Intentions, Barriers and Attitudes towards Improving Postpartum Long-acting Reversible Contraceptive Usage among Pregnant Women in Urban Ghana

Abstract

Aims: Long-acting reversible contraceptives (LARCs) are the most effective reversible methods of contraception with a failure rate of less than 1%. Despite their safety and effectiveness, LARCs are underutilized. This study investigated postpartum LARC use intentions and suggestions to improve postpartum LARC usage among pregnant women seeking antenatal care services in a Ghanaian Urban municipality. Study Design: A facility-based cross-sectional design. Place and Duration of Study: The study was conducted at the antenatal care unit of the Ashanti Regional Hospital in the Kumasi Metropolis of Ghana among 298 pregnant women from August to September, 2018. Methodology: A systematic sampling technique was conducted. A 55-item questionnaire containing socio-demographic, reproductive, intention and attitude, barriers and contraceptive knowledge characteristics was used to gather responses. A multivariable logistic regression analysis was done using (IBM-SPSS version 22.0) to determine predictors of the women’s intention and attitude towards postpartum LARC use. Results: Out of 298 pregnant women included for analysis, 33.9% had postpartum intentions to use LARCs. “I like implant for myself” (AOR=9.00, 95% CI: 4.75-17.05), “I like IUD for myself” (AOR=7.38, 95% CI: 2.93-18.58) and previous use of LARC (AOR=7.03, 95% CI: 2.41-20.52) were predictors of postpartum intentions to use LARC. Intensive education and “worried about the side effects” were the main recommendations and barriers to postpartum LARC usage respectively. Conclusion: Postpartum intention to use LARC was minimal. I like implant for myself”, “I like IUD for myself” and previous use of LARC were associated with intentions to use LARC postpartum. Intensive education and “worried about the side effects” were the main recommendations and barriers to postpartum LARC usage respectively. Attitudinal change towards LARC use through intensive education, easy accessibility of LARC and religious body involvement is key to increase postpartum LARC usage in Ghana and clearing its myths and misconceptions could advance modern contraceptive usage.