Research Article: Patterns of Contraceptive Adoption, Continuation, and Switching after Delivery among Malawian Women

Date Published: January 20, 2017

Publisher: Public Library of Science

Author(s): Dawn M. Kopp, Nora E. Rosenberg, Gretchen S. Stuart, William C. Miller, Mina C. Hosseinipour, Phylos Bonongwe, Mwawi Mwale, Jennifer H. Tang, Tiziana Leone.


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.

Partial Text

Postpartum family planning can help women achieve their fertility goals by allowing them to limit and space their pregnancies. Among nationally representative samples of postpartum women from 21 low- and middle-income countries (including Malawi), 61% had an unmet need for family planning [1]. Of those using family planning, most (51–96%) relied on short-acting methods.

Overall, 634 women who delivered between May and September 2013 enrolled in the parent study. Of these, 539 women (85%) completed the 3-month survey, 480 women (76%) completed the 6-month survey, and 331 women (52%) completed the 12-month survey (Fig 1). All 480 women who had completed both the 3-month and 6-month surveys were included in the analysis, except for one woman was pregnant at the time of the 6-month survey. Therefore, this analysis includes 479 women. Three women who had inconsistent or missing contraceptive data at the 12-month survey and the data from this survey (but not the 3- or 6-month survey) was censored. Women from the original cohort who were not included in this analysis (because they did not complete two or more follow-up surveys) were younger (p = 0.012), less educated (p<0.001), had more trouble obtaining food, clothing, or medications (p = 0.006), and had fewer living children (p = 0.038) than women who were included. In this cohort of postpartum women, the contraceptive method mix changed with more women using LAPM as time from delivery increased. Just over half of women continued the contraceptive method they were using 3 months after delivery. Those that used long-acting methods were more likely to continue using them than those using short-acting methods. Among women who switched their contraceptive method, most switched to a more effective method.   Source: