Knowledge about unintended pregnancy shortly after childbirth: An issue of ineffective counseling or adherence?

BACKGROUND: Being aware of the possibility of becoming pregnant shortly after childbirth before the resumption of the menstrual period is often overlooked but remains a significant contributor to unintended pregnancies and may lead to maternal and neonatal comorbidities. Exploring the extent of awareness and associated factors could help tailor more interventions toward reducing the rates of short-interval unplanned pregnancies. OBJECTIVE: This study explores the extent to which Ghanaian women are aware of the possibility of becoming pregnant shortly after childbirth before the resumption of the menstrual period and its associated factors. DESIGN: A cross-sectional study was conducted using the 2017 Ghana Maternal Health Survey. The women participants were sampled using a two-stage cluster sampling design. METHODS: We analyzed the 2017 Ghana Maternal Health Survey data of 8815 women who had given birth and received both antenatal care and postnatal checks after delivery in health facilities (private and public) and responded to questions on being aware of short interpregnancy intervals. A multivariable survey logistic regression was used for the analysis. RESULTS: Of the 8815 women, approximately 62% of women who received both antenatal care and postnatal examinations before discharge reported being aware of short interpregnancy intervals. Postnatal examination before discharge but not antenatal care was associated with a higher awareness of short interpregnancy intervals. Women who received a postnatal examination were more aware of short interpregnancy intervals than their counterparts (adjusted odds ratio = 1.29, 95% confidence interval: 1.03-1.61). Also, awareness of short interpregnancy intervals increased with age, education, knowledge of the fertile period, contraceptive use, and delivery via cesarean section. CONCLUSION: Over a decade following the initiation of Ghana's free maternal health policy, there remains a significant gap in the awareness of short interpregnancy intervals, even among women who received both antenatal pregnancy care and postnatal examinations before discharge. The unawareness of the short interpregnancy interval observed in approximately 38% of women raises concerns about the effectiveness of counseling or education provided during antenatal care and immediate post-partum care regarding birth spacing, contraceptive use, the timing of resumption of sexual activity, and the extent to which women adhere to such guidance.

A study found more women were unaware of pregnancy soon after birth before mensesUnplanned pregnancies may lead to worsened health conditions for mothers and newborn infants. One possible way this unplanned pregnancy could happen is through unknowingly becoming pregnant soon after birth before menstruation resumes. However, the more we know about pregnancy soon after birth before menstruation resumes, the better we can introduce measures to reduce it. This study examines how well Ghanaian women are aware of the possibility of becoming pregnant soon after birth before menstruation resumes and factors that may influence the awareness. This study analyzed 2017 data collected from women who received pre-delivery care and post-delivery checks before discharge from a health facility. The study findings revealed that 38% of the 8815 women who received both pre-delivery care and post-delivery checks were unaware of pregnancy soon after birth before menstruation resumed. Factors such as post-delivery checks, contraceptive use, delivery through cesarean section, women aged 30 years and over with secondary education and higher, and having knowledge of the periods more appropriate for a woman to be pregnant were more aware of pregnancy soon after birth before menstruation resumed. We proposed that effective counseling and adherence from women who are not planning to get pregnant soon after birth could help reduce the rate of pregnancy soon after birth before menstruation resumes. These unplanned pregnancies can also be avoided by educating women about birth spacing, contraceptive use, and the timing of resumption of sexual activity.

Predictors of prolonged hospitalization after vaginal birth in Ghana: A comparative study.

Early discharge after child delivery although indispensable, but maybe precluded by several factors. The effect of these factors on prolonged length of stay (LOS) after vaginal delivery has been sparsely investigated in Ghana. This limits understanding of potential leading indicators to inform intervention efforts and optimize health care delivery. This study examined factors associated with prolonged LOS after vaginal birth in two time-separated cohorts in Ghana. We analyzed data from Ghana's demographic and health surveys in 2007 and 2017. Our comparative analysis is based on subsamples in 2007 cohort (n = 2,486) and 2017 cohort (n = 8,065). A generalized estimating equation (GEE) with logistic regression was used to examine predictors of prolonged LOS after vaginal delivery. The cluster effect was accounted for using the exchangeable working correlation. The odds ratios (OR) and 95% confidence interval were reported. We found that 62.4% (1551) of the participants in 2007 had prolonged LOS after vaginal delivery, whereas the prevalence of LOS in the 2017 cohorts was 44.9% (3617). This constitutes a 17.5% decrease over the past decade investigated. Advanced maternal age (AOR = 1.24, 95% Cl 1.01-1.54), place of delivery (AOR = 1.18, 95% Cl 1.02-1.37), child's size below average (AOR = 1.14; 95% Cl 1.03-1.25), and problems suffered during/after delivery (AOR = 1.60; 95% Cl 1.43-1.80) were significantly associated with prolonged (≥ 24 hours) length of hospitalization after vaginal delivery in 2017. However, among variables that were available in 2007, only those who sought delivery assistance from non-health professionals (AOR = 1.89, 95% CI: 1.00-3.61) were significantly associated with prolonged LOS in the 2007 cohort. Our study provides suggestive evidence of a reduction in prolonged LOS between the two-time points. Despite the reduction observed, more intervention targeting the identified predictors of LOS is urgently needed to further reduce post-vaginal delivery hospital stay. Also, given that LOS is an important indicator of medical services use, an accurate understanding of its prevalence and associated predictors are useful in assessing the efficiency of hospital management practices and the quality of care of patients in Ghana.