Frequency, correlates, and consequences of discordance between postpartum contraceptive intentions and use: A prospective study among women in Kenya

This study examined discordance between postpartum contraceptive intentions and use among women in Kenya. We used longitudinal, interviewer-administered, face-to-face survey data collected during pregnancy, within 48 hours postpartum, and six months postpartum from 2,240 women enrolled in Postpregnancy Family Planning Choices, a quasi-experimental study of a postpartum contraceptive counseling intervention, implemented in Meru County between 2017 and 2019, with Kilifi County serving as a control site. We summarized contraceptive intention-use discordance immediately postpartum and contraceptive use at six months postpartum by county. Bivariable and multivariable logistic regression examined correlates and consequences of downward discordance, defined as contraceptive non-use despite antenatal intention to use a method; regression analyses were restricted to Meru due to sample size. During pregnancy, 60.9% of women in Kilifi and 81.8% in Meru intended to use postpartum contraception. Immediately postpartum, 5.7% of women in Kilifi and 31.2% in Meru were using a method; by six months postpartum this rose to 56.5% and 80.8%, respectively. After accounting for women’s reasons for non-use and reclassifying women who changed their minds about desired use, 23.9% of women in Kilifi and 20.2% in Meru experienced downward discordance. In Meru, downward discordance was more common among women who were more educated (AOR = 1.53, CI: 1.17-2.01), partnered (AOR = 2.20, CI: 1.15-4.22), employed (AOR = 1.92, CI: 1.26-1.93), and those who lacked involvement in contraceptive decision-making (AOR = 12.22, CI: 6.90-21.67). Women with downward discordance immediately postpartum had 85% lower odds of using contraception six months later than women whose contraceptive preferences were met soon after delivery (AOR = 0.15, 95% CI: 0.07-0.30). Family planning programs should ensure women can access their preferred contraception across the postpartum period to support them in achieving their reproductive goals.