KNOWLEDGE AND PRACTICES REGARDING POSTPARTUM CONTRACEPTION

AMONG WOMEN ATTENDING A TERTIARY CARE CENTRE IN JHANSI, UTTAR

PRADESH
Authors: Dr. Sippy Agrawal, Dr. Diksha Sharma

Affiliation: Department of Obstetrics and Gynaecology, Maharani Laxmi Bai (MLB) Medical
College, Jhansi, Uttar Pradesh, India

Corresponding Author:Dr. Sippy Agrawal

Professor & Head, Department of Obstetrics and Gynaecology, Maharani Laxmi Bai Medical
College, Jhansi, Uttar Pradesh, India

Email:

Mobile:

INTRODUCTION

The World Health Organization defines family planning as a voluntary and informed process that
enables individuals and couples to decide the number and spacing of their children according to
their preferences [1]. The postpartum period, especially the first 12 months after childbirth, is an
important phase for preventing unintended pregnancies and maintaining maternal and child
health. Postpartum family planning (PPFP) helps reduce closely spaced pregnancies by
encouraging the use of appropriate contraceptive methods during this period. An interval of at
least 24 months between pregnancies has been associated with lower maternal and neonatal
morbidity and mortality [2,3].Postpartum contraception helps in avoiding unintended and closely
spaced pregnancies, which are associated with increased maternal and neonatal complications.
Proper spacing between births lowers the risk of maternal anemia, postpartum hemorrhage,
unsafe abortion, uterine rupture, and maternal death. It also reduces the chances of preterm
delivery, low birth weight, neonatal illness, and infant mortality. In addition, postpartum family
planning promotes maternal recovery after delivery and helps improve the health and wellbeing
of both mother and child.
According to NFHS-5, fertility indicators in India have improved in recent years, although
regional differences still exist, especially in states such as Uttar Pradesh [5]. Maternal health
indicators in these regions continue to remain suboptimal. Limited access to reproductive health
services, lower female literacy, and sociocultural factors contribute to unintended pregnancies
and poor utilization of postpartum contraception [6–8].

The Government of India has introduced several initiatives to improve postpartum contraceptive
services, including promotion of Postpartum Intrauterine Contraceptive Devices (PPIUCDs)
through the Ministry of Health and Family Welfare [9]. Despite these efforts, acceptance of
postpartum contraception remains low in many rural and semi-urban areas. The Bundelkhand
region, including Jhansi, is characterized by lower educational status, traditional sociocultural
practices, and limited participation of women in family planning decisions, all of which may
influence contraceptive use [10,11].

Previous studies from North India have reported varying acceptance rates of postpartum
contraception and have highlighted the role of counselling, education, parity, and family support
in contraceptive uptake [12,13]. Understanding the knowledge and practices related to
postpartum contraception may help in improving family planning services and counselling
strategies [14].

This cross-sectional study was conducted at Maharani Laxmi Bai Medical College to assess the
knowledge and practices regarding postpartum contraception among women admitted to the
postnatal wards. The study also aimed to identify reasons influencing acceptance and non-
acceptance of contraceptive methods during the immediate postpartum period.

MATERIALS AND METHODS

Study Design and Setting

This descriptive cross-sectional study was conducted in the Department of Obstetrics and
Gynaecology at Maharani Laxmi Bai Medical College, a tertiary care centre serving patients
from the Bundelkhand region.
Study Duration

The study was carried out over a period of six months from November 2025 to April 2026.

Study Population

The study included postpartum women admitted to the postnatal wards after normal vaginal
delivery or lower segment cesarean section (LSCS).

Postpartum women who were hemodynamically stable, had received family planning
counselling, and provided written informed consent were included in the study.

Women with severe obstetric complications requiring intensive care, history of infertility, or
stillbirth were excluded.

Sample Size

The sample size was calculated using Cochran’s formula for cross-sectional studies. Based on
hospital delivery records, around 1,080 postpartum admissions were expected during the study
period.

Assuming contraceptive awareness of 50%, with a 95% confidence interval and 5% margin of
error, the minimum required sample size was calculated to be 284 after applying finite
population correction.

To account for incomplete responses, a total of 300 participants were included in the study.

Data Collection

Data were collected using a pre-tested semi-structured questionnaire in English. Face-to-face

interviews were conducted after obtaining informed consent from the participants.

Information related to sociodemographic details, obstetric history, awareness of contraceptive

methods, and acceptance of postpartum contraception was recorded.

Ethical Considerations
Ethical approval for the study was obtained from the Institutional Ethics Committee of Maharani
Laxmi Bai Medical College before the start of the study. Written informed consent was obtained
from all participants before enrollment in the study.

Statistical Analysis

The collected data were entered into Microsoft Excel and analyzed using SPSS software. Results
were expressed as frequencies and percentages.

Since the study was descriptive in nature, inferential statistical tests were not applied.

RESULTS

A total of 300 postpartum women fulfilling the inclusion criteria were enrolled in the study.

Table 1. Sociodemographic profile of the participants

Variables N (Total = 300) Percentage (%)

Age (in years)
18-25 129 43.0
25-30 129 43.0
>30 42 14.0
Religion
Hindu 257 85.7
Muslim 43 14.3
Maternal education
Illiterate 120 40.0
10th pass or under 103 34.3
12th pass 60 20.0
Degree holder 17 5.7
Occupation
Variables N (Total = 300) Percentage (%)
Housewife 214 71.3
Labour / Agriculture 69 23.0
Service 17 5.7
Income (INR/month)
<10000 171 57.0
10000-25000 103 34.3
>25000 26 8.7
Parity
1 86 28.7
2-3 154 51.3
4 or more 60 20.0
Age at marriage (in years)
≤18 86 28.7
19-25 189 63.0
>25 25 8.3

Most women in the study were between 18 and 30 years of age. About 40.0% of women were
illiterate, while 71.3% were housewives. More than half of the women had a monthly family
income below INR 10,000.

Table 2. Planning status of the last pregnancy

Last pregnancy N (Total = 300) Percentage (%)

Planned 60 20.0
Unplanned 240 80.0

Most women reported that their recent pregnancy was unplanned.

Table 3. Knowledge regarding contraception

Possesses knowledge of any N (Total = 300) Percentage (%)
contraception
Yes 223 74.3
No 77 25.7

Around three-fourths of the women were aware of at least one contraceptive method.

Table 4. Acceptance and preferred methods of postpartum contraception

Number Percentage (%)

Accepted contraceptives in
current postpartum period
Yes 94 31.3
No 206 68.7
Preferred methods of accepted
contraception
IUD 51 54.3
Barrier 26 27.7
Sterilization 17 18.0
OCPs 0 0.0
DMPA 0 0.0

Only 31.3% of women accepted postpartum contraception. Among those who accepted a
method, intrauterine devices were the most commonly preferred option.

Table 5. Reasons for acceptance of postpartum contraception

Reasons for accepting N (Total = 94) Percentage (%)

Child spacing (temporary delay)68 72.3
Definitive desire for no more 26 27.7
children
Child spacing was the most common reason for accepting contraception.

Table 6. Reasons for non-acceptance of postpartum contraception

Reasons for not accepting N (Total = 206) Percentage (%)

Desire for more children 103 50.0
Spouse/Family refusal 60 29.1
Fear of future infertility 34 16.5
Religious beliefs 9 4.4

Among women who did not accept contraception, the most common reason was the desire for
additional children. Refusal by spouse or family members was also commonly reported.

DISCUSSION

This study assessed the knowledge and acceptance of postpartum contraception among women
admitted to the postnatal wards of Maharani Laxmi Bai Medical College. The findings showed
that although many women were aware of contraceptive methods, acceptance during the
postpartum period remained low.

In the present study, 74.3% of women had heard about at least one contraceptive method before
the current admission. Pal R et al. also reported similar findings in their study among postpartum
women attending tertiary care centres [11]. Studies by Barman K et al. and Kripa S et al. also
reported moderate to high levels of awareness regarding contraceptive methods among women of
reproductive age [15,16]. However, awareness does not always lead to actual contraceptive use.

A large number of women in the present study had low educational status, with 40.0% being
illiterate. Similar observations have been reported in other Indian studies where lower
educational status was associated with lower contraceptive use and higher rates of unplanned
pregnancy [17,18]. Better education may help women understand available contraceptive
methods and make informed reproductive decisions.
The acceptance rate of postpartum contraception in the present study was 31.3%. Similar
acceptance rates have been reported in studies from North India [11,12]. Among women who
accepted contraception, intrauterine devices (IUDs) were the most commonly preferred method.
This could be due to the easy availability of PPIUCD services at institutional delivery centres
and their long-term effectiveness. Najan A et al. also reported improved acceptance of PPIUCD
among women who received focused antenatal counselling [19].

None of the women in the present study opted for oral contraceptive pills or injectable
contraceptives. Fear of side effects, concerns regarding future fertility, and inadequate
knowledge about hormonal methods may have contributed to poor acceptance. Nigam A et al.
and Thapa S et al. reported similar observations in their studies [13,20].

The most common reason for accepting contraception in the present study was the desire for
spacing between pregnancies. Similar findings have been reported in previous Indian studies
where temporary contraceptive methods were mainly preferred for spacing between pregnancies
[14,24].

Among women who did not accept contraception, the desire for more children was the most
common reason. Refusal by spouse or family members was another important factor. Family
members, especially husbands and mothers-in-law, appeared to influence contraceptive decisions
in many cases. Similar findings have been reported in other Indian studies [21–24].

The findings suggest that counselling regarding postpartum contraception should begin during
the antenatal period. Involving spouses and family members during counselling sessions may
improve acceptance of contraceptive methods. Improved awareness about contraceptive methods
and correction of common misconceptions may also help improve postpartum family planning
services.

The present study had certain limitations. Since it was conducted in a tertiary care hospital, the
findings may not represent the general population. In addition, only immediate postpartum
acceptance was assessed, and long-term continuation of contraceptive use was not evaluated
after discharge.
CONCLUSION

In the present study, many women were aware of contraception, but acceptance of postpartum
contraceptive methods remained low. IUCD was the most commonly accepted method among
women who chose contraception.

The common reasons for non-acceptance were desire for more children, refusal by family
members, and fear of side effects or future infertility.

Counselling during the antenatal and postpartum period, along with involvement of husbands
and family members, may help increase acceptance of postpartum contraception.

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