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org Open Access

EURASIAN EXPERIMENT JOURNAL OF BIOLOGICAL SCIENCES (EEJBS)
ISSN: 2992-4138 ©EEJBS Publications
Volume 5 Issue 1 2024

Page | 89
Factors Influencing the Utilisation of Family Planning Services
among Post-Partum Women at Kitagata General Hospital in
Sheema District Uganda
Arishaba Octavia
Faculty of Clinical Medicine and Dentistry, Kampala International University Western Campus Uganda.

ABSTRACT
This study looks into the variables that affect postpartum women at Kitagata General Hospital in Sheema District,
Uganda, using family planning services. For the sake of both mother and child health, postpartum women must use
family planning services, but little is known about the factors influencing this group's adoption of these services. To
collect thorough data, a mixed-methods approach was used, including quantitative surveys and qualitative
interviews. Structured surveys were given to a sample of postpartum women who were patients at Kitagata General
Hospital as part of the quantitative phase. Qualitative interviews were carried out with healthcare practitioners to
obtain an understanding of the obstacles and enablers related to the provision of family planning services. The
results show that a wide range of factors, such as sociocultural attitudes, service accessibility, knowledge, and
perceptions of family planning methods, influence postpartum women's use of family planning services. Designing
focused interventions to increase postpartum women's use of family planning services and enhance mother and child
health outcomes in Uganda's Sheema District requires an understanding of these aspects.
Keywords: Family Planning, Maternal mortality, Women, Postpartum

INTRODUCTION
Maternal mortality remains a significant public health concern in Uganda [1, 2]. It is estimated that if all women
in need of contraceptives in Uganda were using them, the number of maternal deaths would be reduced by 40% [3].
Family planning is very important to the control of population growth, reducing pressure on the environment, and
economic development [3, 4]. Moreover, population control is among the most effective measures for protecting
the environment. If, through female education, women's rights, maternal-child health, and family planning, the
United Nations' low population projection existed in the year 2050 as opposed to the medium projection (2.2 billion
higher), 4.4 million square kilometres of land would be saved and there would be 9.3 billion tonnes less in carbon
dioxide emissions per year [5]. However, contraceptive use in Uganda is low, and the unmet need for family
planning is among the highest in the world [6]. The unmet need for family planning refers to women capable of
reproducing who are not using contraception but wish to postpone their next birth for 2 or more years or to stop
childbearing together [7]. According to the 2012 Demographic and Health Survey (DHS) data, among currently
married rural women, 37% have an unmet need for family planning, and only 27% report currently using effective
contraceptives [8]. Furthermore, 44% of pregnancies are unplanned [9], and the spacing between pregnancies is
poor, which is associated with an increased risk of infant mortality, childhood malnutrition, and complications during
pregnancy [10] One important step in addressing the unmet need for family planning in Uganda is to explore
factors that influence women wanting to delay their next pregnancy to use contraceptives. Prior research in
developing countries has identified an array of multi-level determinants of contraceptive uptake. Examples of
determinants identified at the individual level include age, education, income, relationship status, and religion [11],
and psychosocial factors encompassed by theories of behaviour change, such as one’s knowledge of contraceptive
methods [12], beliefs towards contraceptive efficacy and safety [11, 13, 13] and self-efficacy towards contraceptive
use [14]. At the interpersonal level, evidence from some studies supports the influence of the male partner on
women’s reproductive health and decision-making, especially in resource-limited settings. Gender norms and
unequal power in relationships may manifest in several ways that influence a woman’s ability to use contraceptives,
such as gendered sexual decision-making [15], norms prohibiting communication about sexual health [16], and
intimate partner violence [12]. Additionally, there is increasing support for the importance of contextual
determinants of family planning in resource-limited settings [17]. Health system factors associated with access to
care include access to trained staff, follow-up care, cost, and the environment of health facilities (e.g., wait time, and
space)[18]. While a sizable body of research exists on determinants of family planning uptake among the general
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population, little is known about what factors influence women’s use of contraception postpartum [7] The
postpartum period is considered an ideal time to deliver family planning as women more regularly visit healthcare
facilities during this time [19] and may be more motivated for health behaviour change after having recently given
birth [20]. Given national trends of short intervals between births[21], the provision of postpartum family planning
should be prioritised in Uganda, as there may only be a brief window of time to link many postpartum women to
family planning services before their next pregnancy [7]. Despite the need for increased postpartum family planning
Page | 90 in Uganda, few studies are exploring contraceptive use that specifically targets women postpartum ([22], and
different factors may influence family planning service uptake and contraceptive use during this period [23].
Therefore, the purpose of this study is to explore factors influencing family planning and the utilisation of family
planning services among post-partum women at Kitagata General Hospital in Sheema District, Uganda.
The United Nations Millennium Development Goal aims at reducing maternal mortality by three-quarters between
1990 and 2015. An important intervention towards achieving this target is the promotion of modern family planning
among women in sub-Saharan Africa Despite the need for increased postpartum family planning in Uganda, few
studies are exploring contraceptive use that specifically targets women postpartum. Moreover, very little is known
about how pregnant women in sub-Saharan Africa arrive at their postpartum family planning decisions, even though
this information is critical to the design of strategies to increase the uptake of postpartum family planning. The
purpose of this study, therefore, is to explore factors influencing the utilisation of family planning services among
postpartum women at Kitagata General Hospital in Sheema District, Uganda. The study was designed to determine
the factors influencing the utilisation of family planning services among postpartum women at Kitagata General
Hospital in Sheema District, Uganda.
METHODOLOGY
This chapter presents an evaluation of the research methodology for the proposed study, which includes the study
design, study site and setting, study population, sample size determination, sampling technique, eligibility criteria,
data management, and ethical considerations.
Study Design
A quantitative cross-sectional study approach will be conducted to determine the factors influencing the utilisation
of family planning services among postpartum women at Kitagata General Hospital in Sheema District, Uganda.
Area of Study
The study will be conducted at the ANC clinic at Kitagata General Hospital. The hospital is located in the central
business district of the town of Kitagata, in Sheema District, in the Ankole sub-region, in Western Uganda, about
62 kilometres southwest of Mbarara Regional Referral Hospital. This is about 111 kilometres north of Kabale
Regional Referral Hospital. The coordinates of Kitagata General Hospital are 0°40'21.0"S, 30°09'04.0" E (latitude:
-0.672503; longitude: 30.151111).
Study population
The study will be conducted among post-partum women at Kitagata General Hospital in Sheema District, Uganda.
Inclusion criteria
It will include postpartum women at Kitagata General Hospital in Sheema District, Uganda who fit the eligibility
criteria for family planning.
Exclusion criteria
i. Those not in the postpartum period.
ii. Those that don’t fit the eligibility criteria for family planning.
Sample size determination
The sample size will be determined using Kish Leslie’s formula [24].
n= (Za/2)2p(1-p)
e2
Where n is the required sample size, p is the approximate number of postpartum women at Kitagata General Hospital
in Sheema District, Uganda, and e is the permissible error in the estimate.
Sampling Procedure
Consecutive random sampling techniques will be used to choose respondents to participate in the study, from whom
data will be collected.
Dependent variables
Utilisation of family planning services among post-partum women
Independent variable
The independent variables include socio-demographic factors, knowledge, awareness, perception, and attitude
regarding family planning services.
Data collection method and tools
Data was be collected using an interviewer-administered questionnaire adopted from Tafa & Worku [25] and
adjusted to fit this study. The researcher will meet with the targeted respondents who will take part in the study
 https://www.eejournals.org Open Access
after obtaining permission for data collection from the respondents. Each participant will be required to give
informed consent before enrolling in the study. The researcher will assist the respondents in filling out the
questionnaires by explaining to them for clarification. The properly filled questionnaires will then be collected, and
then data will be taken for analysis. The researcher will use a structured questionnaire, and participants will be asked
similar questions, and from the options, they will pick the best alternative. A pen and paper will be used to record
the necessary information.
Page | 91 Data entry and cleaning
The data in the questionnaire will be checked for completeness, cleaned, and sorted to eliminate obvious inaccuracies
and omissions. The data will then be coded and entered into a computer.
Data Analysis
The qualitative data collected will be statistically analysed and documented using Microsoft Excel and Word version
2019, which will then be analysed using SPSS v.16. The analysed data will then be presented in the form of tables
and graphs, which will be the basis for discussion and conclusions, among others.
Measurement of Variables
The variable ‘Utilisation of family planning services’ is the dependent variable and will be measured on the number
of women that will receive postpartum family planning. The independent variables are the socio-demographic
factors—attitudes, knowledge, and practices—and will be measured in percentage. Specific statistical tests will be
done to determine the relationship between different factors and the utilisation of family planning services among
postpartum women.
Quality Control
To ensure quality control, the researcher will conduct a pre-test using eight questionnaires in the target population,
and data will be collected before the actual study to help in the reconstruction of the questionnaire where necessary.
Ethical Considerations
Participants will be given information regarding the research to seek consent. Each participant’s choice to participate
or not will be respected, and the data collected from participants will be kept confidential. The participants’ names
will not be included while filling out the questionnaire to maintain privacy. It will be communicated that the
information obtained from the participants will be kept under lock and key to only be used for research purposes.
RESULTS
Table 1: Shows the Demographic data of the sample population
Variable Category Frequency Percentage
Age ≤20 9 6
21-30 79 53
31-40 50 33
>40 12 8
Religion Catholic 57 38
Protestant 71 47
Muslim 13 9
Other 9 6
Educational status None 35 23
Primary 52 35
Secondary 34 22
Tertiary 29 20
Occupation Civil servant 46 31
House wife 69 46
Business woman 20 13
Student 9 6
other 7 5
Place of residence Urban 87 58
Rural 63 42
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A total of 150 study participants were involved in the study. The mean age of the study participants was 29.8. The
majority of the study participants (47%) were protestant by religion, while 38% were Catholic. One-hundred-fifteen
(77%) of the respondents attended formal education, while 23% didn’t. Nearly half of the study participants were
housewives (46%). Regarding the place of residence, 87 (58%) lived in urban places. Concerning obstetric history,
44% of the study participants had four or more children, and 76% had a history of family planning utilization. The
implant was the most frequently used family planning (FP) method (39%). Regarding maternal health services,
77% had ANC follow-up, 62% of them delivered their baby in a health institution, and 53% received postnatal care.
Page | 92
Table 2: Shows the Knowledge and Utilization of Postpartum Family Planning Among Women
Knowledge Questions Frequency Percentage
Which method of modern FP do you know (more than one answer was possible)
Pills 21 14
Implant 30 20
Injectable 32 21
IUD (intrauterine device) 5 3
More than one method 36 24
Where do you get information Reason?
Mass media 32 21
Health professionals 66 44
Family 38 25
Friends 17 11
Reason women use Modern FP
Prevention of unwanted pregnancy 39 26
Child spacing 60 40
To limit family size 36 24
Prevention of STI/HIV 6 4
Other 9 6
Discussed about FP with your husband
Yes 116 77
No 35 23
Your husband supported you in using FP
Yes 107 71
No 44 29
Current PPFM used
Pills 27 18
Implant 71 47
Injectable 47 31
IUDs 9 6
Reason for not utilizing PPFP
To get more children 38 25
Family disapproval 27 18
Religious reasons 20 13
Fear of side effects 35 23
Inaccessibility 23 15
Others 5 3
Is PPFP culturally acceptable in your context
Yes 101 67
No 50 33
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All of the respondents had heard about postpartum family planning at least once. About 70% of the respondents had
good knowledge of postpartum family planning. Regarding utilisation, 41% used postpartum family planning. The
most commonly mentioned modern family planning was injectables (21%), and implants (20%). The main source of
information was health professionals (44%), and 40% knew that family planning enables women to control birth
spacing. Most of the study participants (77%) discussed family planning with their husbands, and 71% stated that
their husbands supported them in using family planning. Of those women who utilised postpartum family planning,
Page | 93 47% of them used an implant. Among the women who did not utilise postpartum family planning, the main reason
for not utilising PPFP was to get more children and fear of side effects (25% and 23%), respectively.

Table 3: Shows Utilization of postpartum family planning Among Women

Variables Utilization of postpartum family planning
(%)
Yes No
Age group
≤20 36 64
21-30 37 64
31-40 48 52
>40 39 61
Number of alive children
One 32 68
Two-Three 38 62
Four+ 47 53
PNC Utilization
Yes 53 47
No 27 73

Educational status
None 34 66
Primary 55 45
Secondary 79 21
Tertiary 88 12

The study defined postpartum contraceptive or post-partum family planning (PPFP) as a woman’s use of any modern
method of contraception during the 12 months following her most recent childbirth.
DISCUSSION
The research participants' average PPFP knowledge was found to be 75%, which was lower than that observed in
comparable studies from Nepal, central Ethiopia, and Nigeria [13, 14]. However, it outperformed a research from
Axum, Ethiopia (46%).[26]. The variation may result from variations in study locations and sociodemographic
traits. In addition, this study discovered that 41% of the individuals use PPFP. This number was consistent with the
majority of investigations carried out in Sub-Saharan African nations. Between 40% and 49% of participants in these
studies used PPFP [27]. But the lower figure was reported in Somalia Region, Uganda (28%) and Ethiopia (12%)
[21]. It's possible that this discrepancy results from the different sociodemographic traits and study sites. Sub-
national differences at the state, regional, and district levels were discovered in all three countries in a research to
evaluate the patterns and trends of postpartum family planning in Ethiopia and Nigeria[28]. The observed
discrepancies are more indicative of differences in options for accessing and providing the service, or in social and
cultural norms of behavior. The variances in the use of contemporary contraception during the postpartum period
may have been significantly influenced by the socioeconomic differences in the women's education, place of residence,
and wealth quintile. In general, access to information and services is better in cities and among the wealthiest women
[28]. The significant unmet need for FP in Uganda is attributable to a lack of access to quality services, women's
lack of understanding about side effects and the availability of techniques [5], cultural influences such as husbands,
and religious prohibitions on contraception [29]. These distinctions imply that context-specific interventions are
needed to improve contraceptive use during the postpartum period. In areas with low rates of maternity and child
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care utilization, community-based initiatives may need to be prioritized. While integrating family planning services
into mother and child routine care may be a desirable strategy in areas with high institutional delivery rates, it is
not a universal method. Women with a greater level of education were more likely to be aware of PPFP. This finding
was consistent with other studies that found that women with a higher educational background have a better
understanding of PPFP [11]. Furthermore, women who have used modern FP were shown to be knowledgeable
about modern FP. This could be owing to the counseling and health education provided during the distribution of
Page | 94 contraceptive techniques. Similarly, having an ANC follow-up has been linked to understanding of PPFP in research
[30]. Other studies in Uganda and Tanzania found that health practitioners were the primary source of information
during ANC [31-36]. The use of PPFP was also linked to an increase in the number of live children. It was
congruent with the findings of a study conducted in Burundi and Rwanda, which found that "the likelihood of
utilizing PPFP increased by approximately 30% for a woman with an extra living child" [31]. This study also found
a link between PNC service consumption and PPFP utilization. This was consistent with prior research conducted
in Nigeria, Uganda, and Ethiopia [30]. For example, a study done in southern Ethiopia discovered that women who
used PNC services were nearly twice as likely to use PPFP [32]. This could be attributable to the provision of
contraceptive counselling and promotion during normal PNC visits[33]. This could mean that women who utilize
maternity and newborn health services (PNC, institutional birth, child immunization) are more likely to use
postpartum family planning services, or that by visiting these services, they have greater chances to be convinced
to use them and given a technique. However, due to a lack of capacity and integration of family planning services
with maternal health services, opportunities to enhance the use of PPFP are lost. The most often reported reasons
for using PPFP were to avoid undesired pregnancy, restrict family size, and space children. The reasons for not
using PPFP included a desire to have more children, apprehension about the adverse effects of modern FP, family
disapproval, inaccessibility, and cultural and religious considerations. Religious and cultural variables also influence
postpartum contraceptive acceptance and utilization [34]. One-third of the women in this survey claimed that PPFP
is not culturally acceptable, which is one of the key hurdles to increasing PPFP adoption in Uganda. Cultural norms
that favour childbearing and religious prohibitions on contraception for postpartum mothers have also been noted
in other studies [35]. This suggests that to overcome cultural barriers to PPFP usage, personalizing discussions
during antenatal care and teaching the community about the benefits of birth spacing via community-based
initiatives are required. In Uganda, Local Health Centres and VHTs are in charge of providing community-level
reproductive health services, such as counselling and the provision of some contraceptive methods, as well as
referrals for others [36]Male involvement has also been linked to increased maternal health treatment utilization,
particularly FP, in underdeveloped countries [34].
CONCLUSION
The majority of survey participants expressed good attitudes toward PPFP. However, PPFP was not used by more
than half of postpartum women. PPFP utilization was connected with educational status, understanding of PPFP,
the number of children, and PNC service. The most often reported reasons for using PPFP were to avoid undesired
pregnancy, restrict family size, and space children. The reasons for not using PPFP included a desire to have more
children, apprehension about the adverse effects of modern FP, family disapproval, inaccessibility, and cultural and
religious considerations.
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CITE AS: Arishaba Octavia (2024). Factors Influencing the Utilisation of

Family Planning Services among Post-Partum Women at Kitagata
General Hospital in Sheema District Uganda. EURASIAN
EXPERIMENT JOURNAL OF BIOLOGICAL SCIENCES, 5(1):89-96