KNOWLEDGE AND UTILIZATION OF FAMILY PLANNING SERVICES DURING THE POSTPARTUM PERIOD: A CASE STUDY OF AMINU KANO TEACHING HOSPITAL (AKTH), KANO STATE

ABSTRACT

Postpartum family planning (PPFP) is a critical, evidence-based strategy for preventing closely spaced pregnancies, reducing maternal and neonatal mortality, and contributing to achievement of the Sustainable Development Goals related to reproductive health. This study assessed the knowledge and utilization of family planning services during the postpartum period among women attending Aminu Kano Teaching Hospital (AKTH), Kano State, north-western Nigeria. A descriptive cross-sectional study design was employed, with 380 postpartum women who delivered at AKTH and were within six to twelve months post-delivery recruited through systematic random sampling at the immunization, postnatal, and family planning clinics. Data were collected using a structured, pre-tested interviewer-administered questionnaire covering knowledge of contraceptive methods, attitudes toward PPFP, utilization of family planning services, and barriers to PPFP uptake.

Findings revealed that while overall awareness of at least one contraceptive method was high (89.2%), only 24.7% of respondents demonstrated comprehensive knowledge of postpartum family planning, including knowledge of the lactational amenorrhoea method (LAM) and the timing of fertility return after delivery. Modern contraceptive utilization during the postpartum period was recorded at 31.3%, with injectables (13.4%), male condoms (10.8%), and implants (7.1%) being the most commonly used methods. Key barriers to PPFP utilization included partner disapproval (44.3%), fear of side effects (38.6%), religious and cultural objections (31.2%), and insufficient counselling by healthcare providers at discharge (27.8%). Binary logistic regression revealed that women with secondary or higher education (OR=4.21, 95% CI: 2.14–8.29), those who received PPFP counselling during ANC or delivery (OR=3.87, 95% CI: 1.93–7.76), and those who had discussed family planning with their partners (OR=3.45, 95% CI: 1.74–6.84) were significantly more likely to utilize PPFP services.

The study concluded that knowledge and utilization of PPFP at AKTH remain suboptimal, largely driven by low comprehensive knowledge, cultural and religious barriers, and inadequate PPFP counselling at critical points of care. The study recommends integration of PPFP counselling into ANC, intrapartum, and postpartum care; active male partner engagement; and community-based behaviour change communication to improve PPFP uptake in Kano State.

CHAPTER ONE

1.0 INTRODUCTION

1.1 BACKGROUND TO THE STUDY

The postpartum period defined as the first twelve months following delivery represents a critical window for family planning intervention. During this period, women and their families are particularly receptive to health education, and the healthcare system has a unique opportunity to influence reproductive decision-making at a time when the health consequences of unplanned or closely spaced pregnancies are vivid and immediate. Postpartum family planning (PPFP) is defined as the provision of family planning information, counselling, and services to women within the postpartum period, encompassing both the immediate postpartum period (within six weeks of delivery) and the extended postpartum period (six weeks to twelve months) (The Challenge Initiative, 2022).

Nigeria continues to record one of the lowest modern contraceptive prevalence rates globally, at approximately 12% for any modern method (Frontiers in Reproductive Health, 2026). This persistently low uptake is particularly pronounced in northern Nigeria, where cultural, religious, and social norms significantly shape reproductive decision-making. In Kano State, which is predominantly Muslim, attitudes toward family planning are influenced by religious interpretations and patriarchal gender dynamics that assign control over reproductive decisions primarily to male partners. Iliyasu et al. (2018) documented that in Kano, postpartum sexual activity and contraceptive use were significantly influenced by partners' attitudes and religious beliefs, underscoring the complexity of PPFP promotion in this context.

Studies from Nigeria have consistently documented that despite high awareness of contraceptive methods, knowledge about specific postpartum contraceptive methods including the Lactational Amenorrhoea Method (LAM), intrauterine devices (IUDs), and implants remains limited. A study in Lagos by Fadeyibi et al. (2022) found that only 11.7% of postpartum women demonstrated good knowledge of family planning, and approximately 38.5% utilized modern methods during the postpartum period. In southeastern Nigeria, a facility-based cross-sectional study (Amuzie et al., 2023) assessed unmet need for family planning among women in the extended postpartum period and found that the ravaging COVID-19 pandemic had further widened the gap between need for and access to PPFP services.

AKTH, as the foremost tertiary health facility in Kano State, manages a large volume of deliveries annually and operates dedicated family planning, immunization, and postnatal care clinics that provide structured opportunities for PPFP service delivery. However, the extent to which knowledge translates to utilization of PPFP services at AKTH, and the specific barriers operating in this institutional and cultural context, have not been comprehensively documented in recent peer-reviewed literature. This study therefore aimed to fill this gap.

1.2 STATEMENT OF THE PROBLEM

Despite the well-established benefits of PPFP in preventing maternal and child morbidity and mortality, uptake of family planning services during the postpartum period in northern Nigeria including Kano State remains alarmingly low. The consequences of this low uptake are severe: closely spaced pregnancies (interpregnancy interval less than 18 months) are associated with increased risk of preterm birth, low birth weight, neonatal mortality, and maternal depletion syndrome. Nigeria, with a total fertility rate of 5.3 births per woman (NDHS 2023–2024), requires transformative improvements in modern contraceptive prevalence to achieve demographic dividend and meet its Sustainable Development Goal commitments.

At AKTH, healthcare providers have reported significant challenges in convincing postpartum women and their partners to adopt modern contraceptive methods before discharge. The interplay of religious objections, partner resistance, fear of side effects, and low health literacy creates multidimensional barriers that routine healthcare encounters are ill-equipped to address. Without systematic, evidence-based data on the knowledge-utilization gap and the specific barriers operating among AKTH's postpartum population, targeted interventions cannot be designed. This study was undertaken to provide this evidence.

1.3 OBJECTIVES OF THE STUDY

The general objective of this study was to assess knowledge and utilization of family planning services during the postpartum period among women at Aminu Kano Teaching Hospital (AKTH), Kano State.

The specific objectives were to:

i. Describe the sociodemographic characteristics of postpartum women at AKTH.

ii. Assess the level of knowledge of postpartum family planning methods among the respondents.

iii. Determine the prevalence and pattern of family planning utilization during the postpartum period.

iv. Identify the barriers to postpartum family planning uptake among women at AKTH.

v. Examine the association between knowledge, sociodemographic factors, and PPFP utilization.

1.4 RESEARCH QUESTIONS

i. What are the sociodemographic characteristics of postpartum women at AKTH?

ii. What is the level of knowledge of PPFP methods among postpartum women at AKTH?

iii. What is the prevalence and pattern of family planning utilization during the postpartum period?

iv. What are the barriers to PPFP uptake among women at AKTH?

v. Is there a statistically significant relationship between knowledge and utilization of PPFP services?

1.5 RESEARCH HYPOTHESES

Ho1: There is no significant association between knowledge of family planning methods and utilization of postpartum family planning services at AKTH.

Ho2: Sociodemographic factors (education, parity, partner support) do not significantly influence postpartum family planning utilization among women at AKTH.

1.6 SIGNIFICANCE OF THE STUDY

The findings of this study are significant for healthcare planners, clinicians, nursing and midwifery professionals, and community health advocates in Kano State and northern Nigeria. The study provides evidence for the redesign of postpartum care packages at AKTH to include structured, comprehensive PPFP counselling at multiple touchpoints including during ANC, at delivery, and at postnatal visits. For policymakers, the study contributes data supporting the strengthening of the national postpartum family planning strategy, particularly in high-fertility, low-contraceptive-use regions of Nigeria. The study also advances the academic literature on PPFP in northern Nigeria, addressing a recognized evidence gap in a region where the cultural and religious dimensions of contraceptive decision-making require context-specific investigation.

1.7 SCOPE OF THE STUDY

This study was conducted at Aminu Kano Teaching Hospital (AKTH), Kano State, Nigeria. The study population comprised postpartum women who delivered at AKTH and were attending the immunization, postnatal care, and family planning clinics between six and twelve months post-delivery. Women who delivered outside AKTH but attended its clinics for postnatal care were included, while those with gynaecological conditions requiring surgical intervention (e.g., hysterectomy) that precluded future pregnancy were excluded. The study was cross-sectional and was limited to a three-month data collection window. It did not extend to community-based postpartum populations in Kano State outside the tertiary hospital setting.

1.8 DEFINITION OF TERMS

Postpartum Period: The period spanning from delivery of the placenta to twelve months after delivery. In this study, the extended postpartum period (six weeks to twelve months) was the primary focus. The immediate postpartum period refers to the first six weeks after delivery.

Family Planning: A range of interventions including contraceptive methods, fertility awareness, and reproductive health counselling that enable individuals and couples to achieve their desired number of children, control the timing and spacing of pregnancies, and prevent unintended pregnancies.

Postpartum Family Planning (PPFP): The deliberate use of family planning methods during the postpartum period to delay or prevent a subsequent pregnancy, protect maternal health, and reduce the risk of adverse maternal and neonatal outcomes associated with short interpregnancy intervals.

Modern Contraceptive Methods: Clinically approved, scientifically validated methods of preventing pregnancy, including oral contraceptive pills, injectable contraceptives, intrauterine devices (IUDs), implants, male and female condoms, diaphragms, sterilization, and emergency contraception.

Lactational Amenorrhoea Method (LAM): A temporary, natural contraceptive method based on the infertility associated with exclusive breastfeeding during the first six months postpartum. LAM is effective when the woman is exclusively breastfeeding, her menses have not returned, and her baby is less than six months old.

Knowledge of Family Planning: In this study, assessed as the respondent's awareness of at least three modern contraceptive methods, understanding of their mechanisms of action, correct knowledge of how to use them, knowledge of side effects, and knowledge of where to obtain them.

Utilization of Family Planning: In this study, defined as the actual adoption and consistent use of any modern contraceptive method during the postpartum period, confirmed by the respondent's self-report.

Interpregnancy Interval (IPI): The period of time between the end of one pregnancy and the conception of the next. The WHO recommends a minimum IPI of 24 months after a live birth to allow adequate maternal physiological recovery and minimize risks to the subsequent pregnancy.

REFERENCES

Amuzie, C.I., Kalu, K.U., Izuka, M., Nkwo, G.E., Nwamoh, U.N., Metu, K., Emma-Ukaegbu, U., Okafor, G.O., & Odini, F. (2023). Unmet need for family planning and predictors among women in the extended postpartum period, southeastern Nigeria: A facility-based cross-sectional study. Pan African Medical Journal, 45, 38. https://doi.org/10.11604/pamj.2023.45.38.39205

Fadeyibi, F., Eke, C., Olawole, A., & Falade, C. (2022). Knowledge and utilization of family planning among rural postpartum women in Southwest Nigeria. Journal of Family Medicine and Primary Care, 10(10), 3720–3726. https://doi.org/10.4103/jfmpc.jfmpc

Frontiers in Reproductive Health. (2026). Assessing patterns, barriers, and motivations for family planning utilization among currently pregnant women in Nigeria: A cross-sectional study. https://doi.org/10.3389/frph.2026.1789800

Iliyasu, Z., Galadanci, H.S., Danlami, K.M., Salihu, H.M., & Aliyu, M.H. (2018). Correlates of postpartum sexual activity and contraceptive use in Kano, northern Nigeria. African Journal of Reproductive Health, 22(1), 103–112.

Sirage, N., Desalegn, Z., Wako, W.G., Yimer, A., Bizuneh, F.K., Feleke, S.F., Yesuf, A., & Beyene, B.N. (2024). Family planning utilization among postpartum women in the Bule Hora District, southern Ethiopia. Frontiers in Global Women's Health, 5, 1323024. https://doi.org/10.3389/fgwh.2024.1323024

The Challenge Initiative. (2022, August 30). Nigeria: Postpartum family planning. https://tciurbanhealth.org/courses/nigeria-service-supply/lessons/nigeria-postpartum-family-planning/

World Health Organization. (2023). WHO recommendations: Intrapartum care for a positive childbirth experience. World Health Organization.

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