Determinants of contraceptive use and related behaviors among postpartum women in rural Uganda

Uganda is among the countries with the highest rates of an unmet need for family planning, which is associated with negative health outcomes. The present study aimed to identify factors influencing contraceptive use among postpartum women in Uganda. 258 women who attended antenatal care at a rural Ugandan hospital completed an interview 13 weeks post-partum. We used linear- and logistic-regression models in SPSS to test the following as determinants of intentions to use contraceptives, intentions to delay future pregnancy, and use of an effective contraceptive: sociodemographic variables, time to clinic, power in sexual decision making, history of intimate partner violence, post-partum depression, contraceptive knowledge, attitudes, behavioral skills related to contraceptive use, perceived partner's attitudes towards family planning, partner communication about family planning, and prior use of contraceptives. Statistically significant factors were included in stepwise regression analysis with the three outcomes. With all variables accounted for, significant predictors for the three outcomes include: 1) intentions to use contraceptives: time to clinic (t=-2.28, p=.02), partner attitudes (t=2.12, p=.04), prior use of contraceptives (t=3.08, p=.002); 2) intentions to delay future pregnancy: education (t=2.88, p=.004), depression (t=2.49, p=.01); 3) use of any contraceptives: time to clinic (OR .29, 95% CI .10-.87), intentions to use contraceptives (OR 2.37, 95% CI 1.04-5.41), communication with partner (OR 2.09, 95% CI 1.42-3.07), prior use of contraceptives (OR .07, 95% CI .01-.60). These findings, showing both structural and individual-level determinants of contraceptive use, highlight the importance of using a multi-level approach for interventions that aim to increase contraceptive use.