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. 2024 Nov 21;21(1):169.
doi: 10.1186/s12978-024-01899-7.

Who actualizes postpartum contraceptive intentions? A trajectory cluster analysis

Michelle L O'Brien  1 , Aasli Abdi Nur  2
Affiliations

Who actualizes postpartum contraceptive intentions? A trajectory cluster analysis

Michelle L O'Brien et al. Reprod Health. .

Abstract

Contraceptive intention is an important woman-centered indicator for family planning. Yet, few studies have examined the determinants of women or couples actualizing their contraceptive intentions. We leverage panel data from the Performance Monitoring for Action (PMA) survey in Ethiopia to examine these dynamics among a pregnancy cohort, over the first year postpartum. Using cluster analysis on intent-to-use trajectories, we find distinct patterns across wealth categories, education levels, and regions. Additionally, we find that receiving family planning counseling in both antenatal and postnatal care visits led to a higher likelihood of intending to use. However, counseling did not increase the odds of actualization. We argue that examining actualization through model-based approaches like cluster analysis generates better insight into woman-centered contraceptive demand and provides stronger evidence for strengthening postpartum family planning interventions, than quantifying contraceptive use alone. Modeling postpartum actualization trajectories can shed light on the barriers to women's and couple's reproductive autonomy and inform future investments in both upstream development of better contraceptive methods and downstream implementation.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Sankey plot of intent-to-use trajectories for first year postpartum, PMA Ethiopia
Fig. 2
Fig. 2
Optimal number of clusters using the elbow method (A) and the gap statistic (B)
Fig. 3
Fig. 3
Probabilities of cluster membership based on intent-to-use states across all four waves of the PMA Ethiopia cohort survey
Fig. 4
Fig. 4
Multinomial regression model coefficients. Reference category is Cluster 1—Actualized non-users
See this image and copyright information in PMC

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