Determinants of postpartum contraceptive use: a detailed analysis of the 2022 Ghana Demographic and Health Survey

Background : The postpartum period is a critical window for preventing unintended pregnancies and reducing maternal and neonatal mortality. Despite global commitments, sub-Saharan Africa bears a high burden of unmet contraceptive needs, exacerbating maternal mortality rates. In Ghana, postpartum contraceptive (PPC) prevalence remains low, with significant disparities persisting across rural and urban areas and wealth quintiles. Structural barriers, limited healthcare access, and patriarchal norms restrict women's decision-making autonomy and PPC use. Research has identified individual, interpersonal, and structural factors influencing PPC use, but nationally representative analyses are lacking, particularly in the post-COVID-19 era. Objective: To identify the determinants of postpartum contraceptive (PPC) use among women in Ghana: a detailed analysis of the 2022 Ghana Demographic and Health Survey (GDHS). Method: This descriptive, analytical, cross-sectional study utilized data from the 2022 Ghana Demographic and Health Survey (GDHS), which included 32,400 Ghanaian women of reproductive age (15-49 years). The study examined the determinants of postpartum contraceptive use, with variables sociodemographic, economic and obstetric characteristics of the women. Data analysis was conducted using StataCorp version 18, employing binary logistic regression and mediation analysis to assess associations and indirect effects of the predictors on postpartum contraceptive (PPC) use. Results: The prevalence of postpartum contraceptive (PPC) use among Ghanaian women was 35.1% (95% CI: 34.6, 35.6). Multivariate analysis identified several significant predictors of PPC use, including age, educational level, religious affiliation, residence, region, wealth index, distance to health facility, health decision-maker, and parity. Mediation analysis revealed that wealth quintile significantly mediated the relationship between PPC use and all the covariates examined. Conclusion: The study concludes that, except for marital status, all examined covariates significantly predict postpartum contraceptive (PPC) use. This highlights the need for targeted interventions aimed at reducing socioeconomic disparities among women to enhance PPC use.