Patterns and predictors of contraceptive use among post-caesarean women in Sierra Leone: insights from a five-year longitudinal study

Abstract Caesarean deliveries and short birth intervals predispose to adverse maternal outcomes. Family planning lowers this risk by reducing unplanned pregnancies. This study assessed the uptake and influencing factors of contraceptive use among women at one- and five-years post-caesarean delivery in Sierra Leone. We performed a secondary analysis of data from a multicentre, prospective observational study involving 1,274 women who underwent caesarean delivery in nine hospitals across Sierra Leone between October 2016 and May 2017. The primary outcome was the use of a modern contraceptive method within five years post-delivery. Multivariable logistic regression analyses were used to identify factors associated with contraceptive uptake. Overall contraceptive use at five years was 48.5%. The commonest method used at year one was the intrauterine contraceptive device, but this declined significantly from 40.3% to 0.8% by year five ( p < 0.001). Attending more than two antenatal care visits [aOR 1.96; 95% CI (1.19, 3.23)] and offering a contraceptive method before discharge [aOR 2.44; 95% CI (1.05, 6.40)] were associated with a higher likelihood of modern contraceptive uptake, while delivery at a tertiary/regional facility was associated with a lower likelihood [aOR 0.53; 95% CI (0.34, 0.83)]. Increased contact with the health system was associated with a higher uptake of modern contraceptive methods among post-caesarean women. Strengthening provider–client interaction and integrating contraceptive counselling into routine antenatal and postnatal care could improve contraceptive use and address the unmet need for family planning.