Factors associated with postpartum family planning use in Rwanda.

Background: Resumption and initiation of contraceptive methods after delivery are of critical importance in ensuring the well-being of the mother and the newborn. However, evidence related with postpartum family planning in Rwanda is scanty. This study employed survival analysis techniques to study the time to resumption or initiation of contraceptive methods after childbirth in Rwandan women and the associated factors.

Methods: Data were collected from the 2020 Rwanda Demographic and Health Survey (RDHS). Descriptive statistics were obtained after adjusting for study design. Initial analysis was conducted using the Kaplan-Meier method, followed by univariate and multivariable Cox Hazard proportional models to study factors associated with the initiation of contraceptive use after delivery. Cox Model assumptions were tested using scaled Schoenfeld Residuals.

Results: 5682 women who delivered in the five years preceding the survey were included in this research. The percentage of women who used modern contraceptives was 32%, 55%, 67%, and 79% at one month, six months, one year and two years respectively. Delivery by cesarean section, access to health insurance, and an increase in the number of children under five years of age were associated with increased chances of utilizing modern contraceptives after delivery. An increase in women's age and in the ideal number of children and women with a history of terminated pregnancy were associated with reduced chances of using postpartum family planning. The influence of religion was highlighted, with Catholic women associated with high contraceptive use.

Conclusion: There is a need to strengthen postpartum family planning in Rwanda. Policy makers and clinicians should provide additional customized interventions for women with factors associated with low use.