Background: The health hazards of short inter-birth intervals are severe in Cameroon. One-quarter of inter-birth intervals are less than 24 months and the probability of death before age 5 for children born after a short interval is double that associated with intervals of 36-47 months. We examine the risk of an unintended pregnancy in the 18 months following childbirth in Cameroon, taking into account the protective effects of lactational amenorrhea, delayed resumption of sex as well as contraceptive use.
Methods: Data from 3007 postpartum women in the nationally representative 2018 Cameroon Demographic and Health Survey were used. Risk of an unintended pregnancy was defined from current status information on resumption of sex and menses, contraceptive use, desire for another child within 12 months, and, for the minority of pregnant women, whether the conception was intended. Predictors of risk, and of modern method use, were assessed by bivariate and multivariate analysis.
Results: In the first 6 postpartum months, only 8% of women were fully at risk (i.e., sex and menses resumed but no contraceptive use), rising to 24% at 6-11 postpartum months, and further to 30% at months 12-17. Though 89% wanted to delay the next birth by at least 1 year, only 17% were currently using a modern method. Menstruating women were much more likely to be users than amenorrheic women: 27% versus 15% at months 12-17 postpartum. Urban and better educated women recorded higher contraceptive use but lower protection from other factors than rural, less educated women, with the net result that risk differed little across these population strata. Uptake of maternal and child health (MCH) services was high but only one-third of women had discussed family planning at a facility visit during the preceding 12 months.
Conclusions: These results underscore the need for improved postpartum family planning services by means of closer integration with mainstream health services. In view of evidence from other sources of heavy workload and weak motivation of health staff, this will require strong leadership. A related priority is to increase the number of staff trained in provision of long-acting methods, such as implants.
Keywords: Cameroon; Postpartum family planning; Pregnancy risks.
We use information from mothers with a child under the age of 18 months, who were interviewed in a national survey conducted in 2018. We examine risk of an unintended pregnancy, using data on factors that protect against risk, namely delayed resumption of sex and menses, breastfeeding and contraceptive use. Among mothers with an infant aged less than 6 months, very few were at risk mainly because they had not resumed sex. Among those with an infant aged 6–11 months, 26% had still not resumed sex and an equal proportion was partially protected by delayed resumption of menses. Only 17% were protected by use of a modern contraceptive method, leaving 24% fully at risk. Among those with a child aged 12–18 months, 30% were fully at risk. As expected, well educated, urban women were more likely to use contraception than less privileged women but less likely to be protected by delayed resumption of sex and menses, with the consequence that pregnancy-risk was similar. Though three-quarters of mothers had taken their child for vaccination on three or more occasions, only one-third had discussed family planning with a health provider at a visit to a facility in the previous 12 months. The need for improved contraceptive services for mothers with young children is clear. Short intervals between births are common in Cameroon and these threaten the health of mothers and children. It is equally clear that closer integration of family planning into mainstream health services is needed.
© 2022. The Author(s).