpartum Women in Rural Uganda

Uganda is among the countries with the highest unmet needs for family planning, which is associated with both negative health outcomes for women. The present study was a cross-sectional secondary data analysis using Andersen’s Behavioral Model of Health Service Use (ABM) as a theoretical framework to identifying factors influencing family planning service uptake and contraceptive use among postpartum women in rural Uganda. Participants were 258 women who attended antenatal care at a rural Ugandan hospital and completed an interview approximately 13 weeks postpartum. Bivariate logistic regression models in SPSS were used to test hypothesized ABM factors as determinants of family planning service uptake and contraceptive use postpartum. Variables that were statistically significant in the bivariate models were included in two separate multivariate hierarchical logistic regression analysis with the two outcomes. With all variables accounted for, statistically significant predictors of uptake of family planning services included: education (enabling factor) (AOR=3.03, 95% CI=1.57-5.83), prior use of contraceptives (predisposing factor) (AOR=7.15, 95% CI=1.58-32.37), partner communication about contraceptives (relationship factor) (AOR=1.80, 95% CI=1.36-2.37), and perceived need of contraceptives (need factor) (AOR=2.57, 95% CI=1.09-6.08). Statistically significant predictors of use of contraceptives since delivery included: education (enabling factor) (AOR=2.04, 95% CI=1.05-3.95), prior use of contraceptives (predisposing factor) (AOR=10.79, 95% CI=1.40-83.06), and partner communication about contraceptives (relationship factor) (AOR=1.81, 95% CI=1.34-2.44). These findings identify predisposing, enabling, relationship, and need factors in the ABM as key determinants of postpartum women’s family planning service uptake and contraceptive use, and should be considered in antenatal and postnatal family planning counseling