title: Patterns of Contraceptive Adoption, Continuation, and Switching after Delivery among Malawian Women.
abstract: Women who report use of postpartum family planning may not continue their initial method or use it consistently. Understanding the patterns of method uptake, discontinuation, and switching among women after delivery is important to promote uptake and continuation of effective methods of contraception. This is a secondary analysis of 634 Malawian women enrolled into a prospective cohort study after delivery. They completed baseline surveys upon enrollment and follow-up telephone surveys 3, 6, and 12 months post-delivery. Women were included in this analysis if they had completed at least the 3- and 6-month post-delivery surveys. Descriptive statistics were used to assess contraceptive method mix and patterns of switching, whereas Pearson's χ2 tests were used for bivariable analyses to compare characteristics of women who continued and discontinued their initial post-delivery contraceptive method. Among the 479 women included in this analysis, the use of abstinence/traditional methods decreased and the use of long-acting and permanent methods (LAPM) increased over time. Almost half (47%) discontinued the contraceptive method reported at 3-months post-delivery; women using injectables or LAPM at 3-months post-delivery were significantly more likely to continue their method than those using non-modern methods (p<0.001). Of the 216 women who switched methods, 82% switched to a more or equally effective method. The change in contraceptive method mix and high rate of contraceptive switching in the first 12 months postpartum highlights a need to assist women in accessing effective contraceptives soon after delivery.
authors.affiliation: UNC Project-Malawi, Lilongwe, Malawi.|UNC Department of Obstetrics & Gynecology, Chapel Hill, North Carolina, United States of America.
authors.forename: Dawn M
authors.identifier: http://orcid.org/0000-0003-4065-0625
authors.initials: DM
authors.lastname: Kopp
authors.affiliation: UNC Project-Malawi, Lilongwe, Malawi.|UNC Department of Epidemiology, Chapel Hill, North Carolina, United States of America.
authors.forename: Nora E
authors.initials: NE
authors.lastname: Rosenberg
authors.affiliation: UNC Department of Obstetrics & Gynecology, Chapel Hill, North Carolina, United States of America.
authors.forename: Gretchen S
authors.initials: GS
authors.lastname: Stuart
authors.affiliation: Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, Ohio, United States of America.
authors.forename: William C
authors.initials: WC
authors.lastname: Miller
authors.affiliation: UNC Project-Malawi, Lilongwe, Malawi.|UNC Department of Medicine, Chapel Hill, North Carolina, United States of America.
authors.forename: Mina C
authors.initials: MC
authors.lastname: Hosseinipour
authors.affiliation: Malawi College of Medicine Department of Obstetrics & Gynaecology, Blantyre, Malawi.
authors.forename: Phylos
authors.initials: P
authors.lastname: Bonongwe
authors.affiliation: Bwaila Hospital, Lilongwe District Health Office, Lilongwe, Malawi.
authors.forename: Mwawi
authors.initials: M
authors.lastname: Mwale
authors.affiliation: UNC Project-Malawi, Lilongwe, Malawi.|UNC Department of Obstetrics & Gynecology, Chapel Hill, North Carolina, United States of America.
authors.forename: Jennifer H
authors.initials: JH
authors.lastname: Tang
mesh_terms: D000293:Adolescent; D000328:Adult; D003270:Contraceptive Agents / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D008295:Malawi; D049590:Postpartum Period; D011247:Pregnancy; D055815:Young Adult
chemical_list: D003270:Contraceptive Agents