Postpartum Contraceptive Use in the Comoros: Challenges and Influencing Factors

Abstract

women's awareness and use of FP, Their preferred methods and information sources, the role of healthcare providers, and how social, cultural, and religious factors affect contraceptive decisions and discontinuation. Materials and Methods: This cross-sectional study, conducted from July 10 to December 15, 2024, involved 271 pregnant and postpartum women aged 15–49 across the Comorian islands of Ngazidja, Anjouan, and Mohéli. Participants were recruited from selected health facilities, including PMI, ASCOBEF, and Mbeni Hospital (Ngazidja); CMU, Ndomoni, and Ouani (Anjouan); and CMU Fomboni, Ndrondroni, and Wanani (Mohéli). Data were collected using a structured, interviewer-administered questionnaire assessing knowledge, attitudes, practices, and socio-cultural, economic, and interpersonal factors influencing family planning. Descriptive and inferential statistics (chi-square, t-tests, and regression) were used to analyze the data. Ethical approval and informed consent were obtained. Findings: Awareness was highest for injectables, pills, and implants, while knowledge of IUDs and natural methods was low. Injectables were the most used method, though most participants had never used contraception. Discontinuation was mainly due to side effects and lack of partner approval. Health professionals were the main source of information. Discussions about contraception were most common with husbands and family members. Partner support (41%) and women’s approval (29%) varied, while religion showed limited direct influence. Unique Contribution to Theory, Practice and Policy: These findings underscore the importance of expanding knowledge about the full range of contraceptive options, particularly IUDs and natural methods, to improve informed choice. Addressing side effects through improved counseling, while actively engaging male partners in family planning programs, may reduce discontinuation and increase uptake. Given the strong role of health professionals and family discussions in shaping decisions, interventions should leverage these channels to foster supportive environments for postpartum contraceptive use.