Examining the mismatch between fertility desire and contraceptive behaviour in the extended postpartum period in Uganda

Abstract

In the two years following delivery, women often have an unmet need for family planning, with unplanned and not-optimally spaced pregnancies. Drawing on quantitative and qualitative data, this thesis explores women’s expressed fertility desire, decisions about further childbearing, and contraceptive use among Ugandan women in the extended postpartum period. Data from the 2016 Uganda Demographic and Health Survey (n=5,088 women) were analysed in bivariate and multivariate logistic regression. Qualitative data from 43 interviews with women and men, and 13 family planning providersliving in Mayuge district, Uganda, were transcribed, coded and analysed using thematic analysis.

Overall, most women reported desire for further children; having children of the same sex, was associated with increased fertility desire, as was being Muslim. Practising postpartum abstinence, reporting the last child was unwanted, having at least, or more than the desired number of children, being unmarried, no formal education, and being unemployed were negatively associated with fertility desire. In interviews, Muslim men reported to desire large family sizes; women said to continue childbearing to maintain marital stability—implying a need for family planning programmes to actively engage male partners. Contraceptive use was low (33%) and inconsistent with the 92% of women who said not to want a child soon. In interviews, the mismatch was attributed to poor access to contraceptives, side effects, being amenorrhoeic, and provider and partner attitudes. Women recognised they were not at risk of pregnancy while amenorrhoeic, but did not appreciate they could conceive before return of menstruation; educational efforts are needed to encourage the uptake of contraception during postpartum amenorrhoea.

In conclusion, programme implementers need to take social norms that favour child sex preference into consideration when providing support to women in their fertility-decision making. This could be done through opinion leaders, such as religious leaders and community leaders, to increase understanding of the importance of birth spacing for women and childrens’ health.

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ORCID for Nyovani Madise: orcid.org/0000-0002-2813-5295

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