Abstract
There are limited data on uptake of postpartum family planning (FP), particularly in high HIV prevalence settings. We assessed the timing of modern postpartum FP initiation and the cofactors of earlier uptake using longitudinal data from a clinical trial conducted in Kenya to assess two models of PrEP delivery among pregnant and postpartum women (NCT#03070600). Time to uptake of modern postpartum FP was estimated using survival analysis methods, and Cox proportional hazard models were used to determine cofactors of earlier uptake of modern postpartum FP. Among 4,191 women, median age was 24 years, 17% were aged 15-19 years, 88% were in a steady relationship, 50% intended to be pregnant and 75% were multigravida. The median time to resumption of sex was 8 weeks postpartum versus 24 weeks for uptake of postpartum FP. At 6 weeks postpartum, 42% of women had resumed sex, versus 12% who took up FP; at 14 weeks, 79% versus 38%; at 6 months, 88% versus 59%; and at 9 months, 91% versus 80%, respectively. Injectables and implants were the most common FP methods. Approximately 3.3% of all women became pregnant during the 9-month postpartum period. Being older and having ≤4children was associated with earlier uptake of modern postpartum FP. Women with lower education, primigravida, low social support, history of miscarriage/stillbirth, without a partner at enrolment, not residing with their partners, not receiving financial support from their partner and whose youngest child at enrolment was < 2years had later uptake of postpartum FP. Women who were ambivalent about their immediate previous pregnancy took up postpartum FP later than those who intended to be pregnant. Our findings underscore the importance of addressing the individual, interpersonal, social and obstetric factors associated with timeliness of postpartum FP uptake during the development and delivery of postpartum FP interventions, particularly in high HIV prevalence settings.