Resumption of sexual activity and contraceptive use among postpartum women in the Kumasi Metropolis of Ghana

Resumption of sexual activity and contraceptive use among postpartum women in the Kumasi Metropolis of Ghana | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Resumption of sexual activity and contraceptive use among postpartum women in the Kumasi Metropolis of Ghana Amponsah Peprah, Kwabena Antwi Danso, Kwadwo Sarbeng, Frank Ankobea, and 9 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5000159/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background : The postpartum period presents challenges to women as they contemplate on the desire to space or limit childbirth while meeting the sexual demands of their partners and their own sexual desires. The study looked at the factors that determine the resumption of sexual activity after delivery and their influence on contraceptive use among postpartum women in the Kumasi metropolis. Method : An analytical cross-sectional study was conducted using an interviewer administered structured questionnaire with both closed and open-ended questions, on 853 mothers aged 15-49 years, attending child welfare clinics with babies who were up to one (1) year old in the Kumasi Metropolis of Ghana. Results : Majority (76%) of the women initiated sexual intercourse from 6 weeks after delivery but only 34% used contraceptives, despite the 99% awareness of postpartum family planning services. Response to partners’ demand for sex was the most important stimulus for resumption of sexual activity while unavailability of the partner was the main reason for sexual inactivity after delivery. Marital status (AOR: 4.94, CI=2.99-8.15), residence after delivery (AOR: 0.53, CI=0.38-0.76), resumption of menses (AOR= 0.19, CI= 0.13 – 0.27), birth limiting (AOR= 0.68, CI= 0.45 – 0.98), and birth spacing (AOR= 0.40, 95% CI= 0.18– 0.91) significantly predicted resumption of postpartum sexual activity and contraceptive uptake. Conclusion : Reproductive health service providers in the metropolis should highlight the return to fertility and timing of sexual intercourse after delivery, and adopt strategies to demystify the fear of side effects during counselling and provision of Family Planning services. postpartum contraception sexual activity family planning Figures Figure 1 Figure 2 Figure 3 Figure 4 Background The period after delivery is unique and challenging to women as they go through the process of caring for their newborns, breastfeeding, recovery from the stress of labour and possible complications during delivery and adjusting to the withdrawal of the physiological hormonal changes of pregnancy. 1 They also contemplate on the desire to space or limit childbirth while meeting the sexual demands of their partners and their own sexual desires. 2 The postpartum period also provides an essential avenue for prolonged interaction and counselling of women towards contraceptive use. The healthcare provider is offered an opportunity to discuss and address the health concerns, particularly the reproductive goals of the woman. Exposure to postpartum family planning services is therefore a crucial component of the healthcare that is provided for women after delivery; to prevent unintended and closely spaced pregnancies. Inadequate knowledge about the return of fertility in the postpartum period heightens the susceptibility of women to unintended pregnancies as many women and health providers erroneously assume that fertility returns only with resumption of menses. 4 Women who resume sexual activity before the resumption of menses could be fertile, putting them at risk of a mistimed or unwanted pregnancy. 4 Seizing the opportunity to offer family planning services to women in the postpartum period may result in an increase in the uptake of family planning methods and a reduction in unintended pregnancies. Several factors influence the utilisation of postpartum family planning services. These include age, education level, counselling during antenatal and postnatal clinics, family size, resumption of menses, return to fertility, previous contraceptive experience, knowledge of family planning methods, opinion of partner, and others. Arguably the most important component of the client-related factors is resumption of sexual activity after childbirth since natural conception cannot occur without sexual intercourse. This probably accounted for the adoption of postpartum abstinence (PPA) as the traditional means of contraception in most societies in the developing world. 1 Periods of abstinence from sexual activity following delivery vary greatly among women. Generally, sexual activity in the postpartum runs a graduated course from initial infrequent and irregular activity progressing to more regular sexual encounters later. 5 Studies have also shown that early initiation of sexual intercourse was observed in women who had spontaneous vaginal delivery and in those who stayed at home with their mothers than in-laws and aunts. 6 Despite the regular interaction between healthcare providers and women during the postpartum period, not much is seen in uplifting the interest of women towards contraceptive use especially in developing countries. Postpartum contraceptive uptake is therefore low in the Kumasi Metropolis despite the high awareness levels and availability of the services. 7 In the absence of contraception, the probability of pregnancy is related to the regularity of sexual intercourse. The information on initiation of intercourse after childbirth and the correlation with contraceptive use is important for the refinement of the measurement of exposure to pregnancy. It will also provide relevant information, both quantitative and qualitative; to inform policy and restructure programmes for effective postpartum contraceptive use in the metropolis and other communities. This study therefore sought to look at the factors that determine the resumption of sexual activity after delivery and their influence on the utilisation of contraceptive methods among postpartum women attending child welfare clinics in the Kumasi metropolis. The framework for this study is based on the dynamics and the extent to which the service-related factors and client-related factors influence each other to determine postpartum sexual activity and contraceptive use. Methods The study was cross-sectional with quantitative approach conducted from 4th -31st January, 2018 within the Kumasi metropolitan area (KMA). A structured questionnaire with closed and open- ended questions was used to collect data. The questionnaire was orally administered to the study participants in a face-to-face interview, following explanation of procedure and obtaining informed consent, in a language understood by the participants. Two (2) female research assistants were trained in each facility for the data collection. The data collection took place concurrently at all the six (6) study sites during the working hours of the child welfare clinics. An average of eight (8) participants was recruited in each facility a day. Data were collected on socio-demographic features, the past obstetric history, breastfeeding status and onset of menstruation after the delivery. The women were also asked whether they had resumed vaginal intercourse and if so, when after delivery and whether any contraceptive method was being used and the timing of method initiation. Reasons for non-contraceptive use were also obtained. Reason(s) for commencement of sexual intercourse or otherwise were also recorded. The population for this study was all postpartum women aged 15–49 years, attending the child welfare clinics in the Kumasi metropolis. All women whose babies were up to one-year-old (0–12 months), reporting for immunisation and child welfare assessment who consented to participate in the study, were recruited. However, women attending child welfare clinic but had not delivered a baby in the last one year preceding the survey, those considered not fit to respond adequately to questions asked either due to the health condition of the mother or that of the child and those who had hysterectomy during delivery were excluded from the study. The sample size for the study was calculated using the precision formula by Lesley Kish: n = z 2 pq/ d 2 . According to Winfrey and Kshitiz, 8 the postpartum contraceptive prevalence rate in Ghana is 21.3%. However, assuming that 50% of postpartum women in the metropolis had resumed sexual activity, n = (1.96) 2 (0.50) (0.50)/ (0.05) 2 n = 384.16; ≈ 384 Using the default design effect (deff) of 2.0 in multistage sampling, to achieve the same reliability that a simple random sample (SRS) would produce, the sample size (n) is multiplied by 2; 384 x 2 = 768 Accounting for estimated non-response rate of 10% ≈: 77 N = 768 + 77 N (total sample size) = 845 Thus, the minimum sample size required for the study was 845. A multistage sampling technique was used in this study. Each of the 5 sub-metropolitan health facilities within KMA in addition to Komfo Anokye Teaching Hospital (KATH) which is the only tertiary hospital in the Region was purposively selected. However, the number of clients selected from each facility was determined by probability proportionate to size (attendance) of postpartum women attending the child welfare clinics. Systematic sampling was then employed to get the required sample size for each facility. Pre-testing of the questionnaire was undertaken at the Ejisu municipal hospital. This health facility offers child welfare and family planning services and has similar characteristics as the study health facilities. After the pre-testing, some questions were rephrased or changed from open-ended to closed format, to ensure clarity in order to elicit the correct response from the participants. The raw data were edited and coded. A codebook that defined data to allow for statistical analysis was then developed. The data were field-edited daily and entered into Excel before they were exported into STATA (version 15) for analysis. Initial descriptive statistics in the form of frequencies and percentages were computed for the variables in the data set while further inferential analyses were done to explore statistical association between variables. Appropriate bivariate analyses were carried out to assess statistical association between dependent and independent variables, and stepwise logistic regression model was performed to identify the effect of the factors that were significantly associated with the postpartum resumption of sexual activity and contraceptive use. All computations were done at 95% confidence interval (CI) and Statistical significance was set at p-value of ≤ 0.05. Results The age range of the respondents was 17 to 48years with the mean age being 30.20years (± 5.14). About 1% was below 20years while 3.99% was 40 years and above. Most (80.66%) of the women were married while 8.44% were single and 10.08% were in consensual unions. About 19% of the women had attained tertiary level of education and less than 5.0% had no formal education (Table 1 ). Table 1 Socio-demographic characteristics of study sample Variable Frequency (N = 853) Percentage (100%) Age (years) < 20 7 0.82 20–24 108 12.66 25–29 285 33.41 30–34 274 32.12 35–39 145 17.00 40+ 34 3.99 Marital status Single 72 8.44 Married 688 80.66 Widowed 4 0.47 Cohabiting 86 10.08 Divorced/Separated 3 0.35 Educational Level None 35 4.10 Primary 80 9.38 Middle/JHS 323 37.87 Secondary 254 29.78 Tertiary 161 18.87 Income earning activity Yes 665 77.96 No 188 22.04 Religion Christianity 765 89.68 Islam 78 9.14 African Traditional 7 0.82 No religion 3 0.35 Total 853 100 Majority (76.00%) of the respondents had resumed sexual intercourse after the last delivery. Request for sex by the partner was the major reason (91%) for the resumption. Forty-three (6.62%) of the women engaged in sexual activity because the time seemed convenient for sexual re-union after delivery. Majority (61.57%) of the respondents who had not resumed sexual intercourse since delivery stated that their partners were not available. About 20% of the sexually inactive women indicated that their deliveries were associated with perineal/vaginal tears, episiotomies or caesarean sections while 14.30% were not sexually active because of the fear of getting pregnant. About 81% of the respondents had vaginal delivery though 0.47% was via vacuum extraction while the remaining 19% delivered by caesarean section (Table 2 ). Majority (62.13%) of the respondents practiced exclusive breastfeeding for 3 months. Unintended pregnancy was also recorded among 35 (4.13%) of the respondents. Table 2 Socio-cultural and obstetrics variables Variable No (frequency) Percentage (%) Resumption of sexual activity Yes No 853 648 205 100% 76 24 Reason for resumption of sex after delivery Partner request It was convenient for me To fulfil cultural demand others 650 590 43 3 14 100% 90.77 6.62 0.46 2.15 Reason for sexual inactivity after delivery Partner not available Had vaginal/perineal tears during delivery Fear of pregnancy others 203 125 41 29 8 100% 61.57 20.20 14.29 3.94 Mode of delivery vaginal delivery C-section Assisted vaginal delivery (vacuum) 853 685 164 4 100% 80.30 19.23 0.47 Resumption of menses Yes No 853 606 247 100% 71 29 Residence after delivery In-law Mother Partner Others 853 42 368 440 3 100% 4.92 43.14 51.58 0.35 Unintended pregnancy Yes No 35 818 4.13% 95.87 Exclusive breastfeeding Yes No 853 530 323 100% 62.13 37.87 About a half (47.00%) of the sexually active postpartum women resumed sex at 4-6months, 39.00% at 6weeks-3months, and 2.00% occurred within the puerperium (Fig. 1 ). Majority (71.00%) of the respondents had resumed menses within one year after delivery. About 45.00% of the respondents started experiencing their menses 6 weeks to 3 months after delivery while about 15.00% resumed their menses after the 6 months of delivery and 7.00% had their menses within the first 6 weeks (Fig. 2 ). Majority of the women initiated contraceptive use after 6 weeks of delivery (Fig. 3 ). Awareness of postpartum family planning services was very high (99%). About a third (34%) of the respondents was using a method of contraception at the time of the study. Majority (88.04%) of the women were counselled on healthy timing and spacing of pregnancies while return to fertility was the least information provided during counselling (table 3). Table 3: Counselling on contraception VARIABLE YES (%) Exposure to FP counseling during ANC period 841(98.51) Exposure to PNC FP counseling 848 (99.41) Place of FP counseling after last delivery Child welfare clinic 141 (16.62) Labour ward 9 (1.06) Postnatal Clinic 690 (81.37) Postnatal Ward 4 (0.47) Info. provided during postpartum FP counseling Family planning methods/contraceptives 62 (7.27) Fertility intentions 24 (2.81) Healthy timing and spacing of pregnancies 751 (88.04) Lactation Amenorrhea Method 56 (6.57) Return to fertility /Resumption of sex 8 (0.94) Transition from LAM to other modern methods of FP 80 (9.35) Awareness of postpartum family planning services 844(99) Utilization of Family Planning Services 290(34) The fear of side effects was the main reason for contraceptive non-acceptance (Fig. 4 ) Determinants of postpartum sexual activity Notably, tertiary education of partner (Adjusted OR = 0.19, CI = 0.04–0.87), income status of partner (Adjusted OR = 0.14, CI = 0.05–0.42), residence after delivery (Adjusted OR = 0.53, CI = 0.38–0.76), resumption of menses (Adjusted OR = 0.19, CI = 0.13–0.27), family size (Adjusted OR = 1.47, CI = 1.03–2.11), fertility intention (Adjusted OR = 0.45, CI = 0.33–0.80) and spacing of children (Adjusted OR = 0.40, CI = 0.18–0.91) were significant predictors of sexual activity resumption (Table 4 ). Table 4 Multivariate analysis of the determinants of resumption of sexual activity Variable Unadjusted Adjusted OR 95% (CI) OR 95% (CI) Age < 20 (REF) 1 1 20–24 1.08 0.20–5.92 0.98 0.17–5.40 25–29 1.20 0.22–6.35 1.10 0.20–5.86 30–34 1.59 0.30–8.42 1.46 0.27–7.83 35–39 1.08 0.20–5.83 1.00 0.18–5.45 40+ 1.30 0.21–8.03 1.19 0.19–7.45 Educational status of partner None (REF) 1 1 Primary 0.27 0.05–1.41 0.24 0.44–1.32 Middle/ JSS 0.42 0.09–1.87 0.37 0.07–1.71 Secondary 0.49 0.11–2.17 0.42 0.09–1.94 Tertiary 0.21 0.04–0.95* 0.19 0.04–0.87* Others 0.33 0.02–4.92 0.52 0.02–9.48 Income status of Partner Yes (REF) 1 1 No 0.14 0.05–0.40* 0.14 0.05–0.42* Family Planning Counselling at Antenatal Clinic Yes (REF) 1 1 No 1.58 0.34–7.27 1.56 0.32–7.49 Family Planning counselling at Postnatal Clinic Yes (REF) 1 1 No 1.25 0.13–11.32 1.07 0.11–10.32 Place of FP counselling Labour ward (REF) 1 1 Postnatal ward 1 1 Postnatal clinic 1.01 0.20–4.91 1.00 0.20–4.87 Child welfare clinic 0.55 0.11–2.76 0.54 0.10–2.73 Others 0.85 0.54–13.47 0.85 0.05–13.47 Exclusive Breast feeding Yes (REF) 1 1 No 1.49 1.06–2.09* 1.38 0.98–1.95 Mode of delivery Vaginal Delivery (REF) 1 C Section 1.05 0.70–1.57 1.07 0.71–1.61 Vacuum 0.95 0.09–9.21 1.29 0.12–12.97 Residence after delivery Partner (REF) 1 Mother 0.55 0.40–0.76 0.53 0.38–0.76* Inlaw 1.19 0.51–2.78 1.23 0.50–3.00 Other 0.47 0.04–5.34 0.85 0.06–10.73 Resumption of menses Resumed (REF) 1 Not Resumed 0.20 0.14–0.28 0.19 0.13–0.27* Family size (parity) 1 child (REF) 1 2–4 children 1.20 0.85–1.68 1.47 1.03–2.11* 5 + children 0.83 0.42–1.60 1.24 0.62–2.49 Fertility intention Yes (REF) 1 No 0.66 0.45–0.99 0.68 0.45–0.98* Not sure 0.51 0.33–0.77 0.52 0.33–0.80* Spacing of children 3 yrs 0.38 0.17–0.82 0.40 0.18–0.91* * p < 0.05, REF = Reference category Determinants of postpartum sexual activity and correlation with contraceptive use Marital status (Adjusted OR = 2.52, CI = 1.35–4.69), residence after delivery (Adjusted OR = 0.71, CI = 0.53–0.95), resumption of menses (Adjusted OR = 0.21, CI = 0.14–0.31), spacing of children (Adjusted OR = 1.87, CI = 1.29–2.71) and exclusive breastfeeding (Adjusted OR = 1.38, CI = 1.03 − 1.88) were significant predictors of contraceptive use postpartum (Table 5 ). Table 5 The predictive effects of the determinants of sexual activity on postpartum contraceptive uptake Variable PPFP Uptake Unadjusted Adjusted No_ (%) OR 95% (CI) OR 95% (CI) Marital status Single (REF) 13 (4.47) 1 1 Married 246 (84.54) 2.52 1.35–4.69 2.52 1.35–4.69* Divorced 0 (0.00) 1 1 Cohabiting 32 (11.00) 2.68 1.27–5.65 2.70 1.28–5.67* Widowed 0 (0.00) 1 1 Educational level None (REF) 10 (3.44) 1 1 Primary 21 (7.22) 0.88 0.36–2.15 0.90 0.37–2.18 Middle/JSS 121 (41.58) 1.49 0.69–3.22 1.52 0.70–3.29 SSS 78 (26.80) 1.10 0.50–2.41 1.12 0.51–2.45 Tertiary 61 (20.96) 1.50 0.68–3.39 1.56 0.70–3.48 Residence after delivery Partner (REF) 167 (57.39) 1 1 Mother 112 (38.49) 0.71 0.53–0.95 0.71 0.53–0.95* Inlaw 11 (3.78) 0.58 0.28–1.18 0.58 0.28–1.19 Other 1 (0.34) 0.81 0.07–9.08 0.77 0.06–8.59 Resumption of menses Resumed (REF) 257 (88.32) 1 1 Not Resumed 34 (11.68) 0.21 0.14–0.31 0.21 0.14– 0.31* Fertility intention Yes (REF) 177 (60.82) 1 1 No 76 (26.12) 1.59 1.12–2.26 1.87 1.29–2.71* Not sure 38 (13.06) 0.78 0.51–1.18 0.91 0.59–1.41 Spacing of children < 2yrs (REF) 13 (7.39) 1 1 2–3 yrs 116 (65.91) 2.74 1.45–5.19 3.48 1.81–6.68* 3 yrs and above 47 (26.70) 2.70 1.35–5.40 3.30 1.62–6.72* Educational status of partner None 5 (1.72) 1 1 Primary 12 (4.12) 1.89 0.54–6.57 1.13 0.23–5.38 Middle/ JSS 90 (30.93) 1.75 0.61–4.98 1.31 0.37–4.60 Secondary 106 (36.43) 1.61 0.57–4.56 1.16 0.33–4.04 Tertiary 77 (26.46) 1.32 0.46–3.78 0.96 0.27–3.43 Others 1 (0.34) 1 0.08–11.93 1.56 0.10–23.80 Income status of Partner Yes 286 (98.28) 1 1 No 5 (1.72) 0.73 0.26–2.09 FP counselling after delivery Yes 1 1 No 1.28 0.21–7.76 0.74 0.26–2.10 Place of FP counselling at PNC Labour ward 2 (0.69) 1 1 Postnatal ward 2 (0.69) 3.5 0.28–43.16 3.5 0.28–43.16 Postnatal clinic 252 (87.20) 2.01 0.41–9.76 2.03 0.41–9.86 Child welfare clinic 32 (11.07) 1.02 0.20–5.19 1.02 0.20–5.19 Others 1 (0.35) 1.10 0.07–18.34 1.16 0.07–18.34 Exclusive Breast feeding Yes 165 (56.70) 1 1 No 126 (43.30) 1.41 1.05–1.88 1.38 1.03–1.88* * p < 0.05, REF - Reference category, FP – Family Planning, PPFP – Postpartum Family Planning, PNC – Postnatal Clinic Discussion The proportion of women who had resumed sexual intercourse after delivery (76.0%) is comparable to the 74.5% reported from Nigeria but relatively higher than the 10.6% and 72.5% recorded in Guinea and Congo DRC respectively. 9 It is also higher than the 58.6% recorded for Ghana in 2003. 9 It is however lower than the 93.2% and 93.7% rates from Ethiopia and Bangladesh respectively. 9 These differences in rates of resumption of postpartum sexual intercourse are attributable to diverse cultural and religious practices, societal norms and sexual attitudes of women in different parts of the world. Moreover, the other studies were carried out within 6 months after delivery (where Lactational Amenorroea Method is effective), while the current study included women up to 12 months postpartum. The relatively higher rate of resumption of postpartum sexual intercourse in our study relative to what was recorded for Ghana in 2003 suggests declining postpartum sexual abstinence, which traditionally had been the main stay of birth spacing. 10 This implies that, postpartum women are at increased risk of unintended pregnancy at shorter intervals if contraceptive counselling and utilisation of family planning services are not improved. Unintended pregnancy was recorded among 4% of the respondents this study. The intra-observer variation noted about the commencement of sexual activity among the respondents in this study could be allowed to the different factors cited as reasons why the women resumed sexual intercourse in the postpartum period aside the biologic variations. Most of the women resumed sexual activity to satisfy the demands of their husbands or partners. This is also noted to be the commonest reason in other African settings in Uganda and Cote d’Ivoire, for the recommencement of sexual activity among postpartum women 11 , 12 contrary to advance settings like Canada where desire for sex was the main reason cited for postpartum sexual resumption. 11 The postpartum contraceptive prevalence rate (34%) observed in this study is comparable to the 33% reported in Zambia 13 but lower than the 39% recorded among referred postpartum women in KATH. 14 It is however higher than the recorded rate of 15% by the Kumasi Metropolitan Area in 2012, 7 21.3% for Ghana in 2008, 8 and even the 2014 prevalence rate of 22% for modern methods for all married women in the reproductive age in Ghana. This study also showed a higher use of postpartum contraceptives compared to the 8.0% found in a study in Nigeria that examined the relationship between the utilisation of maternal health care and postpartum contraceptive use. 15 The rate of 34% recorded by this study for Kumasi Metropolis was an improvement over the previous patronage of contraceptive services. This reflects the increased levels of family planning campaigns and counselling in the health facilities (about 99% of the respondents in this study had exposure to family planning education at least during one area of the continuum of maternal care). Most of the respondents received FP counselling during the antenatal period, especially at the antenatal clinic. Some were also directed to the family planning clinic while few of them received counselling during delivery. Nevertheless, FP counselling/education had no association with postpartum contraceptive uptake in this study setting. The insignificant effect of FP counselling on postpartum contraceptive use noted in the current study could be related to the FP information provided, which centred on timing and spacing of pregnancies at the expense of family planning methods and return to fertility. In this regard, issues pertaining to resumption of sexual intercourse and more critically, the fear of contraceptive side effects (which is the most important factor for contraceptive non-acceptance) are not addressed. Generally, postnatal counselling is expected to be a better determinant of contraceptive use than antenatal counselling because it provides immediate opportunity for service provision. However, shorter periods of encounter occur at the postnatal ward/ clinic. 16 The PNC recorded most (81.37%) of the education/counselling sessions in this study. More frequent and regular encounters in the postpartum period occur at the child welfare clinic which has consistently recorded high attendance rates for the 0-11months old in Ghana. 17 However, a few (16.62%) of the women had FP counselling at this unit since normally the welfare of the baby is the focus. Mass education about family planning was the main mode of ‘counselling’ during the use of maternal services in the setting of this study. Although it increases the awareness levels, the expected effects on contraceptive uptake are not realised. Thus, an evaluation of the integration of family planning services across the continuum of care, especially the child welfare clinics and the content of information provided during counselling is imperative. Women differed in their postpartum resumption of sexual activity based on the marital status, parity and education but showed no significant relationship to age, income status or the religious affiliation. This concurs with similar studies in Nigeria, 1 Uganda 18 and Malaysia 18 but differed from others in Gambia 5 and Cote d’Voire. 5 These reflect the inconsistent pattern of the socio-demographic variables noted in diverse settings. Several studies consistently suggest significant association between postpartum contraceptive use and background characteristics of respondents. 19 Aside marital status, the current study however found no significant association between postpartum contraceptive uptake and socio-demographic characteristics of the respondents. This finding compared with a similar study in northern Ghana, 20 Thus, the disagreement between the realised influence of the demographic features on postpartum contraceptive use and what pertains in most literature could be allowed to cultural, religious and societal dynamics. Previous studies have revealed inconsistent reports on the association between mode of delivery and resumption of sexual intercourse after delivery. The findings of this study suggested no significant difference in sexual activity between women who delivered by caesarean section and those who had a form of vaginal delivery; normal or assisted (p > 0.05). this agreed with the findings of Dabiri 21 and Barbara et al. 22 The study however did not stratify the women based on complications such as tears or episiotomies experienced during delivery. Therefore, it could not be related to the suggestion that women who have vaginal delivery with stitches are far less likely to resume intercourse early compared to women who have a vaginal delivery without perineal stitches or who have caesarean sections. 22 As has been found in other studies, the mode of delivery in our setting had no significant effect on postpartum contraceptive uptake. This study showed reduced likelihood of sexual engagement among respondents who stayed with their mothers or other relations compared to those who resided in their matrimonial homes after delivery (CI = 0.38–0.76). In the setting of this study, just like many Akan communities in Ghana, women move to stay with their mothers or older relatives during the first few months after delivery. This keeps them away from sharing the same bed with their partners, invariably delaying the resumption of sexual activity and therefore initiation of contraceptive use. With modernization and societal evolution, some relatives or mothers rather move to stay and support the postpartum women in their matrimonial homes. Expectedly, these women exhibit similar postpartum sexual practices like those who stay with their partners alone. Thus, the critical differential is whether the partner is available or not. In our setting, most women who moved to stay with relatives would have returned to their partners by three (3) months after delivery. These observations may explain the relative more regular and increased proportion of sexual activity from three (3) months after delivery noted in this study which is also collaborated by Borda and others. 9 According to the 2014 Demographic and Health Survey (DHS), infrequent sex or partner being away is the 4th most common reason why contraceptors discontinue the use of a method and may be a crucial factor explaining the reason why some do not initiate a method. 23 This study therefore noted that, staying with a mother after delivery negatively affected contraceptive uptake (CI = 0.53–0.95). The rate of menstrual resumption (71.00%) is fairly higher than what is cited in literature. Ndugwa et al. recorded menstrual resumption among 50% of the respondents at 6 months postpartum. 24 This variation reflects the poor exclusive breastfeeding practice in our setting thereby waving the associated amenorrhoeic effect on women within 6 months postpartum. Resumption of menses was shown in this study to have significant influence on the initiation of sex after delivery (95% CI = 0.13–0.27). This is consistent with the work of Ekabua et al. 6 This suggests high susceptibility to pregnancy, especially as initiation of coitus was significantly associated with non-contraceptive use. Women who had completed their families or wanted to space their children for more than 3years were 60% less likely to resume sexual intercourse compared to those who wanted to have another baby within 2years of delivery (95% CI = 0.18– 0.91). Family size was found in this study to have significant influence on postpartum sexual activity (CI = 1.03–2.11) but not postpartum contraceptive uptake (p > 0.05). This relationship is allowed to the overarching effect of fertility desires as the main predictor of utilisation of reproductive health services. Thus, irrespective of the family size, the desire to space or limit pregnancies is the main reason cited for contraceptive use. This study suggested a less likelihood of sexual engagement (CI = 0.05–0.42) among women whose partners had poor income status even after the multivariate analysis. The poor financial status of partners may allow the women to have some level of autonomy and control in decision making, particularly in matters related to sexual activity. Resumption of sex may thus be at the convenience of the woman. The finding of a significant association between the education level of partner and resumption of sexual intercourse (CI = 0.04–0.87) concurred with that of Osinde and associates. 14 This further reflects the domineering role of men in our society particularly when it comes to the issue of sexual activity. Thus, the predisposition of the man determines the direction of engagement as over 90% of the postpartum sexually active women in this study responded positively to the sexual demands of their partners irrespective of the status of the woman. There was however no significant effect on family planning uptake with respect to the educational and financial status of the partner; an indication of poor male involvement in contraceptive services. Partner support is a crucial factor in family planning uptake in our setting. According to the 2014 GDHS, male opposition is one of the major hindrances to contraceptive use. 23 Conclusion This study has established that, majority of postpartum women in the Kumasi metropolis are sexually active but few are using contraceptives. This will undoubtedly lead to increased rate of unintended pregnancy. The time of resumption of sexual activity varies widely among couples, and is mainly influenced by partner‘s predisposition, socio-demographic and obstetric factors. Postpartum contraceptive uptake is mainly influenced by social factors and fear of contraceptive side effects. Counseling has no association with postpartum sexual activity and contraceptive use because the information that is usually provided does not deal with contraceptive methods and their side effects, return to fertility and timing of intercourse. Reproductive health service providers in the metropolis should put in more efforts to improve the sexual practices of postpartum mothers and the uptake of PPFP services at the facilities. Such measures may include; highlighting the return to fertility and timing of sexual intercourse after delivery, providing information on the various methods of contraception and adopting strategies to demystify the fear of side effects during counselling and provision of services. Further studies into the level of male partner involvement in family planning and the factors that influence their sexual practices especially after delivery will help in the development of interventions aimed at meeting the unmet need for family planning among the postpartum mothers. Abbreviations PPA postpartum abstinence SRS simple random sample KATH Komfo Anokye Teaching Hospital KMA Kumasi metropolitan area CI Confidence Interval OR Odds Ratio FP Family Planning PPFP Postpartum Family Planning PNC Postnatal Clinic Declarations Ethics approval and consent to participate The study was approved by the Committee for Human Research, Publication and Ethics, Kwame Nkrumah University of Science and Technology (CHRPE/AP582/17) prior to the commencement of the study in accordance with the Declaration of Helsinki. Administrative Clearance was also obtained from the Kumasi metropolitan Health Directorate (KMHD/INTRO/13). Study protocol was thoroughly explained to the study participants and written informed consent was obtained from them . Consent for publication Not applicable Availability of data and materials All data generated or analysed during this study are available from the corresponding author on reasonable request Funding This study did not receive funding from private, government or non-for-profit organization. It was self-funded. Authors’ contributions AP conceived the research idea and designed the study; AP and JBY were responsible for the data capture, analysis and interpretation; AP prepared the draft of the manuscript; KAD, ETD, KS, FA, GOA, KAA, SBB, CS, SAT, DZK and EK reviewed and edited the manuscript. All authors critically evaluated the final manuscript for important intellectual content and approved the final version of the manuscript. Authors’ Information AP: Fellow of the Ghana Colleges of Surgeons. Lecturer, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi-Ghana. KAD: Fellow of Ghana and West African Colleges of Surgeons. Professor of Obstetrics & Gynaecology, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi-Ghana. KS: Fellow of the Ghana Colleges of Surgeons, Senior Specialist Obstetrician Gynaecologist, Komfo Anokye Teaching Hospital, Kumasi-Ghana. FA: Fellow of Ghana and West African College of Surgeons. Senior Lecturer and Head of Department, Department of Obstetrics and Gynaecology, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi-Ghana GOA: Fellow of Ghana and West African Colleges of Physicians. Senior Lecturer, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi-Ghana. ETD: Epidemiologist and Fellow of the West African College of Surgeons. Senior Lecturer, School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi-Ghana KAA: Fellow of Ghana and West African Colleges of Surgeons. Lecturer, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi-Ghana SAT: Fellow of Ghana and West African College of Surgeons. Senior Specialist Obstetrician Gynaecologist, Ghana Health Service, Kumasi-Ghana SBB: Fellow of the Ghana Colleges of Surgeons. Senior Specialist Obstetrician Gynaecologist, Ghana Health Service, Kumasi-Ghana CMS: Fellow of the West African College of Surgeons. Consultant Obstetrician Gynaecologist, Komfo Anokye Teaching Hospital, Kumasi-Ghana EK: Member of Ghana College of Surgeons. Specialist Obstetrician Gynaecologist, Komfo Anokye Teaching Hospital, Kumasi-Ghana JBY: Biostatistician, Emergency Medicine Directorate, Komfo Anokye Teaching Hospital, Kumasi-Ghana DZK: Obstetrics and Gynecology specialist, School of Medicine, University for Development Studies/ Tamale Teaching Hospital, Tamale-Ghana Acknowledgements Authors would like to acknowledge the staff of the Family Planning and Reproductive Health unit of Komfo Anokye Teaching Hospital for their support in the data collection. Competing interests The authors declare that they have no competing interests Limitation of the study Respondents might not provide accurate information due to recall bias. Some might have difficulty providing all the information about their sexual activities and even declined to respond to certain questions that may be very essential in the analysis. Only public health facilities were used for the study; therefore, the results might not reflect the status of private facilities. References Owonikoko KM, Adeoye AG, Tijani AM, Adeniji AO. Determinants of resumption of vaginal intercourse in puerperium period in Ogbomoso: consideration for early use of contraceptives. Int J Reprod Contracept Obstet Gynecol. 2014;3:1061–6. Forster DA, McLachlan HL, Rayner J, Yelland J, Gold L, Rayner S. The early postnatal period: exploring women’s views, expectations and experiences of care using focus groups in Victoria, Australia. BMC Pregnancy Childbirth. 2008;8:27. Vernon R. Meeting the family planning needs of postpartum women. Stud Fam Plann. 2009;40(3):235–45. Adeyemi AB, Ijadunola KT, Orji EO, Kuti O, Alabi MM. The unmet need for contraception among Nigerian women in the first year post-partum. Eur J Contracept Reproductive Health Care. 2005;10(4):229–34. Desgrées-du-Loû A, Brou H. Resumption of Sexual Relations Following Childbirth: Norms, Practices and Reproductive Health Issues in Abidjan, Côte d'Ivoire. Reprod Health Matters. 2005;13(25):155–63. Ekabua JE, Ekabua KJ, Odusolu P, Agan TU, Etokidem AJ. Factors associated with contraceptive use and initiation of coital activity after child birth. Open Access J Contracept. 2010;1:85–91. Kumasi. Metropolitan Health Directorate Annual report, 2012. Winfrey William and Kshitiz Rakesh. Use of Family Planning in the Postpartum Period. DHS Comparative Report No. 36. Rockville. Maryland, USA: ICF International; 2014. Borda MR, Winfrey W, McKaig C. Return to Sexual Activity and Modern Family Planning Use in the Extended Postpartum Period: An Analysis of Findings from Seventeen Countries. Afr J Reprod Health. 2010;14(4):75–82. van de Walle, Etienne and, van de Walle F. Postpartum sexual abstinence in tropical Africa (1989). PSC African Demography Working Paper Series , 17. http://repository.upenn.edu/psc_african_demography/17 Odar E, Wandabwa J, Kiondo P. Sexual practices of women within six months of childbirth in Mulago hospital, Uganda. Afr Health Sci. 2003;3(3):117–23. Anzaku AS, Mikah S. Postpartum resumption of sexual activity, sexual morbidity and use of modern contraceptives among Nigerian women in Jos. Ann Med Health Sci Res. 2014;4:210–6. Ross JA, Winfrey WL. Contraceptive use, intention to use and unmet need during the extended postpartum period. Int Fam Plan Perspect. 2001;21(1):20–7. Morhe E, Dalton V. Contraceptive uptake among referred postpartum women in KATH, Ghana. Paper presented at the ICFP: Addis Ababa, Ethopia. November 12–15, 2013. Akinlo A, Bisiriyu A, Esimai O. Influence of use of maternal health care on postpartum contraception in Nigeria. DHS working papers No. 92. Calverton, Maryland, USA: ICF International. 2013. Bwazi C, Maluwa A, Chimwaza A, Pindani M. Utilization of Postpartum Family Planning Services between Six and Twelve Months of Delivery at Ntchisi District Hospital, Malawi. Health. 2014;6:1724–37. Bradley SEK, Trevor N, Croft JD, Fishel, Charles F. Westoff. Revising Unmet Need for Family Planning. DHS Analytical Studies No. 25. Calverton. Maryland, USA: ICF International; 2012. Alice C, Alum IB, Kizza CP, Osingada. Godfrey Katende and Dan K. Kaye. Factors associated with early resumption of sexual intercourse among postnatal women in Uganda. Reproductive Health. 2015;12:107. Do M, Hotchkiss D. Relationships between Antenatal and Postnatal Care and Post-Partum Modern Contraceptive Use: Evidence from Population Surveys in Kenya and Zambia. BMC Health Serv Res 13 2013; 6 . Apanga PA, Adam MA. Factors influencing the uptake of family planning services in the Talensi District, Ghana. Pan Afr Med J. 2015;20:10. http://doi.org/10.11604/pamj.2015.20.10.5301 . Fatemeh Dabiri AP, Yabandeh A, Shahi A, Kamjoo, Saeed Hosseini Teshnizi. The Effect of Mode of Delivery on Postpartum Sexual Functioning in Primiparous Women. Oman Med J. 2014;29(4):276–9. 10.5001/omj.2014.72 . Sayed HAEE. Soad Abd el Salam Ramadan, Heba Abdel-Fatah Ibrahim. Huda Abd Allah Moursi. The Effect of Mode of Delivery on Postpartum Sexual Function and Sexual Quality of Life in Primiparous Women. Am J Nurs Sci. 2017;6(4):347–57. 10.11648/j.ajns.20170604.19 . Ghana Statistical Service (GSS). Ghana Health Service (GHS), and ICF International. Ghana Demographic and Health Survey. Rockville, Maryland, USA: GSS, GHS, and ICF International, 2014. Robert P, Ndugwa J, Cleland NJ, Madise J-C, Fotso, Eliya M. Zulu. Menstrual Pattern, Sexual Behaviors, and Contraceptive Use among Postpartum Women in Nairobi Urban Slums. Journal of Urban Health: Bulletin of the New York Academy of Medicine , Vol. 88, Suppl. 2. 10.1007/s11524-010-9452-6 Sedgh G et al. Unmet Need for Contraception in Developing Countries: Examining. Women’s Reasons for Not Using a Method. New York: Guttmacher Institute, 2016. http://www.guttmacher.org/report/unmet-need-for-contraception-in-developing countries Additional Declarations No competing interests reported. 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Hospital","correspondingAuthor":false,"prefix":"","firstName":"Jonathan","middleName":"Boakye","lastName":"Yiadom","suffix":""},{"id":361903374,"identity":"bfb68aae-fddb-4749-a3f9-f0839b4b0edb","order_by":12,"name":"David Zawumya Kolbilla","email":"","orcid":"","institution":"Tamale Teaching Hospital","correspondingAuthor":false,"prefix":"","firstName":"David","middleName":"Zawumya","lastName":"Kolbilla","suffix":""}],"badges":[],"createdAt":"2024-08-29 23:17:29","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5000159/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5000159/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":67098832,"identity":"abf5736f-ed03-498e-bb57-a2282f32624a","added_by":"auto","created_at":"2024-10-21 07:54:23","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":85582,"visible":true,"origin":"","legend":"\u003cp\u003eInitiation of sexual activity after delivery\u003c/p\u003e","description":"","filename":"Picture1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5000159/v1/4e64d63fd29428d09cf328dd.jpg"},{"id":67098834,"identity":"65b6c919-7843-438e-8fc0-8ecfbbd3df77","added_by":"auto","created_at":"2024-10-21 07:54:24","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":94529,"visible":true,"origin":"","legend":"\u003cp\u003eResumption of menses after delivery\u003c/p\u003e","description":"","filename":"Picture2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5000159/v1/7c8bc57726f48c11cc56e009.jpg"},{"id":67098819,"identity":"15ab944a-1d83-4dd8-9a33-e1526ab90140","added_by":"auto","created_at":"2024-10-21 07:54:20","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":127010,"visible":true,"origin":"","legend":"\u003cp\u003eInitiation of family planning methods use\u003c/p\u003e","description":"","filename":"Picture3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5000159/v1/c382032d2c40b08e9e87bbdb.jpg"},{"id":67098833,"identity":"c7fee22b-db5d-402b-ae95-3d33f317bae0","added_by":"auto","created_at":"2024-10-21 07:54:24","extension":"jpg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":117424,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eReason for not using contraceptive services\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"Picture4.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5000159/v1/26e7e50b84328d8b06271d11.jpg"},{"id":99798460,"identity":"41a620e1-7e30-460e-a11e-c00899d64548","added_by":"auto","created_at":"2026-01-08 13:48:21","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2252732,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5000159/v1/1364875a-1da5-44b5-aa4c-acb084d84665.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Resumption of sexual activity and contraceptive use among postpartum women in the Kumasi Metropolis of Ghana","fulltext":[{"header":"Background","content":"\u003cp\u003eThe period after delivery is unique and challenging to women as they go through the process of caring for their newborns, breastfeeding, recovery from the stress of labour and possible complications during delivery and adjusting to the withdrawal of the physiological hormonal changes of pregnancy.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e They also contemplate on the desire to space or limit childbirth while meeting the sexual demands of their partners and their own sexual desires.\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThe postpartum period also provides an essential avenue for prolonged interaction and counselling of women towards contraceptive use. The healthcare provider is offered an opportunity to discuss and address the health concerns, particularly the reproductive goals of the woman. Exposure to postpartum family planning services is therefore a crucial component of the healthcare that is provided for women after delivery; to prevent unintended and closely spaced pregnancies.\u003c/p\u003e \u003cp\u003eInadequate knowledge about the return of fertility in the postpartum period heightens the susceptibility of women to unintended pregnancies as many women and health providers erroneously assume that fertility returns only with resumption of menses.\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e Women who resume sexual activity before the resumption of menses could be fertile, putting them at risk of a mistimed or unwanted pregnancy.\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e Seizing the opportunity to offer family planning services to women in the postpartum period may result in an increase in the uptake of family planning methods and a reduction in unintended pregnancies.\u003c/p\u003e \u003cp\u003eSeveral factors influence the utilisation of postpartum family planning services. These include age, education level, counselling during antenatal and postnatal clinics, family size, resumption of menses, return to fertility, previous contraceptive experience, knowledge of family planning methods, opinion of partner, and others. Arguably the most important component of the client-related factors is resumption of sexual activity after childbirth since natural conception cannot occur without sexual intercourse. This probably accounted for the adoption of postpartum abstinence (PPA) as the traditional means of contraception in most societies in the developing world.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003ePeriods of abstinence from sexual activity following delivery vary greatly among women. Generally, sexual activity in the postpartum runs a graduated course from initial infrequent and irregular activity progressing to more regular sexual encounters later.\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e Studies have also shown that early initiation of sexual intercourse was observed in women who had spontaneous vaginal delivery and in those who stayed at home with their mothers than in-laws and aunts.\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eDespite the regular interaction between healthcare providers and women during the postpartum period, not much is seen in uplifting the interest of women towards contraceptive use especially in developing countries. Postpartum contraceptive uptake is therefore low in the Kumasi Metropolis despite the high awareness levels and availability of the services.\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e In the absence of contraception, the probability of pregnancy is related to the regularity of sexual intercourse. The information on initiation of intercourse after childbirth and the correlation with contraceptive use is important for the refinement of the measurement of exposure to pregnancy. It will also provide relevant information, both quantitative and qualitative; to inform policy and restructure programmes for effective postpartum contraceptive use in the metropolis and other communities.\u003c/p\u003e \u003cp\u003eThis study therefore sought to look at the factors that determine the resumption of sexual activity after delivery and their influence on the utilisation of contraceptive methods among postpartum women attending child welfare clinics in the Kumasi metropolis.\u003c/p\u003e \u003cp\u003eThe framework for this study is based on the dynamics and the extent to which the service-related factors and client-related factors influence each other to determine postpartum sexual activity and contraceptive use.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThe study was cross-sectional with quantitative approach conducted from 4th -31st January, 2018 within the Kumasi metropolitan area (KMA). A structured questionnaire with closed and open- ended questions was used to collect data. The questionnaire was orally administered to the study participants in a face-to-face interview, following explanation of procedure and obtaining informed consent, in a language understood by the participants.\u003c/p\u003e \u003cp\u003eTwo (2) female research assistants were trained in each facility for the data collection. The data collection took place concurrently at all the six (6) study sites during the working hours of the child welfare clinics. An average of eight (8) participants was recruited in each facility a day.\u003c/p\u003e \u003cp\u003eData were collected on socio-demographic features, the past obstetric history, breastfeeding status and onset of menstruation after the delivery. The women were also asked whether they had resumed vaginal intercourse and if so, when after delivery and whether any contraceptive method was being used and the timing of method initiation. Reasons for non-contraceptive use were also obtained. Reason(s) for commencement of sexual intercourse or otherwise were also recorded.\u003c/p\u003e \u003cp\u003eThe population for this study was all postpartum women aged 15\u0026ndash;49 years, attending the child welfare clinics in the Kumasi metropolis. All women whose babies were up to one-year-old (0\u0026ndash;12 months), reporting for immunisation and child welfare assessment who consented to participate in the study, were recruited. However, women attending child welfare clinic but had not delivered a baby in the last one year preceding the survey, those considered not fit to respond adequately to questions asked either due to the health condition of the mother or that of the child and those who had hysterectomy during delivery were excluded from the study.\u003c/p\u003e \u003cp\u003eThe sample size for the study was calculated using the precision formula by Lesley Kish:\u003c/p\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;z\u003csup\u003e2\u003c/sup\u003e pq/ d\u003csup\u003e2\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eAccording to Winfrey and Kshitiz,\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e the postpartum contraceptive prevalence rate in Ghana is 21.3%.\u003c/p\u003e \u003cp\u003eHowever, assuming that 50% of postpartum women in the metropolis had resumed sexual activity,\u003c/p\u003e \u003cp\u003en = (1.96)\u003csup\u003e2\u003c/sup\u003e (0.50) (0.50)/ (0.05)\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;384.16; \u0026asymp; 384\u003c/p\u003e \u003cp\u003eUsing the default design effect (deff) of 2.0 in multistage sampling, to achieve the same reliability that a simple random sample (SRS) would produce, the sample size (n) is multiplied by 2;\u003c/p\u003e \u003cp\u003e384 x 2\u0026thinsp;=\u0026thinsp;768\u003c/p\u003e \u003cp\u003eAccounting for estimated non-response rate of 10% \u0026asymp;: 77\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eN\u0026thinsp;=\u0026thinsp;768\u0026thinsp;+\u0026thinsp;77\u003c/h2\u003e \u003cp\u003eN (total sample size)\u0026thinsp;=\u0026thinsp;845\u003c/p\u003e \u003cp\u003eThus, the minimum sample size required for the study was 845.\u003c/p\u003e \u003cp\u003eA multistage sampling technique was used in this study. Each of the 5 sub-metropolitan health facilities within KMA in addition to Komfo Anokye Teaching Hospital (KATH) which is the only tertiary hospital in the Region was purposively selected. However, the number of clients selected from each facility was determined by probability proportionate to size (attendance) of postpartum women attending the child welfare clinics. Systematic sampling was then employed to get the required sample size for each facility.\u003c/p\u003e \u003cp\u003ePre-testing of the questionnaire was undertaken at the Ejisu municipal hospital. This health facility offers child welfare and family planning services and has similar characteristics as the study health facilities. After the pre-testing, some questions were rephrased or changed from open-ended to closed format, to ensure clarity in order to elicit the correct response from the participants.\u003c/p\u003e \u003cp\u003eThe raw data were edited and coded. A codebook that defined data to allow for statistical analysis was then developed. The data were field-edited daily and entered into Excel before they were exported into STATA (version 15) for analysis. Initial descriptive statistics in the form of frequencies and percentages were computed for the variables in the data set while further inferential analyses were done to explore statistical association between variables. Appropriate bivariate analyses were carried out to assess statistical association between dependent and independent variables, and stepwise logistic regression model was performed to identify the effect of the factors that were significantly associated with the postpartum resumption of sexual activity and contraceptive use. All computations were done at 95% confidence interval (CI) and Statistical significance was set at p-value of \u0026le;\u0026thinsp;0.05.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eThe age range of the respondents was 17 to 48years with the mean age being 30.20years (\u0026plusmn;\u0026thinsp;5.14). About 1% was below 20years while 3.99% was 40 years and above. Most (80.66%) of the women were married while 8.44% were single and 10.08% were in consensual unions. About 19% of the women had attained tertiary level of education and less than 5.0% had no formal education (Table \u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSocio-demographic characteristics of study sample\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFrequency (N\u0026thinsp;=\u0026thinsp;853)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePercentage (100%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge (years)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.82\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e20\u0026ndash;24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e108\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12.66\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e25\u0026ndash;29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e285\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e33.41\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e30\u0026ndash;34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e274\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32.12\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e35\u0026ndash;39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e145\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e40+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.99\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMarital status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8.44\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e688\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e80.66\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWidowed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.47\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCohabiting\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10.08\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDivorced/Separated\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.35\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEducational Level\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.10\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrimary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9.38\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMiddle/JHS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e323\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e37.87\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSecondary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e254\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29.78\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTertiary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e161\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18.87\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eIncome earning activity\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e665\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e77.96\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e188\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22.04\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eReligion\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChristianity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e765\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e89.68\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIslam\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9.14\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAfrican Traditional\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.82\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo religion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.35\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTotal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e853\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e100\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eMajority (76.00%) of the respondents had resumed sexual intercourse after the last delivery. Request for sex by the partner was the major reason (91%) for the resumption. Forty-three (6.62%) of the women engaged in sexual activity because the time seemed convenient for sexual re-union after delivery. Majority (61.57%) of the respondents who had not resumed sexual intercourse since delivery stated that their partners were not available. About 20% of the sexually inactive women indicated that their deliveries were associated with perineal/vaginal tears, episiotomies or caesarean sections while 14.30% were not sexually active because of the fear of getting pregnant. About 81% of the respondents had vaginal delivery though 0.47% was via vacuum extraction while the remaining 19% delivered by caesarean section (Table \u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Majority (62.13%) of the respondents practiced exclusive breastfeeding for 3 months. Unintended pregnancy was also recorded among 35 (4.13%) of the respondents.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSocio-cultural and obstetrics variables\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo (frequency)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePercentage (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eResumption of sexual activity\u003c/p\u003e \u003cp\u003eYes\u003c/p\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e853\u003c/span\u003e\u003c/p\u003e \u003cp\u003e648\u003c/p\u003e \u003cp\u003e205\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e100%\u003c/span\u003e\u003c/p\u003e \u003cp\u003e76\u003c/p\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReason for resumption of sex after delivery\u003c/p\u003e \u003cp\u003ePartner request\u003c/p\u003e \u003cp\u003eIt was convenient for me\u003c/p\u003e \u003cp\u003eTo fulfil cultural demand\u003c/p\u003e \u003cp\u003eothers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e650\u003c/span\u003e\u003c/p\u003e \u003cp\u003e590\u003c/p\u003e \u003cp\u003e43\u003c/p\u003e \u003cp\u003e3\u003c/p\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e100%\u003c/span\u003e\u003c/p\u003e \u003cp\u003e90.77\u003c/p\u003e \u003cp\u003e6.62\u003c/p\u003e \u003cp\u003e0.46\u003c/p\u003e \u003cp\u003e2.15\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReason for sexual inactivity after delivery\u003c/p\u003e \u003cp\u003ePartner not available\u003c/p\u003e \u003cp\u003eHad vaginal/perineal tears during delivery\u003c/p\u003e \u003cp\u003eFear of pregnancy\u003c/p\u003e \u003cp\u003eothers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e203\u003c/span\u003e\u003c/p\u003e \u003cp\u003e125\u003c/p\u003e \u003cp\u003e41\u003c/p\u003e \u003cp\u003e29\u003c/p\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e100%\u003c/span\u003e\u003c/p\u003e \u003cp\u003e61.57\u003c/p\u003e \u003cp\u003e20.20\u003c/p\u003e \u003cp\u003e14.29\u003c/p\u003e \u003cp\u003e3.94\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMode of delivery\u003c/p\u003e \u003cp\u003evaginal delivery\u003c/p\u003e \u003cp\u003eC-section\u003c/p\u003e \u003cp\u003eAssisted vaginal delivery (vacuum)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e853\u003c/p\u003e \u003cp\u003e685\u003c/p\u003e \u003cp\u003e164\u003c/p\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e100%\u003c/p\u003e \u003cp\u003e80.30\u003c/p\u003e \u003cp\u003e19.23\u003c/p\u003e \u003cp\u003e0.47\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eResumption of menses\u003c/p\u003e \u003cp\u003eYes\u003c/p\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e853\u003c/p\u003e \u003cp\u003e606\u003c/p\u003e \u003cp\u003e247\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e100%\u003c/p\u003e \u003cp\u003e71\u003c/p\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eResidence after delivery\u003c/p\u003e \u003cp\u003eIn-law\u003c/p\u003e \u003cp\u003eMother\u003c/p\u003e \u003cp\u003ePartner\u003c/p\u003e \u003cp\u003eOthers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e853\u003c/p\u003e \u003cp\u003e42\u003c/p\u003e \u003cp\u003e368\u003c/p\u003e \u003cp\u003e440\u003c/p\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e100%\u003c/p\u003e \u003cp\u003e4.92\u003c/p\u003e \u003cp\u003e43.14\u003c/p\u003e \u003cp\u003e51.58\u003c/p\u003e \u003cp\u003e0.35\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnintended pregnancy\u003c/p\u003e \u003cp\u003eYes\u003c/p\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e35\u003c/p\u003e \u003cp\u003e818\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.13%\u003c/p\u003e \u003cp\u003e95.87\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExclusive breastfeeding\u003c/p\u003e \u003cp\u003eYes\u003c/p\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e853\u003c/p\u003e \u003cp\u003e530\u003c/p\u003e \u003cp\u003e323\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e100%\u003c/p\u003e \u003cp\u003e62.13\u003c/p\u003e \u003cp\u003e37.87\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAbout a half (47.00%) of the sexually active postpartum women resumed sex at 4-6months, 39.00% at 6weeks-3months, and 2.00% occurred within the puerperium (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eMajority (71.00%) of the respondents had resumed menses within one year after delivery. About 45.00% of the respondents started experiencing their menses 6 weeks to 3 months after delivery while about 15.00% resumed their menses after the 6 months of delivery and 7.00% had their menses within the first 6 weeks (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eMajority of the women initiated contraceptive use after 6 weeks of delivery (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eAwareness of postpartum family planning services was very high (99%). About a third (34%) of the respondents was using a method of contraception at the time of the study. Majority (88.04%) of the women were counselled on healthy timing and spacing of pregnancies while return to fertility was the least information provided during counselling (table 3).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Taba\" border=\"1\"\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTable\u0026nbsp;3: Counselling on contraception\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eVARIABLE\u003c/span\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eYES (%)\u003c/span\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eExposure to FP counseling during ANC period\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e841(98.51)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eExposure to PNC FP counseling\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e848 (99.41)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePlace of FP counseling after last delivery\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChild welfare clinic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e141 (16.62)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLabour ward\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9 (1.06)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePostnatal Clinic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e690 (81.37)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePostnatal Ward\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (0.47)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eInfo. provided during postpartum FP counseling\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFamily planning methods/contraceptives\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e62 (7.27)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFertility intentions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24 (2.81)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHealthy timing and spacing of pregnancies\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e751 (88.04)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLactation Amenorrhea Method\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e56 (6.57)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReturn to fertility /Resumption of sex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8 (0.94)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTransition from LAM to other modern methods of FP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e80 (9.35)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAwareness of postpartum family planning services\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e844(99)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eUtilization of Family Planning Services\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e290(34)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe fear of side effects was the main reason for contraceptive non-acceptance (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eDeterminants of postpartum sexual activity\u003c/h2\u003e \u003cp\u003eNotably, tertiary education of partner (Adjusted OR\u0026thinsp;=\u0026thinsp;0.19, CI\u0026thinsp;=\u0026thinsp;0.04\u0026ndash;0.87), income status of partner (Adjusted OR\u0026thinsp;=\u0026thinsp;0.14, CI\u0026thinsp;=\u0026thinsp;0.05\u0026ndash;0.42), residence after delivery (Adjusted OR\u0026thinsp;=\u0026thinsp;0.53, CI\u0026thinsp;=\u0026thinsp;0.38\u0026ndash;0.76), resumption of menses (Adjusted OR\u0026thinsp;=\u0026thinsp;0.19, CI\u0026thinsp;=\u0026thinsp;0.13\u0026ndash;0.27), family size (Adjusted OR\u0026thinsp;=\u0026thinsp;1.47, CI\u0026thinsp;=\u0026thinsp;1.03\u0026ndash;2.11), fertility intention (Adjusted OR\u0026thinsp;=\u0026thinsp;0.45, CI\u0026thinsp;=\u0026thinsp;0.33\u0026ndash;0.80) and spacing of children (Adjusted OR\u0026thinsp;=\u0026thinsp;0.40, CI\u0026thinsp;=\u0026thinsp;0.18\u0026ndash;0.91) were significant predictors of sexual activity resumption (Table \u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMultivariate analysis of the determinants of resumption of sexual activity\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eUnadjusted\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eAdjusted\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e95% (CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eOR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e95% (CI)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;20 (REF)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e20\u0026ndash;24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.20\u0026ndash;5.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.17\u0026ndash;5.40\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e25\u0026ndash;29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.22\u0026ndash;6.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.20\u0026ndash;5.86\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e30\u0026ndash;34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.30\u0026ndash;8.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.27\u0026ndash;7.83\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e35\u0026ndash;39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.20\u0026ndash;5.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.18\u0026ndash;5.45\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e40+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.21\u0026ndash;8.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.19\u0026ndash;7.45\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEducational status of partner\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNone (REF)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrimary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.05\u0026ndash;1.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.44\u0026ndash;1.32\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMiddle/ JSS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.09\u0026ndash;1.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.07\u0026ndash;1.71\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSecondary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.11\u0026ndash;2.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.09\u0026ndash;1.94\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTertiary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.04\u0026ndash;0.95*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.04\u0026ndash;0.87*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOthers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.02\u0026ndash;4.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.02\u0026ndash;9.48\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eIncome status of Partner\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes (REF)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.05\u0026ndash;0.40*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.05\u0026ndash;0.42*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFamily Planning Counselling at Antenatal Clinic\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes (REF)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.34\u0026ndash;7.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.32\u0026ndash;7.49\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFamily Planning counselling at Postnatal Clinic\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes (REF)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.13\u0026ndash;11.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.11\u0026ndash;10.32\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePlace of FP counselling\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLabour ward (REF)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePostnatal ward\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePostnatal clinic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.20\u0026ndash;4.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.20\u0026ndash;4.87\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChild welfare clinic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.11\u0026ndash;2.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.10\u0026ndash;2.73\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOthers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.54\u0026ndash;13.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.05\u0026ndash;13.47\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eExclusive Breast feeding\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes (REF)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.06\u0026ndash;2.09*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.98\u0026ndash;1.95\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMode of delivery\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVaginal Delivery (REF)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eC Section\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.70\u0026ndash;1.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.71\u0026ndash;1.61\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVacuum\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.09\u0026ndash;9.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.12\u0026ndash;12.97\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eResidence after delivery\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePartner (REF)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMother\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.40\u0026ndash;0.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.38\u0026ndash;0.76*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInlaw\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.51\u0026ndash;2.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.50\u0026ndash;3.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.04\u0026ndash;5.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.06\u0026ndash;10.73\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eResumption of menses\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eResumed (REF)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNot Resumed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.14\u0026ndash;0.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.13\u0026ndash;0.27*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFamily size (parity)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1 child (REF)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u0026ndash;4 children\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.85\u0026ndash;1.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e1.03\u0026ndash;2.11*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5\u0026thinsp;+\u0026thinsp;children\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.42\u0026ndash;1.60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.62\u0026ndash;2.49\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFertility intention\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes (REF)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.45\u0026ndash;0.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.45\u0026ndash;0.98*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNot sure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.33\u0026ndash;0.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.33\u0026ndash;0.80*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSpacing of children\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;2 yrs (REF)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u0026ndash;3 yrs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.30\u0026ndash;1.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.30\u0026ndash;1.50\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;3 yrs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.17\u0026ndash;0.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.18\u0026ndash;0.91*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e* p\u0026thinsp;\u0026lt;\u0026thinsp;0.05, REF\u0026thinsp;=\u0026thinsp;Reference category\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eDeterminants of postpartum sexual activity and correlation with contraceptive use\u003c/h2\u003e \u003cp\u003eMarital status (Adjusted OR\u0026thinsp;=\u0026thinsp;2.52, CI\u0026thinsp;=\u0026thinsp;1.35\u0026ndash;4.69), residence after delivery (Adjusted OR\u0026thinsp;=\u0026thinsp;0.71, CI\u0026thinsp;=\u0026thinsp;0.53\u0026ndash;0.95), resumption of menses (Adjusted OR\u0026thinsp;=\u0026thinsp;0.21, CI\u0026thinsp;=\u0026thinsp;0.14\u0026ndash;0.31), spacing of children (Adjusted OR\u0026thinsp;=\u0026thinsp;1.87, CI\u0026thinsp;=\u0026thinsp;1.29\u0026ndash;2.71) and exclusive breastfeeding (Adjusted OR\u0026thinsp;=\u0026thinsp;1.38, CI\u0026thinsp;=\u0026thinsp;1.03 \u0026minus;\u0026thinsp;1.88) were significant predictors of contraceptive use postpartum (Table \u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe predictive effects of the determinants of sexual activity on postpartum contraceptive uptake\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePPFP Uptake\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eUnadjusted\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003eAdjusted\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo_ (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eOR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e95% (CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eOR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e95% (CI)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarital status\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSingle (REF)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e13 (4.47)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e246 (84.54)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.35\u0026ndash;4.69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e1.35\u0026ndash;4.69*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDivorced\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0 (0.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCohabiting\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e32 (11.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.27\u0026ndash;5.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e1.28\u0026ndash;5.67*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWidowed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0 (0.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEducational level\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNone (REF)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10 (3.44)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrimary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e21 (7.22)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.36\u0026ndash;2.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.37\u0026ndash;2.18\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMiddle/JSS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e121 (41.58)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.69\u0026ndash;3.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.70\u0026ndash;3.29\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSSS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e78 (26.80)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.50\u0026ndash;2.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.51\u0026ndash;2.45\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTertiary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e61 (20.96)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.68\u0026ndash;3.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.70\u0026ndash;3.48\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eResidence after delivery\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePartner (REF)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e167 (57.39)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMother\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e112 (38.49)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.53\u0026ndash;0.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.53\u0026ndash;0.95*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInlaw\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e11 (3.78)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.28\u0026ndash;1.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.28\u0026ndash;1.19\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1 (0.34)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.07\u0026ndash;9.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.06\u0026ndash;8.59\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eResumption of menses\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eResumed (REF)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e257 (88.32)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNot Resumed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e34 (11.68)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.14\u0026ndash;0.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.14\u0026ndash; 0.31*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFertility intention\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes (REF)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e177 (60.82)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e76 (26.12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.12\u0026ndash;2.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e1.29\u0026ndash;2.71*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNot sure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e38 (13.06)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.51\u0026ndash;1.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.59\u0026ndash;1.41\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSpacing of children\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;2yrs (REF)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e13 (7.39)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u0026ndash;3 yrs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e116 (65.91)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.45\u0026ndash;5.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e1.81\u0026ndash;6.68*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3 yrs and above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e47 (26.70)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.35\u0026ndash;5.40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e1.62\u0026ndash;6.72*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEducational status of partner\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5 (1.72)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrimary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e12 (4.12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.54\u0026ndash;6.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.23\u0026ndash;5.38\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMiddle/ JSS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e90 (30.93)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.61\u0026ndash;4.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.37\u0026ndash;4.60\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSecondary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e106 (36.43)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.57\u0026ndash;4.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.33\u0026ndash;4.04\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTertiary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e77 (26.46)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.46\u0026ndash;3.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.27\u0026ndash;3.43\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOthers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1 (0.34)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.08\u0026ndash;11.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.10\u0026ndash;23.80\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eIncome status of Partner\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e286 (98.28)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5 (1.72)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.26\u0026ndash;2.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFP counselling after delivery\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.21\u0026ndash;7.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.26\u0026ndash;2.10\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePlace of FP counselling at PNC\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLabour ward\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2 (0.69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePostnatal ward\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2 (0.69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.28\u0026ndash;43.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.28\u0026ndash;43.16\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePostnatal clinic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e252 (87.20)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.41\u0026ndash;9.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.41\u0026ndash;9.86\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChild welfare clinic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e32 (11.07)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.20\u0026ndash;5.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.20\u0026ndash;5.19\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOthers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1 (0.35)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.07\u0026ndash;18.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.07\u0026ndash;18.34\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eExclusive Breast feeding\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e165 (56.70)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e126 (43.30)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.05\u0026ndash;1.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e1.03\u0026ndash;1.88*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e* p\u0026thinsp;\u0026lt;\u0026thinsp;0.05, REF - Reference category, FP \u0026ndash; Family Planning, PPFP \u0026ndash; Postpartum Family Planning, PNC \u0026ndash; Postnatal Clinic\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe proportion of women who had resumed sexual intercourse after delivery (76.0%) is comparable to the 74.5% reported from Nigeria but relatively higher than the 10.6% and 72.5% recorded in Guinea and Congo DRC respectively.\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e It is also higher than the 58.6% recorded for Ghana in 2003.\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e It is however lower than the 93.2% and 93.7% rates from Ethiopia and Bangladesh respectively.\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e These differences in rates of resumption of postpartum sexual intercourse are attributable to diverse cultural and religious practices, societal norms and sexual attitudes of women in different parts of the world. Moreover, the other studies were carried out within 6 months after delivery (where Lactational Amenorroea Method is effective), while the current study included women up to 12 months postpartum. The relatively higher rate of resumption of postpartum sexual intercourse in our study relative to what was recorded for Ghana in 2003 suggests declining postpartum sexual abstinence, which traditionally had been the main stay of birth spacing.\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e This implies that, postpartum women are at increased risk of unintended pregnancy at shorter intervals if contraceptive counselling and utilisation of family planning services are not improved. Unintended pregnancy was recorded among 4% of the respondents this study. The intra-observer variation noted about the commencement of sexual activity among the respondents in this study could be allowed to the different factors cited as reasons why the women resumed sexual intercourse in the postpartum period aside the biologic variations. Most of the women resumed sexual activity to satisfy the demands of their husbands or partners. This is also noted to be the commonest reason in other African settings in Uganda and Cote d\u0026rsquo;Ivoire, for the recommencement of sexual activity among postpartum women\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e,\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e contrary to advance settings like Canada where desire for sex was the main reason cited for postpartum sexual resumption.\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThe postpartum contraceptive prevalence rate (34%) observed in this study is comparable to the 33% reported in Zambia\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e but lower than the 39% recorded among referred postpartum women in KATH.\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e It is however higher than the recorded rate of 15% by the Kumasi Metropolitan Area in 2012, \u003csup\u003e7\u003c/sup\u003e 21.3% for Ghana in 2008, \u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e and even the 2014 prevalence rate of 22% for modern methods for all married women in the reproductive age in Ghana. This study also showed a higher use of postpartum contraceptives compared to the 8.0% found in a study in Nigeria that examined the relationship between the utilisation of maternal health care and postpartum contraceptive use.\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e The rate of 34% recorded by this study for Kumasi Metropolis was an improvement over the previous patronage of contraceptive services. This reflects the increased levels of family planning campaigns and counselling in the health facilities (about 99% of the respondents in this study had exposure to family planning education at least during one area of the continuum of maternal care).\u003c/p\u003e \u003cp\u003eMost of the respondents received FP counselling during the antenatal period, especially at the antenatal clinic. Some were also directed to the family planning clinic while few of them received counselling during delivery. Nevertheless, FP counselling/education had no association with postpartum contraceptive uptake in this study setting. The insignificant effect of FP counselling on postpartum contraceptive use noted in the current study could be related to the FP information provided, which centred on timing and spacing of pregnancies at the expense of family planning methods and return to fertility. In this regard, issues pertaining to resumption of sexual intercourse and more critically, the fear of contraceptive side effects (which is the most important factor for contraceptive non-acceptance) are not addressed. Generally, postnatal counselling is expected to be a better determinant of contraceptive use than antenatal counselling because it provides immediate opportunity for service provision. However, shorter periods of encounter occur at the postnatal ward/ clinic.\u003csup\u003e16\u003c/sup\u003e The PNC recorded most (81.37%) of the education/counselling sessions in this study. More frequent and regular encounters in the postpartum period occur at the child welfare clinic which has consistently recorded high attendance rates for the 0-11months old in Ghana.\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e However, a few (16.62%) of the women had FP counselling at this unit since normally the welfare of the baby is the focus. Mass education about family planning was the main mode of \u0026lsquo;counselling\u0026rsquo; during the use of maternal services in the setting of this study. Although it increases the awareness levels, the expected effects on contraceptive uptake are not realised. Thus, an evaluation of the integration of family planning services across the continuum of care, especially the child welfare clinics and the content of information provided during counselling is imperative.\u003c/p\u003e \u003cp\u003eWomen differed in their postpartum resumption of sexual activity based on the marital status, parity and education but showed no significant relationship to age, income status or the religious affiliation. This concurs with similar studies in Nigeria,\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e Uganda \u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e and Malaysia \u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e but differed from others in Gambia \u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e and Cote d\u0026rsquo;Voire. \u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e These reflect the inconsistent pattern of the socio-demographic variables noted in diverse settings.\u003c/p\u003e \u003cp\u003eSeveral studies consistently suggest significant association between postpartum contraceptive use and background characteristics of respondents.\u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e Aside marital status, the current study however found no significant association between postpartum contraceptive uptake and socio-demographic characteristics of the respondents. This finding compared with a similar study in northern Ghana,\u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThus, the disagreement between the realised influence of the demographic features on postpartum contraceptive use and what pertains in most literature could be allowed to cultural, religious and societal dynamics.\u003c/p\u003e \u003cp\u003ePrevious studies have revealed inconsistent reports on the association between mode of delivery and resumption of sexual intercourse after delivery. The findings of this study suggested no significant difference in sexual activity between women who delivered by caesarean section and those who had a form of vaginal delivery; normal or assisted (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). this agreed with the findings of Dabiri \u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e and Barbara et al.\u003csup\u003e\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e The study however did not stratify the women based on complications such as tears or episiotomies experienced during delivery. Therefore, it could not be related to the suggestion that women who have vaginal delivery with stitches are far less likely to resume intercourse early compared to women who have a vaginal delivery without perineal stitches or who have caesarean sections.\u003csup\u003e\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e As has been found in other studies, the mode of delivery in our setting had no significant effect on postpartum contraceptive uptake.\u003c/p\u003e \u003cp\u003eThis study showed reduced likelihood of sexual engagement among respondents who stayed with their mothers or other relations compared to those who resided in their matrimonial homes after delivery (CI\u0026thinsp;=\u0026thinsp;0.38\u0026ndash;0.76). In the setting of this study, just like many Akan communities in Ghana, women move to stay with their mothers or older relatives during the first few months after delivery. This keeps them away from sharing the same bed with their partners, invariably delaying the resumption of sexual activity and therefore initiation of contraceptive use. With modernization and societal evolution, some relatives or mothers rather move to stay and support the postpartum women in their matrimonial homes. Expectedly, these women exhibit similar postpartum sexual practices like those who stay with their partners alone. Thus, the critical differential is whether the partner is available or not.\u003c/p\u003e \u003cp\u003eIn our setting, most women who moved to stay with relatives would have returned to their partners by three (3) months after delivery. These observations may explain the relative more regular and increased proportion of sexual activity from three (3) months after delivery noted in this study which is also collaborated by Borda and others.\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e According to the 2014 Demographic and Health Survey (DHS), infrequent sex or partner being away is the 4th most common reason why contraceptors discontinue the use of a method and may be a crucial factor explaining the reason why some do not initiate a method.\u003csup\u003e\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e This study therefore noted that, staying with a mother after delivery negatively affected contraceptive uptake (CI\u0026thinsp;=\u0026thinsp;0.53\u0026ndash;0.95).\u003c/p\u003e \u003cp\u003eThe rate of menstrual resumption (71.00%) is fairly higher than what is cited in literature. Ndugwa et al. recorded menstrual resumption among 50% of the respondents at 6 months postpartum.\u003csup\u003e\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e This variation reflects the poor exclusive breastfeeding practice in our setting thereby waving the associated amenorrhoeic effect on women within 6 months postpartum. Resumption of menses was shown in this study to have significant influence on the initiation of sex after delivery (95% CI\u0026thinsp;=\u0026thinsp;0.13\u0026ndash;0.27). This is consistent with the work of Ekabua et al.\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e This suggests high susceptibility to pregnancy, especially as initiation of coitus was significantly associated with non-contraceptive use.\u003c/p\u003e \u003cp\u003eWomen who had completed their families or wanted to space their children for more than 3years were 60% less likely to resume sexual intercourse compared to those who wanted to have another baby within 2years of delivery (95% CI\u0026thinsp;=\u0026thinsp;0.18\u0026ndash; 0.91). Family size was found in this study to have significant influence on postpartum sexual activity (CI\u0026thinsp;=\u0026thinsp;1.03\u0026ndash;2.11) but not postpartum contraceptive uptake (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). This relationship is allowed to the overarching effect of fertility desires as the main predictor of utilisation of reproductive health services. Thus, irrespective of the family size, the desire to space or limit pregnancies is the main reason cited for contraceptive use.\u003c/p\u003e \u003cp\u003eThis study suggested a less likelihood of sexual engagement (CI\u0026thinsp;=\u0026thinsp;0.05\u0026ndash;0.42) among women whose partners had poor income status even after the multivariate analysis. The poor financial status of partners may allow the women to have some level of autonomy and control in decision making, particularly in matters related to sexual activity. Resumption of sex may thus be at the convenience of the woman.\u003c/p\u003e \u003cp\u003eThe finding of a significant association between the education level of partner and resumption of sexual intercourse (CI\u0026thinsp;=\u0026thinsp;0.04\u0026ndash;0.87) concurred with that of Osinde and associates.\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e This further reflects the domineering role of men in our society particularly when it comes to the issue of sexual activity. Thus, the predisposition of the man determines the direction of engagement as over 90% of the postpartum sexually active women in this study responded positively to the sexual demands of their partners irrespective of the status of the woman. There was however no significant effect on family planning uptake with respect to the educational and financial status of the partner; an indication of poor male involvement in contraceptive services. Partner support is a crucial factor in family planning uptake in our setting. According to the 2014 GDHS, male opposition is one of the major hindrances to contraceptive use.\u003csup\u003e\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study has established that, majority of postpartum women in the Kumasi metropolis are sexually active but few are using contraceptives. This will undoubtedly lead to increased rate of unintended pregnancy.\u003c/p\u003e \u003cp\u003eThe time of resumption of sexual activity varies widely among couples, and is mainly influenced by partner\u0026lsquo;s predisposition, socio-demographic and obstetric factors. Postpartum contraceptive uptake is mainly influenced by social factors and fear of contraceptive side effects.\u003c/p\u003e \u003cp\u003eCounseling has no association with postpartum sexual activity and contraceptive use because the information that is usually provided does not deal with contraceptive methods and their side effects, return to fertility and timing of intercourse.\u003c/p\u003e \u003cp\u003eReproductive health service providers in the metropolis should put in more efforts to improve the sexual practices of postpartum mothers and the uptake of PPFP services at the facilities. Such measures may include; highlighting the return to fertility and timing of sexual intercourse after delivery, providing information on the various methods of contraception and adopting strategies to demystify the fear of side effects during counselling and provision of services.\u003c/p\u003e \u003cp\u003eFurther studies into the level of male partner involvement in family planning and the factors that influence their sexual practices especially after delivery will help in the development of interventions aimed at meeting the unmet need for family planning among the postpartum mothers.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePPA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003epostpartum abstinence\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSRS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003esimple random sample\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eKATH\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eKomfo Anokye Teaching Hospital\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eKMA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eKumasi metropolitan area\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eConfidence Interval\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eOR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eOdds Ratio\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eFP\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eFamily Planning\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePPFP\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePostpartum Family Planning\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePNC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePostnatal Clinic\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003e\u003cem\u003eEthics approval and consent to participate\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was approved by the\u0026nbsp;Committee for Human Research, Publication and Ethics, Kwame Nkrumah University of Science and Technology (CHRPE/AP582/17) prior to the commencement of the study in accordance with the Declaration of Helsinki. Administrative Clearance was also obtained from the Kumasi metropolitan Health Directorate (KMHD/INTRO/13). Study protocol was thoroughly explained to the study participants and written informed consent was obtained from them\u003cstrong\u003e.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eConsent for publication\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAvailability of data and materials\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data generated or analysed during this study are available from the corresponding author on reasonable request\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eFunding\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study did not receive funding from private, government or non-for-profit organization. It was self-funded.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAuthors\u0026rsquo; contributions\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAP conceived the research idea and designed the study; AP and JBY were responsible for the data capture, analysis and interpretation; AP prepared the draft of the manuscript; KAD, ETD, KS, FA, GOA, KAA, SBB, CS, SAT,\u0026nbsp;DZK\u0026nbsp;and EK reviewed and edited the manuscript. All authors critically evaluated the final manuscript for important intellectual content and approved the final version of the manuscript.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAuthors\u0026rsquo; Information\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAP: Fellow of the Ghana Colleges of Surgeons. Lecturer, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi-Ghana.\u003c/p\u003e\n\u003cp\u003eKAD: Fellow of Ghana and West African Colleges of Surgeons. Professor of Obstetrics \u0026amp; Gynaecology, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi-Ghana.\u003c/p\u003e\n\u003cp\u003eKS: Fellow of the Ghana Colleges of Surgeons, Senior Specialist Obstetrician Gynaecologist, Komfo Anokye Teaching Hospital, Kumasi-Ghana.\u003c/p\u003e\n\u003cp\u003eFA: Fellow of Ghana and West African College of Surgeons. Senior Lecturer and Head of Department, Department of Obstetrics and Gynaecology, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi-Ghana\u003c/p\u003e\n\u003cp\u003eGOA: Fellow of Ghana and West African Colleges of Physicians. Senior Lecturer, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi-Ghana.\u003c/p\u003e\n\u003cp\u003eETD: Epidemiologist and Fellow of the West African College of Surgeons. Senior Lecturer, School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi-Ghana\u003c/p\u003e\n\u003cp\u003eKAA: Fellow of Ghana and West African Colleges of Surgeons. Lecturer, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi-Ghana\u003c/p\u003e\n\u003cp\u003eSAT: \u0026nbsp;Fellow of Ghana and West African College of Surgeons. Senior Specialist Obstetrician Gynaecologist, Ghana Health Service, Kumasi-Ghana\u003c/p\u003e\n\u003cp\u003eSBB: Fellow of the Ghana Colleges of Surgeons. Senior Specialist Obstetrician Gynaecologist, Ghana Health Service, Kumasi-Ghana\u003c/p\u003e\n\u003cp\u003eCMS: Fellow of the West African College of Surgeons. Consultant Obstetrician Gynaecologist, Komfo Anokye Teaching Hospital, Kumasi-Ghana\u003c/p\u003e\n\u003cp\u003eEK: Member of Ghana College of Surgeons. Specialist Obstetrician Gynaecologist, Komfo Anokye Teaching Hospital, Kumasi-Ghana\u003c/p\u003e\n\u003cp\u003eJBY: Biostatistician, Emergency Medicine Directorate, Komfo Anokye Teaching Hospital, Kumasi-Ghana\u003c/p\u003e\n\u003cp\u003eDZK: Obstetrics and Gynecology specialist, School of Medicine, University for Development Studies/ Tamale Teaching Hospital, Tamale-Ghana\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAcknowledgements\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAuthors would like to acknowledge the staff of the Family Planning and Reproductive Health unit of Komfo Anokye Teaching Hospital for their support in the data collection.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eCompeting interests\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLimitation of the study\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eRespondents might not provide accurate information due to recall bias. Some might have difficulty providing all the information about their sexual activities and even declined to respond to certain questions that may be very essential in the analysis. Only public health facilities were used for the study; therefore, the results might not reflect the status of private facilities.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eOwonikoko KM, Adeoye AG, Tijani AM, Adeniji AO. Determinants of resumption of vaginal intercourse in puerperium period in Ogbomoso: consideration for early use of contraceptives. Int J Reprod Contracept Obstet Gynecol. 2014;3:1061\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eForster DA, McLachlan HL, Rayner J, Yelland J, Gold L, Rayner S. The early postnatal period: exploring women\u0026rsquo;s views, expectations and experiences of care using focus groups in Victoria, Australia. 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Health. 2014;6:1724\u0026ndash;37.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBradley SEK, Trevor N, Croft JD, Fishel, Charles F. Westoff. Revising Unmet Need for Family Planning. DHS Analytical Studies No. 25. Calverton. Maryland, USA: ICF International; 2012.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlice C, Alum IB, Kizza CP, Osingada. Godfrey Katende and Dan K. Kaye. Factors associated with early resumption of sexual intercourse among postnatal women in Uganda. Reproductive Health. 2015;12:107.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDo M, Hotchkiss D. Relationships between Antenatal and Postnatal Care and Post-Partum Modern Contraceptive Use: Evidence from Population Surveys in Kenya and Zambia. BMC Health Serv Res 13 2013; \u003cem\u003e6\u003c/em\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eApanga PA, Adam MA. 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Menstrual Pattern, Sexual Behaviors, and Contraceptive Use among Postpartum Women in Nairobi Urban Slums. \u003cem\u003eJournal of Urban Health: Bulletin of the New York Academy of Medicine\u003c/em\u003e, Vol. 88, Suppl. 2. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s11524-010-9452-6\u003c/span\u003e\u003cspan address=\"10.1007/s11524-010-9452-6\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSedgh G et al. Unmet Need for Contraception in Developing Countries: Examining.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWomen\u0026rsquo;s Reasons for Not Using a Method. New York: Guttmacher Institute, 2016. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://www.guttmacher.org/report/unmet-need-for-contraception-in-developing countries\u003c/span\u003e\u003cspan address=\"http://www.guttmacher.org/report/unmet-need-for-contraception-in-developing countries\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"postpartum, contraception, sexual activity, family planning","lastPublishedDoi":"10.21203/rs.3.rs-5000159/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5000159/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e: The postpartum period presents challenges to women as they contemplate on the desire to space or limit childbirth while meeting the sexual demands of their partners and their own sexual desires. The study looked at the factors that determine the resumption of sexual activity after delivery and their influence on contraceptive use among postpartum women in the Kumasi metropolis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethod\u003c/strong\u003e: An analytical cross-sectional study was conducted using an interviewer administered structured questionnaire with both closed and open-ended questions, on 853 mothers aged 15-49 years, attending child welfare clinics with babies who were up to one (1) year old in the Kumasi Metropolis of Ghana.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e: Majority (76%) of the women initiated sexual intercourse from 6 weeks after delivery but only 34% used contraceptives, despite the 99% awareness of postpartum family planning services.\u003c/p\u003e\n\u003cp\u003eResponse to partners’ demand for sex was the most important stimulus for resumption of sexual activity while unavailability of the partner was the main reason for sexual inactivity after delivery. Marital status (AOR: 4.94, CI=2.99-8.15), residence after delivery (AOR: 0.53, CI=0.38-0.76), resumption of menses (AOR= 0.19, CI= 0.13 – 0.27), birth limiting (AOR= 0.68, CI= 0.45 – 0.98), and birth spacing (AOR= 0.40, 95% CI= 0.18– 0.91) significantly predicted resumption of postpartum sexual activity and contraceptive uptake.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e: Reproductive health service providers in the metropolis should highlight the return to fertility and timing of sexual intercourse after delivery, and adopt strategies to demystify the fear of side effects during counselling and provision of Family Planning services.\u003c/p\u003e","manuscriptTitle":"Resumption of sexual activity and contraceptive use among postpartum women in the Kumasi Metropolis of Ghana","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-10-21 07:53:24","doi":"10.21203/rs.3.rs-5000159/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"28629d8c-6112-452f-b868-963c1707bf40","owner":[],"postedDate":"October 21st, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-01-07T21:53:37+00:00","versionOfRecord":[],"versionCreatedAt":"2024-10-21 07:53:24","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5000159","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5000159","identity":"rs-5000159","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}