Do women with a previous unintended birth subsequently experience missed opportunities for postpartum family planning counseling? A multilevel mixed effects analysis

Bibliographic Data

ID19591858
AuthorsOtobo I Ujah (0000-0002-9899-9013, University of South Florida, corresponding author), Jason L Salemi (0000-0002-0077-6023, University of South Florida, corresponding author), Rachel B Rapkin (University of South Florida, corresponding author), William M Sappenfield (University of South Florida, corresponding author), Elen M Daley (University of South Florida, corresponding author), Richard Kirby (0000-0002-3489-401X, University of South Florida, corresponding author)
EditorsJulia Robinson (0000-0003-0719-3995)
Year2024
Volume4
Issue6
Pagese0002570
Publication date2024-06-05
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenuePLOS Global Public Health (JOURNAL)
Journal identifiersISSN: 2767-3375 • E-ISSN: 2767-3375
PublisherPublic Library of Science (PLoS) (PUBLISHER)
DOI10.1371/journal.pgph.0002570
PMID38838062
OpenAlexW4399367539
LanguageEN
References cited50

Client-provider communication about family planning (FP) remains an important strategy for preventing unintended pregnancy. Yet, the literature lacks empirical studies examining whether and how women’s intendedness of a recent pregnancy may impact subsequent receipt of FP counseling. We investigated whether the intendedness of a recent pregnancy is associated with subsequent missed opportunities (MOs) for FP counseling, taking into account compositional and contextual factors. We performed a secondary analysis using pooled data from the 2016, 2017 and 2018 Performance Monitoring and Accountability 2020 cross-sectional surveys conducted in Nigeria, adjusting for complex design effects. Weighted multilevel logistic regression modeling was used to examine the relationships between pregnancy intention and MOs, overall and at the health facility, using two-level random intercept models. In the analytic sample of women within 24 months postpartum ( N = 6479), nearly 60% experienced MOs for FP counseling overall and even 45% of those who visited a health facility visit in the past 12 months ( N = 4194) experienced MOs. In the multivariable models adjusted for individual-/household- and community-level factors, women whose recent birth was either mistimed or unwanted were just as likely to have MOs for FP counseling as their counterparts whose pregnancy was intended ( p > 0.05). Factors independently associated with a MOs include individual/household level factors such as level of education, exposure to FP media, household wealth index and contextual-level variables (geographic region). While evidence that pregnancy intendedness is associated with MOs for FP counseling remains inconclusive, efforts to mitigate these MOs requires prioritizing women’s prior pregnancy intentions as well as equipping healthcare providers with the capacity need to provide high-quality client-centered FP counseling, particularly for women whose recent birth was unintended

Environmental health · Family medicine · Family planning · Logistic regression · Multilevel model · Population · Pregnancy · Receipt · Unintended pregnancy · Demography · Global Maternal and Child Health · Maternal and Perinatal Health Interventions · Medicine · Psychology · Reproductive Health and Contraception