Postpartum modern contraception utilization and its determinants in Ethiopia: A systematic review and meta-analysis

Abstract

Background: Contraceptive use is the best and most cost-effective strategy to reduce feto-maternal adverse effects of short birth intervals. More than two-thirds of women in developing countries who do not want to conceive are not using contraception methods. Although there were various primary studies in different parts of the country, there is no nationally representative evidence on postpartum modern contraception utilization and its determinants in Ethiopia.

Objective: This review was aimed to determine the best available pieces of evidence to pool the magnitude of postpartum modern contraception utilization and find out its determinants.

Methods: Published studies were extensively searched by using electronic databases and unpublished studies were identified from the digital library. All observational studies conducted on the magnitude of postpartum modern contraception utilization and its determinants in Ethiopia were included. Data were extracted on the Microsoft Excel spreadsheet and analyzed using STATA 14.1 version. A random-effects model was used to estimate the pooled magnitude of postpartum modern contraception utilization with a 95% confidence interval (CI). Inverse variance (I2) was used to identify the presence of heterogeneity and forest plot was used to estimate the pooled magnitude of postpartum contraception utilization. The presence of publication bias was assessed by funnel plots and Egger's statistical tests. Sub-group analysis was computed to minimize underlying heterogeneity.

Findings: In this review, 19 primary studies were included. The pooled magnitude of postpartum modern contraception utilization in Ethiopia was 45.79% (95%CI 36.45%, 55.13%). The review found that having more than four Antenatal care visits(ANC), having postnatal care visit (PNC), having a formal education, history of family planning use, history of counseling on family planning, and having greater than four alive children as significant determinants of postpartum modern contraception utilization.

Conclusion: The magnitude of postpartum modern contraception utilization in Ethiopia was low. ANC visit, PNC visit, maternal educational status, history of previous family planning use, counseling on family planning, and number of alive children were found to be significant determinants of postpartum modern contraception utilization. Therefore, strengthening focused ANC and PNC services to encourage women in utilizing modern contraception during the postnatal period is needed.

Fig 1. PRISMA flow diagram of included studies in the systematic review and meta-analysis postpartum modern contraception utilization in Ethiopia, 2020.

Fig 2. Forest plot of the pooled magnitude of postpartum modern contraception utilization in Ethiopia, 2020.

Fig 3. Forest plot subgroup analysis of magnitude of postpartum modern contraception utilization in Ethiopia, 2020.

Fig 4. Funnel plot with 95% confidence limit of the pooled magnitude of postpartum modern contraception utilization in Ethiopia, 2020.

Fig 5. Sensitivity analyses for single study influence of magnitude of postpartum modern contraception utilization in Ethiopia, 2020.

Fig 6. Forest plot of association between postpartum modern contraception utilization and number of ANC visit in Ethiopia, 2020.

Fig 7. Forest plot of association between postpartum modern contraception and PNC visit among postnatal women in Ethiopia, 2020.

Fig 8. Forest plot of association between postpartum modern contraception utilization and educational status of the women in Ethiopia, 2020.

Fig 9. Forest plot of association between postpartum modern contraception utilization and number of parity among postnatal women in Ethiopia, 2020.

Fig 10. Forest plot of the association between postpartum modern contraception utilization and counseling on family planning among postnatal women in Ethiopia, 2020.

Fig 11. Forest plot of association between postpartum modern contraception utilization and history of previous family planning use in Ethiopia, 2020.

Fig 12. Forest plot of the association between postpartum modern contraception utilization and partner approval for family planning use among postnatal women in Ethiopia, 2020.

Fig 13. Forest plot of the association between postpartum modern contraception utilization and place of residence of postnatal women in Ethiopia, 2020.

Fig 14. Forest plot of association between postpartum modern contraception utilization and number of alive children in Ethiopia, 2020.