Structured Antenatal Counselling and Postpartum Contraceptive Uptake in South West Nigeria

BACKGROUND: Antenatal clinic is an opportunity to counsel women on the need for postpartum contraception. This study was designed to determine the effect of structured antenatal counselling on postpartum contraceptive uptake. MATERIALS AND METHODS: A prospective intervention study was conducted in the antenatal clinic of Olabisi Onabanjo University Teaching Hospital, Sagamu from July 15, 2018 to June 31, 2019. Two hundred antenatal attendees were randomly allocated to intervention and control groups. Women in the control group had routine antenatal counselling by the nurses/midwives, whereas those in the intervention group had well-structured antenatal contraceptive education sessions at each antenatal visit. A data capture sheet was used to obtain relevant information at presentation in labor and completed 6 months postpartum through phone conversation. RESULTS: The overall contraceptive acceptor prevalence was 35.5%. Majority of the contraceptive acceptors (42.3%) opted for intrauterine contraceptive devices. The contraceptive prevalence among the intervention group was 45% when compared with 26% among the controls. This was statistically significant (χ(2) =7.883, P = 0.005). However, after multivariate logistic regression analysis, the intervention (structured antenatal counselling) was not found to be a significant determinant of postpartum contraceptive uptake [adjusted odds ratio (AOR) 1.0; confidence interval (CI) 0.4–2.2; P = 0.941). Previous history of contraceptive usage, attending six or more antenatal visits, and Islamic religion were significant determinants of postpartum contraceptive uptake [(AOR 34.3; CI 7.1–164.6; P < 0.001) (AOR 8.0; CI 2.9–22.3; P < 0.001) (AOR 8.3; CI 3.3–10.0; P < 0.001), respectively]. CONCLUSION: Incorporation of structured antenatal contraceptives counselling was not significantly better than routine antenatal care in its effect on postpartum contraceptive uptake. There is need for deliberate efforts to encourage women to attend antenatal clinics in which contraceptive information would be provided during routine visits.