الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Postpartum family planning is the prevention of unplanned pregnancy and closely spaced pregnancies through the first 12 months after delivery, as they are associated with increased maternal, newborn, and children under-5 morbidity and mortality. So, it is recommended an interval of at least 24 months as interpregnancy interval in order to reduce the risk of adverse effects on the mother, and the infant. Breastfeeding woman can use many modern contraceptive methods immediately after delivery includes IUDs, implants, female sterilization, POPs, LAM, and condoms. WHO recommends that, women receive information on FP and benefits of birth spacing during antenatal care, immediately after delivery and during postpartum visits. Aims of the study: The present study aims to determine postpartum contraceptive utilization among women in 1st year postpartum, and to identify factors associated with post-partum family planning utilization among women who had given birth during the past 12 months. Methodology: The present study is cross sectional design, conducted on two urban and two rural PHC units in Assiut district among 455 postpartum women who had given birth 12 months prior to the study. Data were collected through personal interview by using structured questionnaire, which was divided into four sections: including sociodemographic characteristics of the women, obstetric and reproductive history, knowledge, attitude, and practices towards PPFP, integration of PPFP within MCH services. Results: The results of the study are organized into two sections Section (1): descriptive statistics: Mean age of the mothers is 26.87± 5.7, about half of them urban residents, and with secondary education and above were 67.3%.Around half of the women (56.5%) delivered 2-3 times and about 32% reported history of previous unintended pregnancy. Menstruation resumed in 69.9% of them with the majority of women menses resumed during the first six weeks. 54.5% of participants use PPFP during the first year after childbirth, 44.8% of them started utilization during first six weeks postpartum and most common method used was copper IUD (37.1%). The principal reasons for using contraceptives are limiting pregnancy (59.7%) and spacing or delaying childbirth (40.3%). While the main reasons why some of the participants are not using PPFP methods include husband disapproval (32.4%), planning to get pregnant soon (23.2%).Less than three quarters (73.4%) of participants get information from family and friends, while 29.7% of them get their information from health care providers. Regarding knowledge among postpartum women, the mean overall knowledge score was 3.2 ± 1.29 SD, and more than half (52.3%) of participants have positive attitude towards PPFP Regarding Integration of PPFP with MCH services most women (95.1%) attended at least 4 antenatal visits. However, only 5.3% of them received FP counseling during antenatal visits. Also, nearly half (49.9%) of participants delivered the last child at public or university hospital, however, only 1.3% received FP counseling during delivery. Moreover, only 3.5% received FP counseling during postpartum period. Section (2): Factors associated with PPFP utilization. Increase in mean age of women and their partners is associated with statistically significant increase in PPFP utilization. Also, Urban residents have significantly higher percent of PPFP utilization compared to rural residents. Secondary education and above of women and their partners show significant association with increased PPFP utilization and increase in socioeconomic level significantly associated with increase in PPFP utilization. Participants who delivered three or more times have statistically significant higher percent of PPFP utilization compared to participants who delivered one or two times. Also, having at least one male child shows significant association with increased PPFP utilization. Resumption of menstruation after the last delivery is associated with statistically significant higher percent of PPFP utilization. And women who have ever used FP method before have statistically significant higher percent of PPFP utilization. Higher mean of FP knowledge score and attitude score among PPFP user were significantly associated with increased in PPFP utilization. Health care provider as source of information, women received FP counseling during antenatal visits, delivered the last child in a hospital and received FP counseling at postpartum visit to the health care facility have statistically significant higher percent of PPFP use. Therefore, the current study concluded that: Out of 455 women who were interviewed, the prevalence of postpartum contraception in Assiut district 54.5%, urban users were 74.8% and rural users were 27.9%.Copper IUD was the most widely used method of contraception followed. The most common reasons why women do not use FP methods are husband disapproval, planning to get pregnant soon. Factors influencing postpartum family planning uptake: Sociodemographic factor that positively associated with PPFP utilization were; Increased age of both spouses, secondary education level or above of both spouses, urban residency, women who working for cash, women who live in nuclear family and higher socioeconomic level. Obstetric history factors that positively associated with PPFP utilization were; para three or more or having three or more living children, women who have at least one male child, resumption of menstruation, women who ever used FP methods before. Awareness and good attitude toward PPFP were positively associated with increase in PPFP utilization. Healthcare provider as source of information significantly associated with PPFP utilization. Attending four or more antenatal care visits, receiving antenatal FP counselling, facility-based delivery, counselling during postnatal period were associated with increased PPFP utilization. In highlight of these results, the study recommends: For policy maker: Various health educational measures that promote PPFP uptake must be put in MCH centers. Continuous training programs for health care providers with regular evaluation sessions to make sure they are adequately informed about updates in PPFP. Integration of FP services with other MCH services (antenatal, natal, and postnatal) and during routine child vaccination. For health care providers: Health care providers should target specific FP barriers such as misconceptions about timing of contraceptive initiation, criteria of lactational amenorrhea method……etc. Women who deliver at health facilities should be counseled about PPFP and offered a family planning method before discharge and/or at postnatal clinics. Increased health education on PPFP for partners of postpartum women specially when they come requesting birth certificates. For researchers: Further studies must also be conducted to determine whether the integration of family planning into other services has improved the uptake. Further studies included husband and engaged them in programs that increase PPFP utilization. Determinants of unmet need for contraception among postpartum women in Assiut district For media: Designing of creative awareness tools and materials to be delivered through the social medias and T.V to increase women and their partners’ awareness about PPFP and early starting of contraceptive use