title: Postpartum contraception utilization among low-income women seeking immunization for infants in Mumbai, India.
abstract: OBJECTIVE
  The objective was to examine postpartum contraception utilization among Indian women seeking immunization for their infants in three low-income communities in Mumbai, India.
  
  
  METHODS
  We conducted a cross-sectional questionnaire of low-income postpartum women seeking immunization for their infants at three large urban health centers in Mumbai. Contraceptive utilization data were collected as part of a larger study focused on the impact of postpartum domestic violence on maternal and infant health. Descriptive, bivariate and multivariate analyses were conducted to describe and identify predictors of postpartum contraceptive utilization.
  
  
  RESULTS
  Postpartum women aged 17-45 years (N=1049) completed the survey; 44.5% (n=467) reported resuming sexual relations with their husbands. Among these women, the majority (65.3%; n=305) reported not currently using contraception. In multivariate analyses, women who did not discuss postpartum family planning with their husbands, had not used contraception previous to the recent birth, and had experienced physical violence or forced sex were more likely to not use postpartum contraception (adjusted odds ratios=1.47-1.77). Among the 162 women using contraception, the most common time to initiation of contraception was 5 weeks postpartum, and the most common method used was condoms 77.8% (n=126).
  
  
  CONCLUSIONS
  Contraception nonuse was common among urban, low-income postpartum women in India. This study highlights the importance of developing interventions to increase use of highly effective contraceptive methods postpartum, and that spousal violence and lack of marital communication may present barriers to postpartum contraception utilization. Infant immunization may represent an opportunity for provision of contraceptives and contraceptive counseling.
  
  
  CONCLUSIONS
  This original research study is a unique contribution to the literature because it presents data regarding the nonuse of postpartum contraception among women seeking immunizations for their infants in urban centers in a developing country. It also reveals barriers to not using postpartum contraception and provides data for future interventions.
authors.affiliation: Department of Reproductive Medicine, University of California, San Diego School of Medicine, San Diego, CA 92103, USA; Center on Gender Equity and Health, Division of Global Public Health, University of California, San Diego School of Medicine, San Diego, CA, USA. Electronic address: smody@ucsd.edu.
authors.forename: Sheila K
authors.initials: SK
authors.lastname: Mody
authors.affiliation: National Institute for Research on Reproductive Health, Mumbai, India.
authors.forename: Saritha
authors.initials: S
authors.lastname: Nair
authors.affiliation: Center on Gender Equity and Health, Division of Global Public Health, University of California, San Diego School of Medicine, San Diego, CA, USA; Joint Doctoral Program in Public Health (Global Health), University of California, San Diego/San Diego State University, San Diego, CA, USA.
authors.forename: Anindita
authors.initials: A
authors.lastname: Dasgupta
authors.affiliation: Center on Gender Equity and Health, Division of Global Public Health, University of California, San Diego School of Medicine, San Diego, CA, USA.
authors.forename: Anita
authors.initials: A
authors.lastname: Raj
authors.affiliation: National Institute for Research on Reproductive Health, Mumbai, India.
authors.forename: Balaiah
authors.initials: B
authors.lastname: Donta
authors.affiliation: Population Council, New Delhi, India.
authors.forename: Niranjan
authors.initials: N
authors.lastname: Saggurti
authors.affiliation: National Institute for Research on Reproductive Health, Mumbai, India.
authors.forename: D D
authors.initials: DD
authors.lastname: Naik
authors.affiliation: Center on Gender Equity and Health, Division of Global Public Health, University of California, San Diego School of Medicine, San Diego, CA, USA.
authors.forename: Jay G
authors.initials: JG
authors.lastname: Silverman
mesh_terms: D000293:Adolescent; D000328:Adult; D002662:Child Health Services; D017280:Condoms; D003268:Contraception Behavior / Q000208:ethnology; D003276:Contraceptives, Oral / Q000008:administration & dosage*; D003430:Cross-Sectional Studies; D005193:Family Planning Services; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D007114:Immunization; D007194:India; D007223:Infant; D008425:Maternal Behavior / Q000208:ethnology; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000208:ethnology; D049590:Postpartum Period; D011204:Poverty Areas; D012725:Sexual Behavior / Q000208:ethnology; D013179:Spouse Abuse / Q000208:ethnology; D019037:Urban Health Services; D055815:Young Adult
chemical_list: D003276:Contraceptives, Oral
keywords: Birth-to-pregnancy interval; Contraception; Immunization; Postpartum