Unintended Pregnancy, Postpartum Contraception, and Healthcare Utilization Among Young Married Women Affected by HIV in Kenya.

다국어 초록 (Multilingual Abstract)

Women with an unintended pregnancy are at risk of a repeat unintended pregnancy. Although use of postpartum contraception is an effective way to prevent repeat unintended pregnancies, the majority of unintended pregnancies globally occur in women who are not using contraception. Unintended pregnancies can have negative health and social consequences for both women and their children. This study aimed to better understand the use of postpartum contraceptives and healthcare services by married women with unintended versus intended pregnancy in south-western Kenya, with a special focus on young women.The study followed an exploratory sequential mixed methods design. In the first phase, young married women with intended and unintended pregnancies were qualitatively interviewed at around 12 months postpartum. The interviews explored their lived experiences in early marriage and pregnancy and their use of contraceptives and healthcare services. In the second quantitative analysis phase, data from a larger sample of married female participants in the same geographic region were analyzed using bivariate and multi- variable logistic regression, including exploratory mediation and moderation analyses.Finally, the qualitative themes that emerged from the participants were integrated with the results of the quantitative analysis to provide mixed method findings.The mixed method findings suggest that women with a recent unintended pregnancy are at higher risk of a repeat unintended pregnancy due to multiple social and economic vulnerabilities that lead to their reduced likelihood of postpartum contraceptive use, although in quantitative analysis this effect was only statistically significant for older women. Both quantitative and qualitative data indicated that women with significantly older male partners (larger age disparity) have reduced use of both postpartum contraceptives and healthcare services. Thus, the factors that existed leading to an unintended pregnancy may persist after birth of the child and compromise both postpartum healthcare utilization and contraceptive use. These results suggest that there is need to address the challenges faced by poor young women that result in early marriage, to deliver contraceptive education to men as well as women, and improve family planning counseling for couples starting early in the pregnancy for the reduction of unintended pregnancies and improvements in maternal and child health.