Early resumption of sexual intercourse and associated factors among postpartum women in sub-Saharan Africa: Analysis of recent Demographic and Health Survey data (2019–2024)

Abstract

Background: Early resumption of sexual intercourse after childbirth poses significant health risks, including infections, unintended pregnancies, and adverse maternal outcomes. Despite the importance of postpartum sexual health, it remains an overlooked issue, particularly in sub-Saharan Africa, where early sexual resumption is highly prevalent. Objective: To examine the prevalence and factors associated with early sexual resumption among postpartum women in sub-Saharan Africa, providing insights to inform targeted interventions and policies to improve postpartum health. Design: A community-based cross-sectional study design. Methods: Data from the most recent Demographic and Health Survey conducted between 2019 and 2024 across sub-Saharan African countries were used. A total weighted sample of 65,292 postpartum women was included in the analysis. A multilevel mixed-effects model with robust Poisson regression was fitted to identify factors associated with early resumption of sexual intercourse. The deviance statistic was used to assess model fitness. In the multivariable regression analysis, adjusted prevalence ratios with 95% confidence intervals (CIs) were calculated to estimate the strength of associations, with statistical significance set at p -value <0.05. Results: The prevalence of early resumption of sexual intercourse was 65.27% (95% CI: 64.91, 65.64). Women’s age, educational level, employment status, religion, wealth index, media exposure, family size, whether the child was alive, parity, a woman’s desire for more children, and place of residence were statistically significant factors associated with the early resumption of sexual intercourse. Conclusion: About two in three postpartum women resumed sexual intercourse early after childbirth. Targeted postpartum counseling, family planning access, and media campaigns are crucial to raising awareness of early sexual resumption risks, particularly among those desiring more children, wealthier, and rural women. Psychosocial support for bereaved mothers and workplace policies supporting postpartum women can help reduce contributing pressures.