ANTENATAL AND POSTNATAL HEALTH SERVICES UPTAKE AND CONTRACEPTIVE USE AMONG WOMEN IN GHANA

ABSTRACT

 Maternal and child health and family planning are important issues that have population and health implications globally. The use of antenatal and postnatal health care services are important components of maternal and child health care services. The essence of these health care services is to ensure good health of mothers and babies before, during and after birth. Also, the use of modern contraceptives ensures good health of mothers and their babies through good child spacing, reduction in the risk of short pregnancy intervals and prevention of unintended pregnancy. Thus, all the three health components are aimed at ensuring good maternal and child health. However, there are still some knowledge gaps in understanding the relationship among antenatal, postnatal health care and contraception. Studies have shown high utilisation of antenatal and postnatal health care services within the Africa sub region by women, but this is not reflecting in their use of modern contraceptives. Contraceptive education is provided during antenatal and postnatal health care services and studies have shown influence of contraceptive education on contraceptive use, however, the level of women‘s use of modern contraceptive is still low. Therefore, this study aimed at examining the relationship between antenatal, postnatal health care utilisation and modern contraceptive use among women. It also sought to explore the contraceptive education women receive during antenatal and postnatal health care services. The study adopted a mixed methods sequential explanatory design. The quantitative components used three rounds of the Ghana Demographic and Health Survey conducted in 2003, 2008 and 2014. The sample included all postpartum women aged 15-49 years who gave birth in the 23 months preceding the surveys. A total sample of 4,863 postpartum women (GDHS 2003-1,421; GDHS 2008-1,178; GDHS 2014- 2,264) was used for this study. The quantitative analysis was done on the relationship between antenatal, postnatal health care services and contraceptive use and also demographic and socioeconomic characteristics of postpartum women. The qualitative component of the study consisted of in-depth individual interview among 30 women on the content, frequency and materials on contraceptive counselling provided during antenatal and postnatal health care. The dependent variable for this study was modern contraceptive use; the intermediate variable was contraceptive counselling and the main independent variables were antenatal and postnatal health care services. The results showed high utilisation of antenatal and postnatal health care services among postpartum women in all the three surveys. However, the proportion of postpartum women using modern contraceptives was not as high as the proportion using antenatal and postnatal health care services. At the bivariate level, high modern contraceptives use was recorded among postpartum women who utilised both antenatal and postnatal health care services. At the multivariate level, the results indicated a high probability of modern contraceptive use among postpartum women who utilised only antenatal health care and both antenatal and postnatal health care services. The qualitative results revealed that women receive contraceptive information on the benefits of using contraceptives during antenatal and postnatal health care service provision. They also receive information on both short and long-term methods of contraception. However, contraceptive counselling is not provided very often and counselling materials are rarely used. The study therefore concludes that there is higher use of modern contraceptives among women who utilize both antenatal and postnatal health care services. The study therefore, recommends that women should always be encouraged to have continuous contact with the health system especially both antenatal and postnatal health care because this has the potential to increase their use of contraceptives and also improve their sexual and reproductive health.