Health system factors influencing up take of postpartum modern family planning methods among Hiv - seropositive women in Busia county, Kenya

Abstract

Postpartum family planning (PPFP) is crucial for promoting optimal timing and spacing of pregnancies and reducing maternal and child health risks. With the pre-existing reduced immune system, enabling human immunodeficiency virus (HIV)-seropositive women to avoid untimed pregnancies after the first 12 months of childbirth can reduce vertical transmission, child and maternal mortalities associated with HIV infection, and equally reduce the overall burden on the already stressed health care systems. Busia County, Kenya, faces unique reproductive health challenges, especially among HIV-seropositive women, where high rates of HIV incidence (6.7%) intersect with significant reproductive health needs. The county has a high unplanned pregnancy rate (78%) among HIV-seropositive women, exacerbating risks of mother-to-child HIV transmission (9.7%), which exceeds the national target of 5%. Although postpartum family planning (PPFP) is critical to address these concerns, only 56% of women in this population report using modern family planning methods postpartum. This study aimed to assess health system factors influencing the uptake of Postpartum (PP) modern FP methods among HIV-seropositive women in Busia County. Specifically, it determined the prevalence of PP modern FP method uptake, client-reported health service delivery factors, health provider-related factors, and commodity-related factors that affected the uptake of Postpartum modern FP methods among HIV-seropositive women in Busia County. It was across-sectional studythatinvolved311HIV-seropositive women who had a child 12- 24 months of age. These women were selected from Maternal and Child Health outpatient clinics within Busia County referral hospital, Alupe, Teso North, Khunyangu, Nambale, Port Victoria, and Samia Sub-County hospitals in Busia County. The respondents were selected through systematic random sampling and 14 health providers were selected through purposive sampling for the key informant insights. Quantitative data from the respondents was collected using a pretested questionnaire while qualitative data was collected using a KII guide. The quantitative data was analyzed using STATA 15, employing descriptive statistics, logistic regression, and Chi-square tests while thematic induction was done for the qualitative data. The study had a 100% response rate with the participant‘s mean age being 32.04 (± 6.02)years and 51.1% being between 25 - 34 years. Most of the women were married (74.6%), unemployed (77.4%), and had primary as the highest level of education (56.6%). At a 95% confidence interval, the study results revealed that 73.3% (95% CI 68.0 - 78.1) of the participants had utilized PP modern FP at some point. However, only 53.1% (95% CI 46.9 - 58.2) reported consistent PP modern FP method use throughout the first 12 months postpartum. After adjusting for variables significant at bivariate analysis, the study showed increased odds of PP modern FP method uptake among respondents who reported having been provided information on all types of FP methods (aOR 2.33, 95% CI 1.19 - 4.16, p=0.012). However, regarding commodity-related factors, users were more likely to have received PP modern FP methods, with significant differences in those who never found a method unavailable (57.9%). Persistent stock-outs of the different modern FP methods hindered PP modern FP service provision. Regarding health provider-related factors, PP modern FP method users were more likely to have been counseled during clinic visits (85.5%), during pregnancy (86.1%) and found waiting times acceptable (81.8%). Staffing and motivation also played important roles in FP uptake. This study found gaps in the uptake of PP modern FP methods among HIV-seropositive women in Busia County, Kenya. While initial uptake is high, consistent use through PP remains low, primarily influenced by the availability of comprehensive FP information and various health system factors. Persistent stock-outs of modern FP methods and inadequate counseling during clinic visits and pregnancy further impede consistent PP modern FP method use. Addressing these health provider and commodity-related factors is crucial to improving FP service delivery and reducing maternal and child health risks in high HIV-incidence areas like Busia County.