Postpartum emotional fertility intentions in Ethiopia: an insight and correlates from a national women and newborns cohort study.

backgroundWomen´s emotional fertility intentions to conceive are an integral part of Reproductive Health (RH) right which can also be considered as decision-making over their fertility. In this study, postpartum emotional fertility intention was measured by asking a cohort of women how they would feel if they became pregnant by their one year postpartum following the index birth. Emotional health and couples communication are key during pregnancy, childbirth and in the postpartum period coupled with the simultaneous reproductive coercion (RC) minimization. The postpartum period is a key for the newborns milestones development and in maintaining maternal emotional, psychosocial, and mental health. Therefore, this study aimed at determining the level of one-year postpartum emotional fertility intention and identifying its correlates among a cohort of one-year postpartum women. The Ethiopian Federal Ministry of Health and relevant developmental partners can use this evidence as an action point to empower women to exercise their reproductive health rights and rights related to reproduction.

methodsNationally representative Ethiopia Performance Monitoring for Action (EPMA) women and newborns cohort survey data collected from eligible women in four rounds were further analyzed in this study. This study collected real-time data on various sexual, reproductive, maternal and newborns nationwide priority indicators using customized Open Data Kit Mobile application. These data were collected using a standard pretested questionnaire prepared in English and translated in three local languages (Amharic, Afan Oromo and Tigrigna) by well-experienced resident enumerators. This study was limited to the further analysis of 1,703 non-pregnant women by their one-year postpartum. Frequencies were computed to describe the study participant's characteristics. The partial proportional odds statistical modeling was fitted to identify correlates for the hierarchical variation in one-year postpartum emotional fertility intention. Results were presented in the form of percentages and odds ratios alongside with 95% Confidence Interval. Statistical significance was declared at a p-value of 0.05.

resultsThe proportion of one-year postpartum emotional fertility intention of being unhappier was found to be nearly two thirds, 64.87% (62.20%, 67.45%). Nearly one in 6, (17.12% (15.15%, 19.29%)) and one in 20, (4.63% (3.60%, 5.94%)) women reported that they have experienced a mixed and very happy feelings in the same period. The proportional cumulative odds of one-year postpartum emotional fertility intention were 0.66 (0.44, 0.97) and 0.43 (0.29, 0.63) respectively among women who reported that they had ever used contraceptive and those who reported that they have resumed their contraceptive use by one-year postpartum compared with their counterparts. The proportional cumulative odds of one-year postpartum emotional fertility intention were found to be lower and asymmetrical among women with higher birth order and those who do not want to have additional children.

conclusionOne-year postpartum emotional fertility intention of being unhappier is more pronounced in Ethiopia which calls for enhancing intended and spaced pregnancies by ensuring women reproductive health decision making autonomy. Activities and efforts that promote spaced pregnancies, and diversifying access to postpartum contraceptives are likely to improve the level of one-year postpartum emotional fertility intention. Activities and interventions that enable women to decide over their contraceptive use alongside patient-centered contraceptive use counseling could also contributed to the improvement of one-year postpartum emotional fertility intention as well. The study findings implied that awareness creation on and availing the specific inter-pregnancy contraceptive services and mental health preconception care packages could also contribute in addressing the varying level of one-year postpartum emotional fertility intention. The other implication of the findings calls for strengthening postpartum contraceptive counseling and intensifying actual service provision. Besides, enabling high parity women to use contraceptive through access and diversification of the methods could help in this regard. Moreover, installing the inter-pregnancy preconception care packages in the health care system, enhancing informed contraceptive use decision making and improving one-year postpartum contraceptive uptake are imperative. Provision of one-year post-partum contraceptive could reduce maternal and newborns morbidity and mortality through spacing, improving women´s emotional and mental health in the postpartum period. These activities and interventions are very critical to improve postpartum emotional fertility intention.