Contraceptive Adoption and Continuation among Postpartum Women in India’s urban slums

Abstract The unmet need for postpartum contraception provides a critical opportunity to introduce modern contraceptives due to the increased use of maternal care health services. However, limited knowledge exists regarding program reach in urban slum settlements and the impact of interventions on improving the adoption and continuation of modern contraceptives. The study aimed to assess the influence of health worker exposure and service delivery point visitation on contraceptive use within the postpartum period. This study utilized data from a subset of an output tracking survey conducted in 2019, focusing on 1,503 women aged 15-34 years who had given birth within the last three years. Multinomial logistic regression and proportional Hazard models were employed to assess the program’s effect on contraceptive adoption and continuation. Among urban slum residents, 38% to 46% initiated the use of modern reversible contraceptives within six and 12 months after delivery. Interpersonal communication with ASHA/FPA (Accredited Social Health Activist /Field Program Associates) inter-spousal communication, and self-efficacy were significant predictors of contraceptive adoption, with the latter two variables remaining significant at 12 months. Women with higher parity, education, and self-efficacy were less likely to discontinue the adopted method. While program exposure influenced contraceptive adoption, the analysis did not find an impact of health worker interaction or service delivery point visitation on the continuation of postpartum contraception. This study emphasizes the need for targeted interventions and continuous support to improve adoption and continuation rates. Barriers such as inter-spousal communication and self-efficacy should be addressed to enhance the effectiveness of postpartum family planning programs. Further research is needed to develop comprehensive strategies that address these challenges and improve postpartum contraceptive outcomes.