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Introduction Postpartum family planning (PPFP) has been reported to decrease the risk of stunting by increasing the interval between pregnancies by 0.9 percent every month. In Indonesia, the prevalence of stunting affects 21.6% in 2022; however, it is expected that by 2024, the figure would drop to 14%. Objective This study aims to analyze the relationship between gender equality and husband support in the use of PPFP. Methods The study was conducted using a cross-sectional method and took place from August to October 2022. The participants comprised 210 women who had given birth in the first 4 to 12 months in Kulon Progo, Yogyakarta, Indonesia. The data was collected from women who visited the pediatrics and family planning clinics of community health centers from August to October 2022, using a structured questionnaire and analyzed using both the Chi-Square Test and Binary Logistic Regression Analysis. Results The results showed that 38.1% of the participants used PPFP. The estimated results reveal that variables such as education, husband support, gender equality, home visits, and postnatal visits (p < 0.05) influenced the implementation of postpartum contraception. While other variables such as age, occupation, income, number of children, and parity did not affect the model (p > 0.05). Conclusion Participating in postpartum family planning requires the husband's support and gender equality. We recommend a deliberate effort on improving postnatal mothers using postpartum family planning, one of the strategies is to increase intensive outreach to pregnant women with higher education to their husbands about the importance of postpartum family planning.

Background Though modern contraceptive use among married women in Nepal has increased from 26% in 1996 to 43% in 2016, it remains low among postpartum women. Integration of counselling on family planning (FP) at the time of antenatal care (ANC) and delivery has the potential to increase post-partum contraceptive use. This study investigates the quality of FP counselling services provided during ANC visits and women’s perceptions of its effectiveness in assisting them to make a post-partum family planning (PPFP) decision. Methods In-depth interviews (IDIs) were conducted with 24 pregnant women who had attended at least two ANC visits in one of the six public hospitals that had received an intervention that sought to integrate FP counselling in maternity care services and introduce postpartum intrauterine device insertion in the immediate postpartum period. IDIs data were collected as part of a process evaluation of this intervention. Women were selected using maximum variation sampling to represent different socio-demographic characteristics. IDIs were audio recorded, transcribed verbatim in Nepali, and translated into English. Data were organized using Bruce-Jain quality of care framework and analyzed thematically. Results Overall, the quality of FP counselling during ANC was unsatisfactory based on patient expectations and experience of interactions with providers, as well as FP methods offered. Despite their interest, most women reported that they did not receive thorough information about FP, and about a third of them said that they did not receive any counselling services on PPFP. Reasons for dissatisfaction with counselling services included very crowded environment, short time with the provider, non-availability of provider, long waiting times, limited number of days for ANC services, and lack of comprehensive FP-related information, education and counselling (IEC) materials. Women visiting hospitals with a dedicated FP counselor reported higher quality of FP counselling. Conclusions There is an urgent need to re-visit the format of counselling on PPFP during ANC visits, corresponding IEC materials, counselling setting, and to strengthen availability and interaction with providers in order to improve quality, experience and satisfaction with FP counselling during ANC visits. Improvements in infrastructure and human resources are also needed to adequately meet women’s needs.

Background: Maternal mortality in Liberia is one of the highest in Sub-Saharan Africa. Post-partum family planning (PPFP) can reduce the risk of maternal mortality by preventing unwanted and closely spaced pregnancies. Yet, the uptake of PPFP is low in Liberia. Objective: We investigated the barriers to acceptance of PPFP use among women in Montserrado County, Liberia. Materials and Methods: A cross-sectional facility-based survey was conducted using a multistage sampling technique to select 378 women within 12 months' post-partum period. Results: About half of our respondents were <25 years (52.9%), 24.1% were married, 66.4% had at least secondary education and 92.1% were Christians. The most commonly reported barriers were the fear of side effects (22.0%) and the post-partum abstinence (22.2%). Binary logistic regression analysis showed that being within the early post-partum period, i.e., within the first 6 months (adjusted odds ratio [AOR] = 0.23, 95% confidence interval [CI] [0.09-0.60] and lack of access to PPFP [AOR = 0.22, 95% CI [0.09-0.52]). Importantly, women who were married [AOR = 1.686, 95% CI (0.65, 4.36)] and those who were aware of PPFP [AOR 3.69, 95% CI (1.224, 11.096)] increased the likelihood of using PPFP. Conclusion: Important barriers to the utilisation of PPFP in Liberia were being within early post-partum period, lack of access and awareness of PPFP including myths and misconception. Therefore, health communication targeting mothers for PPFP at every contact with maternal and childcare services should be encouraged.

Background Postpartum family planning (PPFP) focuses on prevention of unintended pregnancy and closely spaced pregnancies through the first 12 months following childbirth. Adoption of family planning during the postpartum period in Egypt faces unique challenges. This study aimed to explore the socio-cultural and health service challenges related to PPFP in Alexandria, Egypt, from perspectives of family planning providers working in public settings. Methods Three focus group discussions were conducted in the period from May to July 2017. It included 32 family planning physicians working in the family health centers and maternal and child health centers in Alexandria for 3 years or more. A discussion guide was prepared. Analysis of data was done using thematic data analysis using a deductive approach. Results The working experience of participants ranged from 3 to 30 years. The most frequently reported reasons for unmet need for PPFP were cultural norms about the contraceptive effects of lactation and inaccurate knowledge of women about the conditions for appropriate use of the lactation amenorrhea as a contraceptive method. The most commonly cited challenge related to the quality of service was the inadequate health education services about PPFP. Lack of training and supervision of community health workers was one of the underlying causes of the perceived inadequacy of the service. Conclusions Mass media campaigns advocating for family planning are urgently needed with full support from the government. Improvement of health education services is a must. Redistribution of family planning providers with an increase in the staff members is highly recommended.

Immediate postpartum family planning refers to the provision of family planning counseling and contraception methods to a woman within the first 48 hours after childbirth. This provision of family planning fills gaps in terms of Knowledge (limited evidence on overall IPPFP utilization beyond single methods inadequate data on how women's empowerment, partner involvement and counseling quality jointly influence IPPFP utilization), practice (poor understanding of health facility- and provider-related barriers such as;- counseling practices, staff training, method availability and documentation), Methodologically, the study generates, the current status of IPPFP utilization, and identify the barriers of IPPFP utilization. An institution-based cross-sectional study was conducted at public hospitals in Addis, Ababa, from February to March 2025 with a total of 442 study participants. Systematic random sampling technique was used to select the study participants. Pretested, structured interviewer-administered questionnaire was used to collect the data. Collected data were entered into Epi-data version 3.1 and analyzed using the Statistical Package for the Social Sciences (SPSS). Bi-variable logistic regression analysis was carried out and Statistical significance was declared at a p value <0.05 with a 95% confidence interval. The prevalence of immediate postpartum family planning utilization was 17.5% (95% CI: 14.3-21.5). Factors significantly associated with IPPFP utilization included good knowledge (AOR = 4.8; 95% CI: 1.73-13.3), receiving postnatal counseling (AOR = 2.11; 95% CI: 1.07-4.17), awareness of contraceptive contraindications (AOR = 2.82; 95% CI: 1.02-3.23), and having 2-4 living children (AOR = 2.7; 95% CI: 1.35-5.40). IPPFP utilization was low compared to the national target (40%). Key factors influencing utilization included knowledge, postnatal counseling, awareness of contraindications, and parity. Strengthening counseling before discharge, improving community awareness, and ensuring providers consistently offer IPPFP to all eligible women are recommended to enhance utilization.

Background Immigrant women’s challenges in realizing sexual and reproductive health and rights (SRHR) are exacerbated by the lack of knowledge regarding how to tailor post-partum contraceptive services to their needs. Therefore, the overall aim of the IMPROVE-it project is to promote equity in SRHR through improvement of contraceptive services with and for immigrant women, and, thus, to strengthen women’s possibility to choose and initiate effective contraceptive methods post-partum. Methods This Quality Improvement Collaborative (QIC) on contraceptive services and use will combine a cluster randomized controlled trial (cRCT) with a process evaluation. The cRCT will be conducted at 28 maternal health clinics (MHCs) in Sweden, that are the clusters and unit of randomization, and include women attending regular post-partum visits within 16 weeks post birth. Utilizing the Breakthrough Series Collaborative model, the study’s intervention strategies include learning sessions, action periods, and workshops informed by joint learning, co-design, and evidence-based practices. The primary outcome, women’s choice of an effective contraceptive method within 16 weeks after giving birth, will be measured using the Swedish Pregnancy Register (SPR). Secondary outcomes regarding women’s experiences of contraceptive counselling, use and satisfaction of chosen contraceptive method will be evaluated using questionnaires completed by participating women at enrolment, 6 and 12 months post enrolment. The outcomes including readiness, motivation, competence and confidence will be measured through project documentation and questionnaires. The project’s primary outcome involving women’s choice of contraceptive method will be estimated by using a logistic regression analysis. A multivariate analysis will be performed to control for age, sociodemographic characteristics, and reproductive history. The process evaluation will be conducted using recordings from learning sessions, questionnaires aimed at participating midwives, intervention checklists and project documents. Discussion The intervention’s co-design activities will meaningfully include immigrants in implementation research and allow midwives to have a direct, immediate impact on improving patient care. This study will also provide evidence as to what extent, how and why the QIC was effective in post-partum contraceptive services. Trial registration NCT05521646, August 30, 2022.

Low uptake of family planning (FP) particularly during the postpartum period contributes to unintended pregnancies, thus increasing the risk of maternal morbidity and mortality globally. This cross-sectional mixed-methods study explored barriers to FP in rural southwest Nigeria using surveys from 388 men and women and interviews with 14 midwives across three states (June–July 2022). Eligible participants included postpartum women, men, and midwives. Quantitative data were analyzed using SPSS, and qualitative data using Braun and Clarke's thematic analysis in Atlas.ti. The results show that although 62.6% of respondents had good knowledge of FP, only 35.5% reported current use. However, positive attitude (OR=1.689, 𝑝<0.05), tertiary education (OR=2.331, 𝑝<0.05), and having multiple partners (OR=1.793, 𝑝<0.05) were significant predictors. Thematic analysis of provider interviews revealed user-related, provider-related, and health system barriers. The study highlights the need for targeted FP education and structural interventions to improve uptake and overcome both individual and systemic challenges in rural communities. La faible utilisation de la planification familiale, en particulier pendant la période post-partum, contribue aux grossesses non désirées, ce qui augmente le risque de morbidité et de mortalité maternelles à l'échelle mondiale. Cette étude transversale à méthodes mixtes a exploré les obstacles à la planification familiale dans les zones rurales du sud-ouest du Nigéria à l'aide d'enquêtes auprès de 388 hommes et femmes, ainsi que d'entretiens avec 14 sages-femmes dans trois États (juin–juillet 2022). Les participantes admissibles comprenaient des femmes en post-partum, des hommes et des sages-femmes. Les données quantitatives ont été analysées à l'aide de SPSS, et les données qualitatives selon l'analyse thématique de Braun et Clarke dans Atlas.ti. Les résultats indiquent que bien que 62,6 % des répondants aient une bonne connaissance de la planification familiale, seulement 35,5 % ont déclaré en faire un usage actuel. Toutefois, une attitude positive (OR=1,689, p<0,05), un niveau d'études supérieures (OR=2,331, p<0,05) et le fait d'avoir plusieurs partenaires (OR=1,793, p<0,05) étaient des prédicteurs significatifs. L'analyse thématique des entretiens avec les prestataires a révélé des obstacles liés aux usagers, aux prestataires et au système de santé. L'étude souligne la nécessité d'une éducation ciblée sur la planification familiale et d'interventions structurelles pour améliorer l'utilisation et surmonter les obstacles individuels et systémiques dans les communautés rurales.

Background: One of the manifestations of family development is pregnancy planning, where this method is applied 0–42 days after childbirth. Post-partum contraception is an effort to avoid pregnancy by using contraceptive medicine from 42 days to 84 days after childbirth. Purpose: This research aims to analyze the attitudes of fertile couples who use contraceptive devices after childbirth during the COVID-19 pandemic and the factors that influence it. Method: This research uses a quantitative method approach. The sampling technique was random sampling with proportional sampling so that 280 respondents were obtained from 3 regencies/cities in West Java with high fertility rates and low post-partum contraceptive participation rates. Quantitative data analysis used univariate, bivariate, and multivariate methods. Result: The results showed that the final model of the analysis of the most determining factors for post-partum contraception during a pandemic were family support, healthcare staff support, counselling with healthcare staff, attitudes, and age at first marriage. Conclusion: Fertile couples with the highest amount of family support are more likely to use post-partum contraceptive devices during COVID-19. The results of this study can be used as material for consideration in making decisions about post-partum contraception, especially during the COVID-19 pandemic.

Background. The copper intrauterine device is one of the most safe, effective, and cost-effective methods for preventing unintended pregnancy. It can be used postpartum irrespective of breastfeeding to improve birth spacing and reduce unintended pregnancy and maternal-child mortality. However, this method remains highly underutilized. Methods. We developed a multi-level intervention to increase uptake of the postpartum intrauterine device (PPIUD, defined as insertion up to six weeks post-delivery) in Kigali, Rwanda. High-volume hospitals and health centers were selected for implementation of PPIUD counseling and service delivery. Formative work informed development of a PPIUD counseling flipchart to be delivered during antenatal care, labor and delivery, infant vaccination visits, or in the community. Two-day didactic counseling, insertion/removal, and follow-up trainings were provided to labor and delivery and family planning nurses followed by a mentored practicum certification process. Counseling data were collected in government clinic logbooks. Insertions and follow-up data were collected in logbooks created for the implementation. Data were collected by trained government clinic staff and abstracted/managed by study staff. Stakeholders were involved from intervention development through dissemination of results. Results. Two hospitals (and their two associated health centers) and two additional health centers were selected. In 6-months prior to our intervention, 7.7 PPIUDs/month were inserted on average at the selected facilities. From August 2017-July 2018, we trained 83 counselors and 39 providers to provide PPIUD services. N=9,020 women received one-on-one PPIUD counseling after expressing interest in family planning who later delivered at a selected health facility. Of those, n=2,575 had PPIUDs inserted (average of 214.6 insertions/month), a 29% uptake. Most PPIUDs (62%) were inserted within 10 minutes of delivery of the placenta. Conclusions. This successful, comprehensive intervention has the potential to make a significant impact on PPIUD uptake in Rwanda. The intervention is scalable and adaptable to other sub-Saharan African countries.

Background Family planning services in the post-partum period, termed post-partum family planning (PPFP) is critical to cover the unmet need for contraception, especially when institutional delivery rates have increased. However, the intention to choose PPFP methods such as post-partum intrauterine devices (PPIUD) remains low in countries such as Nepal. Community health workers such as Female Community Health Volunteers (FCHVs) could play an important role in improving the service coverage of PPFP in Nepal. However, their knowledge of PPFP and community-based services related to PPFP remain unclear. This study aims to assess the effect on community-based PPFP services by improving FCHV’s knowledge through orientation on PPFP. Methods We conducted this mixed-methods study in Morang District in Nepal. The intervention involved orientation of FCHVs on PPFP methods. We collected quantitative data from three sources; via a survey of FCHVs that assessed their knowledge before and after the intervention, from their monthly reporting forms on counseling coverage of women at different stages of pregnancy from the communities, and by interviewing mothers in their immediate post-partum period in two selected hospitals. We also conducted six focus group discussions with the FCHVs to understand their perception of PPFP and the intervention. We performed descriptive and multivariable analyses for quantitative results and thematic analysis for qualitative data. Results In total, 230 FCHVs participated in the intervention and their knowledge of PPFP improved significantly after it. The intervention was the only factor significantly associated with their improved knowledge (adjusted odds ratio = 24, P  < 0.001) in the multivariable analysis. FCHVs were able to counsel 83.3% of 1872 mothers at different stages of pregnancy in the communities. In the two hospitals, the proportion of mothers in their immediate post-partum period whom reported they were counseled by FCHVs during their pregnancy increased. It improved from 7% before the intervention to 18.1% ( P  < 0.001) after the intervention. The qualitative findings suggested that the intervention improved their knowledge in providing PPFP counseling. Conclusion The orientation improved the FCHV’s knowledge of PPFP and their community-based counseling. Follow-up studies are needed to assess the longer term effect of the FCHV’s role in improving community-based PPFP services.