Increasing postpartum family planning using an evidence-based approach: the success of a university teaching hospital in Rwanda

Abstract

BACKGROUND

The most efficient way to increase the prevalence of contraceptive use is to provide family planning to women after delivery, particularly in countries with high health facility delivery rates.

OBJECTIVE

This study aimed to increase the uptake of postpartum family planning in hospitals in Rwanda.

STUDY DESIGN

This mixed-methods cohort study was conducted at a teaching hospital in Rwanda from June 2022 to July 2022, with uptake of postpartum family planning recorded until March 2025. This study was part of a broader research aimed at improving maternal and neonatal outcomes in the hospital. The postpartum family planning rates were extracted from the Health Management Information System before the study was conducted and up to March 2025 to demonstrate the sustainability of the interventions introduced based on the recommendations derived from the study. The two components of the study were as follows: (1) telephone interviews with key staff in district hospitals and (2) interviews with a sample of mothers who delivered at the hospital. Analysis of the responses to open-ended questions was performed using inductive reasoning, whereas quantitative data were analyzed using Microsoft Excel (Microsoft, Redmond, WA). Ethical approval was obtained in May 2022.

RESULTS

Higher family planning uptake rates were observed after cesarean delivery (90%; P=.04), in women aged 39 to 43 years (100%), and in women who had discussed family planning during pregnancy (80%; P=.00). The reasons for refusing family planning were associated with cultural/religious beliefs and values. Some women were not offered family planning, particularly on weekends. Teamwork and engagement in or emphasis on postpartum family planning within the maternity unit of district hospitals were responsible for increased postpartum family planning uptake. The implementation of the recommendations at the hospital increased postpartum family planning uptake from 26% (April 2022) to 89% (March 2025).

CONCLUSION

The findings highlight the importance of family planning counseling during pregnancy. Within the hospital, an increased awareness of the importance of family planning among staff, teamwork, and involvement of all midwives in the provision of family planning were the key factors to improve uptake.