Contraceptive use dynamics in Zimbabwe : postpartum contraceptive behaviour

The analysis finds that contraceptive use is widespread following births in Zimbabwe, with contraceptive initiation concentrated in the early postpartum period. At the same time, breastfeeding is almost universal and prolonged, in contrast to a much shorter period of postpartum abstinence. These findings suggest a widespread and prolonged overlap of contraceptive use, breastfeeding, and postpartum amenorrhoea in Zimbabwe. This finding suggests considerable redundant use of contraception in the country and raises questions about the efficiency of current postpartum family planning policy in light of concerns that redundant use of contraception may result in shorter birth intervals than might have been achieved under alternative policies. However, this study shows that contraceptive continuation rates are higher among women who initiate use early in the postpartum period than among women who initiate use later, suggesting that women who initiate use early in the postpartum period are likely to achieve similar birth intervals as women who initiate use later, although the study did not examine directly the length of birth intervals. Overlap between contraceptive use and postpartum abstinence is less common. Contrary to findings in other countries, the study found no evidence of a relationship between postpartum contraceptive use and the duration of breastfeeding or postpartum amenorrhoea. It did, however, find evidence of a negative association between postpartum contraceptive use and the duration of postpartum abstinence. The timing of contraceptive initiation does not coincide with weaning, except for a minority of women. There are also demographic and socioeconomic differentials to be considered. Postpartum contraceptive use is more widespread and occurs earlier in urban areas compared with rural areas and among educated women. Older, high parity women are less likely to use contraception postpartum, and fertility preferences appear to have little effect on postpartum contraceptive behavior. Early postpartum contraceptive use is particularly common in the Harare/Chitungwiza province. This in turn results in very high levels of an overlap between contraceptive use and breastfeeding, postpartum amenorrhoea, and postpartum abstinence. (Author abstract, modified)