A Theory of Planned Behaviour Analysis of Barriers and Facilitators of Immediate Postpartum Contraception Uptake in Southwestern Uganda

Abstract

Background: Closely spaced pregnancies increase the risks of maternal and perinatal morbidity. Initiation of contraception in the immediate postpartum period offers a critical opportunity to address this unmet need during a window when women are in contact with health services. We explored barriers and facilitators of immediate postpartum contraceptive uptake at a tertiary hospital in southwestern Uganda, using the Theory of Planned Behavior. Methods: We conducted a qualitative descriptive study between August and December 2025 at Mbarara Regional Referral Hospital. Using purposive sampling, we conducted 7 focus group discussions among postpartum women (24), spouses (19), midwives (20), and doctors (12) involved in maternity care using semi-structured interview guides grounded in the TPB. Audio-recorded interviews were transcribed verbatim, translated where necessary, and analysed using thematic analysis. Themes were deductively mapped onto the TPB domains of attitudes, subjective norms, and perceived behavioural control until no new themes emerged across successive focused group discussions. Results: Participants generally viewed postpartum family planning positively and recognized its role in child spacing, maternal recovery, and family wellbeing. However, uptake was hindered by fears of side effects, misconceptions about infertility and contraceptive failure, concerns regarding immediate postpartum initiation, and limited awareness of methods suitable for use. While partner support facilitated uptake, opposition and community myths discouraged use. Perceived behavioural control was constrained by inadequate counselling, limited provider confidence, poor integration of family planning services within maternity care, and inconsistent availability of contraceptive methods. Conclusion: Immediate postpartum contraceptive uptake is influenced by interconnected individual, social, and health-system factors. It requires multi-level interventions: integrated contraceptive counselling across the antenatal–postnatal continuum, structured male partner engagement, correction of community misconceptions, training of health care providers, and onsite availability of methods within labour wards and theatres