{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,7]],"date-time":"2026-01-07T14:00:41Z","timestamp":1767794441543,"version":"3.49.0"},"reference-count":31,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2025,8,1]],"date-time":"2025-08-01T00:00:00Z","timestamp":1754006400000},"content-version":"unspecified","delay-in-days":1,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["bmjph"],"accepted":{"date-parts":[[2025,6,9]]},"published-print":{"date-parts":[[2025,8]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Despite prior research suggesting that the mode of delivery (MOD) may influence subsequent postpartum behaviour, limited evidence exists about how contraceptive use and method choice differ following caesarean section (CS) compared with vaginal delivery (VD). This study aimed to explore variation in self-reported postpartum contraceptive use by MOD and to examine whether MOD was associated with contraceptive method choice among a nationally representative sample of postpartum women in Nigeria.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We analysed nationally representative cross-sectional data from the 2021 Nigeria Multiple Indicator Cluster Survey. The study sample included all women aged 15\u201349 years who had a live birth in the 2 years preceding the survey (n=4277). We employed multivariable logistic regression to assess the association between MOD and any postpartum contraceptive use and multinomial logistic regression to evaluate the association between MOD and contraceptive method choice (categorised as highly effective, moderately effective or least effective).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Overall, 1074\u2009women (28.7%) reported using a contraceptive method within 2 years postpartum (vaginal, 27.7%; caesarean, 40.1%; p=0.0025). Compared with women who had VD, those who had CS had significantly higher odds of postpartum contraceptive use (adjusted OR (aOR) = 1.52; 95% CI 1.03 to 2.25). However, when disaggregated by contraceptive method choice, the associations were not statistically significant: least effective methods (aOR=1.37; 95%\u2009CI 0.71 to 2.66), moderately effective methods (aOR=1.49; 95%\u2009CI 0.89 to 2.52) and most effective methods (aOR=1.84; 95%\u2009CI 0.97 to 3.49), although all estimates were suggestive of higher odds among caesarean births.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Caesarean delivery was independently associated with higher overall postpartum contraceptive use and showed a positive\u2014though not statistically significant\u2014association with the use of least, moderately and most effective methods. These findings underscore the importance of person-centred counselling to ensure that all postpartum women, regardless of delivery mode, receive comprehensive information on the full range of contraceptive options, thereby promoting informed choice and equitable access.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjph-2024-001998","type":"journal-article","created":{"date-parts":[[2025,8,1]],"date-time":"2025-08-01T07:50:11Z","timestamp":1754034611000},"page":"e001998","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Postpartum contraceptive use after vaginal and caesarean birth in Nigeria: a nationwide population-based analysis"],"prefix":"10.1136","volume":"3","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9899-9013","authenticated-orcid":false,"given":"Otobo I","family":"Ujah","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynaecology, Federal University of Health Sciences Otukpo, Otukpo, Nigeria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8388-8401","authenticated-orcid":false,"given":"Omoregie","family":"Irowa","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology, Federal University of Health Sciences Otukpo, Otukpo, Nigeria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ferdinand C","family":"Obi","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology, Our Lady of Apostles (OLA) Hospital, Jos, Nigeria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christopher O","family":"Egbodo","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology, Jos University Teaching Hospital, Jos, Nigeria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Innocent A O","family":"Ujah","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology, Federal University of Health Sciences Otukpo, Otukpo, Nigeria"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,7,31]]},"reference":[{"key":"2026010703054262000_3.2.e001998.1","doi-asserted-by":"crossref","first-page":"871","DOI":"10.1016\/j.bpobgyn.2014.05.007","article-title":"Postabortal and postpartum contraception","volume":"28","author":"Cameron","year":"2014","journal-title":"Best Pract Res Clin Obstet Gynaecol"},{"key":"2026010703054262000_3.2.e001998.2","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2021.18912","article-title":"Association of Expanded Prenatal Care Coverage for Immigrant Women With Postpartum Contraception and Short Interpregnancy Interval Births","volume":"4","author":"Rodriguez","year":"2021","journal-title":"JAMA Netw Open"},{"key":"2026010703054262000_3.2.e001998.3","doi-asserted-by":"crossref","first-page":"100897","DOI":"10.1016\/j.srhc.2023.100897","article-title":"Postpartum contraception usage in immigrants compared with non-immigrants in Buffalo, NY","volume":"37","author":"Stevens","year":"2023","journal-title":"Sex Reprod Healthc"},{"key":"2026010703054262000_3.2.e001998.4","first-page":"1","article-title":"Postpartum contraceptive use and unmet need for family planning in five low-income countries","volume":"12 Suppl 2","author":"Pasha","year":"2015","journal-title":"Reprod Health"},{"key":"2026010703054262000_3.2.e001998.5","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1002\/ijgo.14928","article-title":"Postpartum contraception: A matter of guidelines","volume":"164","author":"Grandi","year":"2024","journal-title":"Int J Gynaecol Obstet"},{"key":"2026010703054262000_3.2.e001998.6","doi-asserted-by":"publisher","DOI":"10.2307\/2673801"},{"key":"2026010703054262000_3.2.e001998.7","unstructured":"World Health Organization (WHO) . Programming strategies for postpartum family planning, 2013. Available: https:\/\/www.who.int\/publications\/i\/item\/9789241506496 [Accessed 6 Jun 2022]."},{"key":"2026010703054262000_3.2.e001998.8","unstructured":"World Health Organization (WHO) . World Health Organization; Report of a WHO technical consultation on birth spacing: Geneva, Switzerland 13-15 June 2005, 2007. Available: https:\/\/www.who.int\/publications\/i\/item\/WHO-RHR-07.1 [Accessed 6 Jun 2025]."},{"key":"2026010703054262000_3.2.e001998.9","doi-asserted-by":"crossref","DOI":"10.3389\/fgwh.2023.1284614","article-title":"The determinants of postpartum contraceptive use in Nigeria","volume":"4","author":"Anyatonwu","year":"2023","journal-title":"Front Glob Womens Health"},{"key":"2026010703054262000_3.2.e001998.10","article-title":"Unmet need for family planning and predictors among women in the extended postpartum period, southeastern Nigeria: a facility-based cross-sectional study","volume":"45","author":"Amuzie","year":"2023","journal-title":"Pan Afr Med J"},{"key":"2026010703054262000_3.2.e001998.11","unstructured":"National Bureau of Statistics (NBS) and United Nations Children\u2019s Fund (UNICEF) . August, 2022. Multiple Indicator Cluster Survey 2021, Survey Findings Report. Abuja, Nigeria: National Bureau of Statistics and United Nations Children\u2019s Fund, 2022. 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