Menstrual pattern, sexual behaviors and contraceptive use among postpartum women in Nairobi urban slums: evidence from longitudinal data

Robert P. Ndugwa, London School of Hygiene and Tropical Medicine (LSHTM)
John G. Cleland, London School of Hygiene and Tropical Medicine (LSHTM)
Nyovani Madise, University of Southampton
Jean-Christophe Fotso, African Population and Health Research Center (APHRC)

Postpartum months provide a challenging period for poor women. This study examined patterns of menstrual resumption, postpartum sexual behaviors and contraceptive use among postpartum poor women. Women were eligible for the study if they had a birth during the period after September 2006 and were residents of the two Nairobi slum communities under continuous demographic surveillance. A monthly calendar type questionnaire was administered retrospectively to cover the period since birth to the interview date and data on sexual behavior, menstrual resumption, breastfeeding patterns, and contraception was collected. The results show that sexual resumption occurs earlier than menses and postpartum contraceptive resumption. Out of all postpartum months where women were exposed to the risk of another pregnancy, about 28% were months where no contraceptive method was used. Menstrual resumption acts as a trigger for initiating postpartum contraceptive use with a heightened peak of first contraceptive use occurring shortly after the first month when menses are reported. Minimal differences in contraceptive method choice were observed between women who are early adopters than late adopters in respect of menstrual resumption. Postpartum poor women in marginalized areas such as slums need increased access to reproductive health services. Postnatal visits and other subsequent health system contacts are promising opportunities for reaching postpartum women with a need for family planning services.