Influence of Antenatal Family Planning Counselling on Attitude Towards Early Postpartum Family Planning: A Randomised Controlled Trial in Kenya

Abstract

Background: Globally, women value postpartum family planning (PPFP) for health and pregnancy spacing. It is imperative to understand the diverse aspects influencing women’s attitudes towards early PPFP to address them effectively. There is a lack of comparative studies on the effectiveness of interventions to improve attitudes towards early PPFP. Bridging this gap is vital for evidence-based FP promotion and better maternal and child health outcomes. This study, therefore, compared attitudes toward early PPFP across nurse-led, community-based, and routine ANC groups.
Methods: The study was a randomised control trial conducted in Kisumu County among pregnant women. Three arms were established: nurses’ and community interventions and a control. Sample size was determined based on expected differences in contraceptive use postpartum. Multistage sampling involving purposive, cluster, and simple random sampling was used. The intervention involved providing antenatal information on postpartum family planning (PPFP) using a mobile phone-based tool. Attitudes towards PPFP were measured using Likert scales and analysed through ANOVA. The study aimed to assess the impact of interventions on attitudes towards early PPFP.
Results: Most participants (96.4%) had a positive attitude towards early PPFP, though some factors were linked to reduced positivity. Higher education (OR 0.6, 95% CI, 0.4 to 0.9, P=.026), comorbidity (OR 0.2, 95% CI, 0.1 to 0.6, P=.006), and longer counselling waiting and turnaround times (OR 0.9, 95% CI, 0.8–1.0, P=.059) and (OR: 0.9, 95% CI: 0.9 to 1.0, P=.032) were associated with more negative attitudes, while good perceived health increased positivity (OR 3.1, 95% CI, 1.0 to 9.2, P=.043). There was no significant difference in attitude between study arms (F (2,243) =3.0, P=.053).
Conclusion: The study found a generally positive attitude towards early PPFP among participants, but no significant difference in attitude between intervention and control arms. Negative attitudes were associated with comorbidities, longer waiting times, and counselling turnaround times. The study recommends improvements in counselling quality by optimising waiting and turnaround times.