Knowledge and Attitudes among Primary Healthcare Physicians Regarding Immediate Postpartum Contraception in Cairo, Egypt

Allam MF, Elhazek AA, Amin GE, Eltaieb EM and Talib YMA

Published on: 2019-10-17

Abstract

Background: Family planning has a great impact on maternal and child health. Postpartum contraception is defined as the prevention of unintended pregnancy and closely spaced pregnancies in the first 12 months following childbirth.

Purpose: To assess the level of knowledge and attitudes regarding immediate postpartum contraception among primary health care [PHC] physicians in Egypt.

Material and Methods: A pilot cross-sectional study conducted among 100 PHC physicians from 3 health districts in Cairo governorate, Egypt. The study was conducted between August and October 2017. Data were collected through a pre-designed validated self-administered questionnaire on sociodemographic characteristics and knowledge and attitude questions regarding postpartum contraception.

Results: The mean knowledge score was 31.75 ± 9.24; 72% of physicians had a poor knowledge score, and 9% had good knowledge scores. The mean attitude score was 76.92 ± 8.81, and 56% had a favorable attitude. There was no significant difference in knowledge and attitude scores in terms of gender, residence, marital status and PHC center. However, there was a significant difference in knowledge scores in terms of age and experience. There was a significant difference in total knowledge score and attitude when comparing scientific degrees, with higher scores among those with master’s degrees.

Conclusion: There was an unsatisfactory level of knowledge regarding immediate postpartum contraception; there were also a high percentage of favorable and neutral attitudes among the participating physicians. Thus, training courses should be designed for PHC physicians to maintain and improve their knowledge and skills regarding immediate postpartum contraception.

Keywords

Attitude; Knowledge; Physicians; Postpartum contraception

Introduction

Family planning implies the ability of individuals and couples to anticipate and attain their desired number of children through the spacing and timing of births via contraception and the treatment of involuntary infertility [1]. Worldwide, nearly two-thirds of women in their first postpartum year have inadequate contraception [2]. In Egypt, approximately 13% of currently married women are considered to have an unmet need for family planning [3]. The traditional paradigm of starting contraception at a woman’s 6-week postpartum visit has been revolutionized; the emphasis is shifting towards providing women with the most effective methods as early as possible postpartum [4]. The postpartum months are a challenging time for women because of breastfeeding, childcare, and the resumption of menstruation and sexual relations [5]. Overall, one-fourth of women ovulate between 25 and 39 days postpartum, long before the traditional 6-weeks postpartum visit [6]. Thus, all women should be advised to use contraception before this time if they do not wish to become pregnant again [7]. Studies have reported that 20% of women of all ages resume sexual activity before 4 weeks postpartum [8]. This strong trend towards initiating contraception prior to the postpartum discharge home highlights the need for antepartum patient counselling about postpartum contraception. All of these new opportunities shift the burden of postpartum contraception counselling onto the shoulders of the prenatal care provider. The American College of Obstetricians and Gynecologists and the American Academy of Pediatrics recommend that a primary focus of routine prenatal and postpartum care should be the discussion of contraceptive options and the prompt immediate initiation of postpartum contraception [10]. Despite its appeal in Egypt, immediate postpartum contraception has not widely acquired an established role in the portfolio of contraception. Only one recent study was conducted to examine the level of knowledge and attitudes regarding immediate postpartum contraception among physicians of a tertiary referral hospital in Alexandria, Egypt [11]. The aim of the current pilot study is to assess the level of knowledge and attitudes regarding immediate postpartum contraception among primary health care [PHC] physicians in Egypt.