Factors associated with utilization of contraceptives among postpartum women in sub-Saharan Africa: A Systematic Review and Meta-Analysis

Abstract

In the last 20 years, the use of contraceptive methods has increased steadily in Africa. However, the utilization of contraceptives by postpartum women is still low. Social and cultural beliefs, fear of side effect and partner disapproval were the main reasons associated with the low utilization. Therefore, this systematic review and meta-analysis summarized the evidence on the factors associated with utilization of contraceptives among postpartum women in sub-Saharan Africa (SSA). Objective: To identify the main determinant of factors associated with postpartum contraceptive utilization by women in sub-Saharan Africa, until March 2020. Methods: Published observational studies were searched in major databases including PubMed, Cochrane Library, Medline, Excerpta Medical Database (EMBASE), SCOPUS and Google Scholar. Unpublished studies were retrieved manually from ResearchGate and institutional repositories. Joanna Briggs Institute quality assessment checklist was applied to evaluate the quality of studies. RevMan software was used for data synthesis and statistical analysis. Chi-square (I2) with P-value were used to identify the degree of heterogeneity between studies included. Subgroup and sensitivity analysis was done to identify the sources of heterogeneity. A random effect model was applied if I2 >50 %. Results:-The odds of postpartum contraceptive utilization were less among women's whose educational status were below primary level (OR, 0.49; 95%C.I:0.34-0.70, P<0.0001) and delivered a baby at home (OR, 0.44; 95%C.I:0.26-0.76,P=0.003). In addition to that a women having ANC follow up (OR,2.95; 95%C.I:2.11-4.12,P<0.0001), having PNC follow up (OR,2.81;95%C.I:2.03-3.90,P<0.0001), having previous history of contraceptive use (OR,3.50; 95%C.I:2.40-5.10,P<0.0001) and resume sexual intercourse since delivery (OR,8.35; 95%C.I:4.57-15.26,P<0.0001) were more likely associated with postpartum contraceptive utilization. Conclusion: Improving women’s access to ANC attendance and promoting facility delivery will be a gateway for them to have the opportunity learn about, get access to, and utilize postpartum contraception. Systematic review registration number: - CRD42020175861