Assessment of Immediate Postpartum Contraception Uptake Among Women Delivering by Cesarean Section in Southwestern Uganda

Abstract

Introduction The immediate postpartum period represents a critical opportunity to initiate contraception to prevent short interpregnancy intervals and associated adverse maternal and neonatal outcomes. However, uptake of postpartum contraception remains low in many low-resource settings despite increasing rates of caesarean delivery. This study assessed the uptake and determinants of immediate postpartum contraception (IPPC) following cesarean delivery in Uganda. Objectives To determine the prevalence of IPPC uptake and factors associated with IPPC among women delivering by cesarean section (CS) at Mbarara Regional Referral Hospital, Mbarara, Uganda. Methods Between November 2024 and February 2025, we conducted a cross-sectional study and systematically sampled mothers who delivered by CS. Data were collected through structured electronic surveys and medical records abstraction. IPPC uptake was defined as a mother who took on a contraceptive method within the first 72 hours following a CS. We estimated the prevalence of IPPC and used logistic regression to identify sociodemographic, medical, obstetric, and contraceptive factors associated with IPPC. Results A total of 429 women were enrolled, with a mean age of 27 years. The prevalence of IPPC uptake was 6.8% (95% CI: 4.7-9.6). The commonest contraceptive method taken up was bilateral tubal ligation (75.8%, 22/29). The reasons for IPPC non-uptake were preference to first heal (238/400, 59.5%), chose natural methods (92/400, 23%), lack of awareness (42/4000, 10.5%), needed partner consent (14/400, 3.5%), and unavailability of the methods (7/400, 1.75%). Factors associated with immediate postpartum uptake were no formal education (adjusted odds ratio (aOR) = 8.52, 95% CI: 1.88-38.5; p < 0.005) and having ever used postpartum contraception (aOR = 5.08, 95% CI: 1.32-19.44; p < 0.018). Conclusion and recommendation Uptake of immediate postpartum contraception remains suboptimal among women undergoing cesarean delivery. Having no formal education and prior postpartum contraception use were independently associated with IPPC uptake. Strengthening the integration of contraceptive counseling and method provision during the antenatal, intrapartum, and postpartum periods may substantially improve uptake and improve maternal and neonatal outcomes.