Determinants of postpartum family planning uptake among women in the union of the Comores: the role of socio-demographic characteristics, partner support, and contraceptive awareness

Abstract

Background: The postpartum period is an important opportunity to prevent unintended pregnancies through family planning (FP). Despite high contraceptive awareness, postpartum FP (PPFP) uptake remains low in many low- and middle-income countries (LMICs), including Comoros. This study assessed factors associated with postpartum contraceptive uptake among women in the Union of the Comoros. Methods: A cross-sectional study was conducted among 251 pregnant and postpartum women aged 15 -49 years attending health facilities across the three islands of Comoros from July to December 2024. Data were collected using a structured questionnaire, and associations with PPFP uptake were assessed using chi-square tests. Ethical approval was obtained (UI/EC/24/0302 and N°24002/CNESS/PR). Results: Among the participants, 78.9% had knowledge of FP, while 65.0% reported current contraceptive use. Injectable contraceptives were the most commonly used method (43%), followed by implants (23%) and oral contraceptive pills (12%). PPFP uptake was significantly associated with island of residence (p=0.0005), educational level (p=0.042), and number of living children (p=0.013). Women from Anjouan had the highest proportion of contraceptive use (25.0%), followed by Ngazidja (23.0%) and Mohéli (16.0%). Higher contraceptive uptake was observed among women with secondary and tertiary education compared with those without formal education. Women with three or more living children had the highest proportion of contraceptive use (46.1%). Age, marital status, employment status, income sufficiency, and desire for another child were not significantly associated with PPFP uptake. Conclusions: PPFP uptake in Comoros is influenced by geographic location, education, and parity. Improving access to quality PPFP services and targeted interventions may enhance contraceptive use and maternal health outcomes.