Postpartum contraceptive use in Bangladesh: understanding users' perspectives

Abstract

Qualitative and quantitative data are used to explore postpartum contraceptive use in two populations in Bangladesh. Findings from in-depth interviews with contraceptive users illustrate that women are primarily concerned with their own and their newborn child's health and well-being in the period following childbirth. In addition, women are aware of a diminished risk of pregnancy during the period of postpartum amenorrhea. These perceptions, plus a belief that modern methods of contraception are "strong" and potentially damaging to health, mean that the majority of women are reluctant to adopt family planning methods soon after birth, despite a desire to avoid closely spaced pregnancies. Supplementation of the child's diet is also shown to be an important factor determining the timing of postpartum contraceptive initiation. The findings suggest that current policies promoting contraception to women in the immediate postpartum period are inappropriate for many Bangladeshi women.

PIP: This study examined female contraceptive users' understandings, preferences, and behaviors during the postpartum period in Bangladesh. Qualitative and quantitative data focused on the vulnerability of mother and child, the risk of conception, breast feeding's protection against pregnancy, modern method use, postpartum use, and use during breast feeding. Two cohorts were used to examine the relationship between the timing of contraceptive use and resumption of menses, contraceptive use during postpartum amenorrhea, delays in adoption, and contraceptive use during breast feeding. Data were obtained from a range of qualitative data sources in the rural Matlab maternal health and family planning treatment area and in a Dhaka slum study area of the Urban Health Extension Project. Quantitative data were obtained from the Record Keeping System of Matlab and the Urban Surveillance System among a 2-year cohort of 5483 women who had given birth in Matlab in 1990-91. Findings indicate that family planning services should be integrated within maternal and child health care for women in the postpartum period. After childbirth, women are preoccupied with their and their child's health. This preoccupation influences women's priorities and behavior. Bangladeshi women seldom begin contraception soon after birth. Most breast feed for an extended period. The current policy that promotes contraception immediately after birth is inappropriate. Postpartum strategies should incorporate lactational amenorrhea and teach women about breast feeding's impact on fertility. Providers should be sensitive to women's fears and concerns.