Uptake of postpartum long-acting reversible contraception among adolescent mothers in Kamuli District, Uganda

Abstract

Repeat adolescent pregnancy and child bearing is associated with higher morbidity and mortality risk compared to primary pregnancies. To reduce their incidence in adolescence, use of Long- Acting Reversible Contraception (PPLARC) in the early postpartum period, within 6 weeks of giving birth is most ideal for adolescent mothers as it can guarantee optimal interpregnancy and birth intervals. To assess the uptake of, factors associated with and perceptions towards Postpartum Long-acting Reversible Contraception among adolescent mothers in Kamuli district, Uganda. Between April and May 2024, a mixed methods study was conducted in Kamuli district, where 634 randomly selected adolescent mothers who had had a live birth from their most recent pregnancy and were within the 6 weeks to 6 months postpartum period were engaged in structured interviews for the quantitative domain whereas 15 adolescent mothers and 9 health care providers were purposively sampled and engaged in in-depth and key informant interviews respectively, for the qualitative domain of the study. Quantitative data was analyzed in SPSS version 25, using a binomial logit model, while qualitative data was analyzed thematically. The prevalence of PPLARC uptake among adolescent mothers in Kamuli district was 7%. Being currently married (aOR = 13.99[95% CI = 4.12 - 47.51]), reception of family planning counseling after child birth (aOR = 6.99 [95% CI = 1.90 – 25.72]), being told about the possibility of receiving an intrauterine device or implant just after childbirth by skilled birth attendants (aOR = 36.63 [95% CI = 6.37 – 50.66]), having been in a marital relationship for 24 months (aOR = 3.29 [95% CI = 1.16 - 9.30]), a history of modern contraception use (aOR = 2.85 [95% CI = 1.51 - 5.38]), and being categorically educated about the need for postpartum contraception (aOR = 2.81 [95% CI = 1.21 – 6.54]) were associated with higher odds of PPLARC uptake. Misconceptions about long-acting reversible contraceptives, perceived side effects, husband support, family planning counselling and stockout of contraceptives were the perceived antecedents of PPLARC uptake. Few adolescent mothers in Kamuli district utilize PPLARC. Thus, majority are at a very high risk of repeat pregnancy and birth during adolescence. This is being driven mostly by adolescent intrapersonal, interpersonal and to a comparatively lesser extent, institutional characteristics. Strengthening contraception counseling and service provision to adolescent mothers and encouraging partner involvement in maternal health care including contraception would improve PPLARC uptake.