Dynamics of postpartum contraceptive use, and their relationship to antenatal intentions, in Northern Tanzania

In Tanzania, unmet need for contraception is high, particularly in the extended postpartum period. Starting contraceptive counselling during antenatal care would reach 97% of pregnant women with muchneeded information. Delivering effective and personalized antenatal counselling requires an understanding of the dynamics of postpartum contraceptive use, and their relationship to contraceptive intentions reported antenatally. Through a baseline survey of 5284 pregnant women in Mwanza, Northern Tanzania, and a follow-up survey at 6-15 months postpartum, we examine patterns and determinants of contraceptive use throughout the postpartum period, compare them to patterns of past contraceptive use and assess their correspondence with contraceptive intentions reported antenatally. We uncover new patterns in timing of uptake, method mix and discontinuation (particularly regarding the role of condoms), and highlight important determinants of postpartum contraceptive behaviour. We discuss the implications of these findings for antenatal contraceptive counselling, and suggest innovative ways in which they can inform contraceptive counselling initiatives.