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Impact of Postpartum Contraceptive Counselling on Postpartum Family Planning Uptake among Women in Nigeria

Abstract

Postpartum family planning is an important component of maternal and reproductive healthcare because it enables women and couples to make informed decisions about the timing and spacing of subsequent pregnancies. Closely spaced and unintended pregnancies may increase health risks for women and infants, making access to appropriate postpartum contraceptive services an important public health priority. Despite the availability of contraceptive methods in Nigeria, postpartum family planning uptake remains affected by limited knowledge, misconceptions about contraceptive methods, fear of side effects, partner influence, cultural beliefs, inadequate counselling, financial barriers, and limited access to appropriate services. Postpartum contraceptive counselling provides an opportunity for women to receive accurate, individualized, and timely information about available contraceptive methods, their benefits, potential side effects, eligibility, effectiveness, and appropriate timing of initiation. Against this background, this study investigates the impact of postpartum contraceptive counselling on postpartum family planning uptake among women in Nigeria. The study will be anchored on the Health Belief Model, Theory of Planned Behavior, and Social Ecological Model. The Health Belief Model explains how women's perceptions of pregnancy risk, perceived benefits of contraception, perceived barriers, perceived severity of unintended pregnancy, and cues to action may influence contraceptive decision-making. The Theory of Planned Behavior emphasizes attitudes, subjective norms, perceived behavioural control, and behavioural intentions in determining women's decisions to adopt postpartum family planning. The Social Ecological Model recognizes the influence of individual, interpersonal, community, healthcare-system, and broader societal factors on contraceptive use. Collectively, these theoretical perspectives provide a suitable framework for explaining how postpartum contraceptive counselling may influence family planning uptake among women in Nigeria. The study will adopt a quantitative analytical cross-sectional or quasi-experimental research design. The study population will comprise postpartum women attending selected hospitals, primary healthcare centres, postnatal clinics, and community-based maternal health services across Nigeria. A multistage sampling technique will be used to select states, local government areas, communities, healthcare facilities, postpartum clinics, and eligible women. Postpartum contraceptive counselling will be assessed using indicators such as exposure to counselling, timing of counselling, frequency and duration of counselling sessions, information on available contraceptive methods, effectiveness, benefits, possible side effects, contraindications, return to fertility, breastfeeding considerations, method selection, partner involvement where appropriate, informed choice, counselling by trained healthcare providers, and follow-up support. Postpartum family planning uptake will be assessed using indicators such as adoption of a modern contraceptive method during the postpartum period, method initiation before discharge or during postnatal follow-up, continued contraceptive use, choice of method, adherence to recommended use, and attendance at family planning follow-up services. Data will be collected using structured questionnaires, postpartum clinic records, family planning registers, contraceptive service records, and relevant maternal and reproductive health programme documents. Descriptive statistics will be used to summarize participants' characteristics, exposure to contraceptive counselling, contraceptive knowledge, and family planning uptake. Inferential statistical techniques, including chi-square tests, t-tests, correlation analysis, and logistic or multiple regression analysis where appropriate, will be used to determine the impact of postpartum contraceptive counselling on family planning uptake. Where a quasi-experimental design is adopted, family planning uptake among women receiving structured postpartum contraceptive counselling may be compared with uptake among women receiving routine postpartum care, while relevant demographic, socioeconomic, obstetric, breastfeeding, partner-related, and healthcare-access factors are appropriately controlled. Diagnostic tests will also be conducted to assess the reliability, validity, and robustness of the findings. The study is expected to find that postpartum contraceptive counselling has a significant positive impact on postpartum family planning uptake among women in Nigeria. Women who receive comprehensive, timely, and individualized contraceptive counselling are expected to demonstrate higher uptake of appropriate modern contraceptive methods than women with limited or no exposure to postpartum counselling. Accurate information about contraceptive effectiveness, possible side effects, breastfeeding compatibility, return to fertility, and method options may reduce misconceptions and improve women's confidence in making informed reproductive health decisions. Counselling provided before hospital discharge and reinforced during postnatal and family planning visits may create opportunities for women to initiate and continue appropriate contraceptive use. However, concerns about side effects, partner opposition, cultural and religious beliefs, misinformation, financial constraints, limited availability of preferred contraceptive methods, and inadequate follow-up may reduce uptake. The study therefore expects accessible, respectful, voluntary, client-centred, and evidence-based postpartum contraceptive counselling to contribute significantly to improved postpartum family planning uptake among women in Nigeria. The study is expected to contribute to the literature on postpartum contraceptive counselling, postpartum family planning, contraceptive uptake, reproductive health, birth spacing, maternal health, family planning services, and public health in Nigeria. The findings will provide useful information to the Federal Ministry of Health and Social Welfare, National Primary Health Care Development Agency, state ministries of health, hospitals, primary healthcare centres, family planning providers, midwives, nurses, obstetricians, community health workers, reproductive health programmes, development partners, and policymakers regarding strategies for improving postpartum contraceptive services. The study will also provide evidence-based recommendations for integrating comprehensive contraceptive counselling into antenatal, maternity, postnatal, and child-immunization services, strengthening provider training, ensuring availability of a broad range of contraceptive methods, improving follow-up services, addressing misconceptions about contraception, and promoting informed and voluntary postpartum family planning choices among women across Nigeria.

Keywords: Postpartum contraceptive counselling, postpartum family planning uptake, contraception, women, birth spacing, reproductive health, family planning services, postpartum care, maternal health, Nigeria, public health.