2. Methodology
2.1. Study Setting
The study took place in the maternity ward of Abass Ndao Hospital Center, a hospital of the City of Dakar with national status. As regards the infrastructure, it includes a delivery room, a triage room, a pathological pregnancy unit comprising 5 rooms having 10 beds in total, a normal postpartum unit of 8 beds, a pathological postpartum unit of 8 beds, two recent operated-patient units of 8 beds, cubicles having a total of 6 beds. The health staff includes eight (8) obstetrician-gynecologists, thirty-four (34) midwives, twenty-nine (29) nurses and one (1) social worker.
2.2. Type and Period of Study
Type of study: this was a cross-sectional and descriptive study among women users of family planning at Abass Ndao Hospital Center.
Study period: This study took place from January to May 2023.
2.3. Study Population
Our study population included all patients using family planning having a medical file during the study period.
2.4. Data Collection Procedures
The data were collected from the medical files of women using family planning using a previously tested form. The data collected included:
Sociodemographic data: age, marital status, level of education, gynecological-obstetrical and medical-surgical history;
Clinical data: anthropometric data (weight and height), blood pressure expressed in mm Hg with a measurement in both arms;
Family planning method used.
2.5. Data Entry and Analysis
After manual sorting, data entry and analysis were carried out using Excel and Sphinx software. Data analysis was performed using STATA MP 16.0. with:
1) A descriptive part to calculate means with their standard deviation for quantitative variables, frequencies for qualitative variables;
2) An analytical part to look for the determinants of the use of family planning. The tests (Wilcoxon and Kruskal Wallis tests) were used according to their conditions of application, the test was significant when the p value was less than or equal to 0.05.
2.6. Ethical Consideration
Administration of the questionnaire was carried out with the consent of the beneficiaries. In addition, the confidentiality, anonymity, discretion and medical secrecy expected by these women were respected. The head of the maternity department had given his agreement for the conduct of this study.
3. Results
During the study period we included one hundred and seven women (107).
3.1. Descriptive Results
Age: The mean age of the patients was 29.5 years ±6.8 with extremes of 14 and 45 years and the median age of 29 years. The 25-34 age group was the most represented (52.3%). Twenty-six (26) patients were 35 years and older i.e. 24.3% and twenty-four (24) i.e. 22.4% patients between 18 and 24 years old.
Marital status: The status of “married women” was in the majority (90.7%, n=97) followed by “single women” (8.4%, n=9) and there was only one (1) divorced woman.
Level of education: The majority of women were educated (89.6%, n=95) of whom 41.5% (n=39) had secondary level and 33% (n=31) higher level. On the other hand 10.4% (n=9) of the patients were not schooled.
Occupation: About one quarter (n=27) of the patients were employees of the formal private sector, 23.4% (n=25) housewives and 21.5% (n=23) schoolgirls-students.
Date of last menstrual period (LMP): The date of the last menstrual period was recorded in one hundred and four (104) patients. Eighteen (18) of our patients had their menstruation during the study. Twenty-three (23) of our patients were in the postpartum period. Thirteen (13) of our patients had amenorrhea.
Duration of menstruation: The mean duration of menstruation was five (5) days with extremes of three (3) and eight (8) days.
Menstrual cycle: The menstrual cycle was regular in ninety-four (94) women i.e. 87.9%.
Parity: The population of our study was constituted essentially of multiparous women (49.5%, n=53) followed by primiparous women (40.2%, n=43). Nulliparous women numbered eleven (11) i.e. 10.3%.
Number of children: The mean number of children was two (2) with extremes from 0 to 8. Almost all the women had at least one child (89.7%, n=96).
History of abortion: Among the 107 patients, fourteen (14) i.e. 13.1% had a history of abortion of whom eleven (11) patients i.e. 10.3% had had an abortion and three (3) i.e. 2.8% had had several abortions.
Stillbirth: Among the 107 patients, four (4) of them had a history of stillbirth i.e. 3.7% of whom three (3) patients i.e. (2.8%) had one (1) and one (1) patient had two (2) stillbirths.
Breastfeeding pattern: The breastfeeding pattern was recorded in 93 patients. Among the latter, seventy-three (73) i.e. 78.5% practiced exclusive breastfeeding and twenty (20) of them i.e. 21.5% preferred mixed breastfeeding.
Blood pressure: The mean systolic blood pressure was 112 mm Hg ±11.9 with extremes of 90 and 140 mm Hg. The mean diastolic blood pressure was 73 mm Hg ±10.3 with extremes of 50 and 110 mm Hg. Ninety (90) of the patients i.e. 84.1% were normotensive and four (4) of the patients i.e. 3.7% were hypotensive; on the other hand thirteen (13) of the patients i.e. 12.1% were hypertensive.
Anthropometric data: Weight status was assessed in fifty-one (51) patients. The mean weight was 72.7 kg ±13.4 and extremes of 52 and 118 kg. The mean height was 1.67 ±0.1 and extremes of 1.55 and 1.81 m. The mean BMI was 26.2 ±5.0 and extremes of 17.4 and 39.1. Twenty-one (21) i.e. 41.2% of our patients had a normal weight, thirteen (13) i.e. 25.5% of our patients were obese and fifteen (15) i.e. 29.4% of our patients were overweight.
Source of knowledge: The main source of information on family planning was of medical origin through health workers (32.7%, n=35) then the husband (8.4%, n=9) and the parents (2.8%, n=3).
Table 1. Distribution of patients according to information sources.
Information sources | Number (n) | Pourcentage (%) |
Health worker | 35 | 32,7 |
Husband | 9 | 8,4 |
Parents | 3 | 2,8 |
Other | 60 | 56,1 |
Total | 107 | 100 |
Contraceptive method: The contraceptive methods most used were Depo injectable (41.1%, n=44) and Jadelle (27.1%, n=29) followed by Implanon (22.4%, n=24) then the IUD (intrauterine device) (9.4%, n=10).
Table 2. Distribution of patients according to types of contraception.
Contraceptive methods | Number (n) | Percentage (%) |
Injectable Depo-Provera | 44 | 41,1 |
Jadelle | 29 | 27,1 |
Implanon | 24 | 22,4 |
Intrauterine device | 10 | 9,4 |
Total | 107 | 100 |
3.2. Analytical Results
The practice of contraception was statistically correlated with parity; indeed the more children the woman has the more she is inclined to use contraception (p=0.011). On the other hand this practice was independent of age (p=0.516), of the marital status of the patients (p=0.224), of the level of education (p=0.716), of body build (p=0.634) and of blood pressure status (p=0.097).
4. Discussion
Age: The mean age of family planning users was 29.5 years ±6.8 with extremes ranging from 14 and 45 years. Similar results were obtained both at the national and African level, the mean age of users being between 28 and 30 years
| [8] | Leye, M. (2012). Knowledge, attitudes and practices on modern contraception in the district of Bambey. Medicine in Sub-Saharan Africa. |
| [9] | Sarr, C. (2013). Contraception service provision at the Institute of Social Hygiene of Dakar: Review of ten years of activities (Medical thesis). UCAD, Dakar. |
| [10] | Diarra, L. (2012). Epidemiological and clinical study of family planning at the AMPPF headquarters clinic in Bamako (Medical thesis). |
[8-10]
. Similar trends were observed in Mali where authors such as Sanogo
| [11] | Sanogo, D., RamaRao, S., Jones, H., Ndiaye, P., Mbow, B., & Diop, C. B. (2003). Improving quality of care and use of contraceptives in Senegal. African Journal of Reproductive Health, 7(2), 57-73. |
[11]
, Jean Marie and Sao
| [12] | Sao, O. B. (2008). Assessment of quality of care in the family planning unit of the reference health center of Commune V of Bamako (Medical thesis). Bamako. |
[12]
speak of profiles of users predominantly aged 25 to 34 years. On the other hand, Ba
| [13] | Ba, MG, et al. (1999). A 5-year clinical evaluation of Norplant implants in Senegal. Contraception, 59(2), 91-95. |
[13]
and Diop
| [14] | Diop, S. N., Ba‑Gueye, M., Tall, A., & Diadhiou, F. (2003). Norplant contraceptive implants: Evaluation of side effects, weight and blood pressure in three family planning clinics in Dakar, Senegal. Journal of Obstetric Gynecology and Reproductive Biology 32(3), 246-251. |
[14]
, in their studies conducted on Norplant® in Senegal, had found a higher mean age respectively of 31.3 and 32 years unlike Diarra in Mali in 2012 who had found a lower mean age of 27.4 years.
Overall, these results confirm that modern contraception remains mainly mobilized by women in the full period of reproductive activity, often already engaged in motherhood. Recent national analyses
| [6] | FP2030FP2030, & Track20. (2023). Youth Opportunity Brief - Senegal: Modern contraception and unmet need among adolescent girls and young women. |
| [15] | National Agency for Statistics and Demography (ANSD), & ICF. (2023). Senegal: Continuous Demographic and Health Survey 2019-2023. ANSD/ICF. |
[6, 15]
moreover show that the prevalence of modern contraception is highest among women aged 25-34 years, both at the national level and in urban settings. Studies focused on young people in Dakar also indicate that, if contraceptive initiation can be early, regular use remains more frequent after a few years of sexual life and sometimes after a first pregnancy
| [5] | Guttmacher Institute. (2020). Sexual and reproductive health of young Senegalese women. |
| [16] | Sidze, E. M., Lardoux, S., Speizer, I. S., Faye, C. M., & Mutua, M. (2014). Young women's access to and use of contraceptives: The role of providers' restrictions in urban Senegal. International Perspectives on Sexual and Reproductive Health, 40(4), 176-183. |
[5, 16]
. The persistence of high fertility rates at advanced ages, described in several countries of the sub-region, helps explain this still relatively late resort to family planning
| [14] | Diop, S. N., Ba‑Gueye, M., Tall, A., & Diadhiou, F. (2003). Norplant contraceptive implants: Evaluation of side effects, weight and blood pressure in three family planning clinics in Dakar, Senegal. Journal of Obstetric Gynecology and Reproductive Biology 32(3), 246-251. |
| [17] | National Institute of Statistics and Demography. (1994). Demographic and Health Survey, Burkina Faso 1993. |
[14, 17]
.
Level of education: In our study, the majority of women were educated (89.6%, n = 95), with a strong representation of secondary and higher levels. This rate is clearly higher than those reported in several previous works: Leye et al reported 65.8% of educated women, whereas the study by Sane Ndiaye found 65.7%. In Mali, Diarra reported 81.3% of schooled women and Jean M. 72%, whereas Sidibe observed a markedly lower literacy level, at 47.98%. These differences suggest an overall progression of female schooling among family planning users, but also differences of context between countries, study settings and periods of observation.
Many recent analyses confirm that education constitutes a major determinant of the use of modern contraception. Women who have reached at least the secondary level have higher probabilities of adopting a modern method, due to better access to information, greater decision-making autonomy and an increased capacity to negotiate within the couple
| [3] | Population Reference Bureau. (2021). Family planning in West Africa: Progress and persistent challenges. |
| [18] | Barry, M. S. (2021). Marital status and non-use of modern contraception among women exposed to the risk of unwanted pregnancy in Guinea (1999-2018) (Doctoral thesis). University of Burgundy-Franche-Comté. |
| [19] | Equipop. (2025). The stakes of family planning in West Africa. |
[3, 18, 19]
. In Senegal, reports devoted to the sexual and reproductive health of adolescent girls and young women show that schooling not only prolongs the period before first marriage, but is also accompanied by more frequent use of modern methods, particularly in urban settings
| [5] | Guttmacher Institute. (2020). Sexual and reproductive health of young Senegalese women. |
| [6] | FP2030FP2030, & Track20. (2023). Youth Opportunity Brief - Senegal: Modern contraception and unmet need among adolescent girls and young women. |
[5, 6]
. Even when the statistical association between level of education and contraceptive use does not appear significant in a given study, the convergence of the available works argues in favor of a structuring role of female education in the dynamics of family planning, by strengthening women’s capacity to plan and master their reproductive life.
Occupation: About one quarter (25.2%, n=27) of the patients were employees of the formal private sector, 23.4% (n=25) housewives and 21.5% (n=23) schoolgirls-students. This distribution reflects a certain social diversification of the users, who are no longer only housewives, as some older studies suggested. In Diarra’s study, housewives were the most represented (30.3%), followed by schoolgirls/students (28.1%)
| [10] | Diarra, L. (2012). Epidemiological and clinical study of family planning at the AMPPF headquarters clinic in Bamako (Medical thesis). |
[10]
. This could be explained by the fact that employees of the private sector tend to be better informed than housewives or as a lever for organizing reproductive life in relation to professional constraints. Compared with our results, those of Traore showed that housewives represented 63.3% of users against 8% of civil servants, which reflects a context where family planning remained more anchored in households than in formal salaried environments
| [20] | Traoré, M. J. (2010). Knowledge and use of contraception at the reference health center of Commune IV of the district of Bamako (Medical thesis). Bamako. |
[20]
.
In our study, schoolgirls and students used contraception at a rate of 21.5%; this confirms contraceptive needs concern young women still in schooling.
In our study, the non-negligible share of employees of the private sector suggests that contraception is also mobilized as a lever for organizing reproductive life in relation to professional constraints, these women often being better informed on the available methods and more concerned with planning their pregnancies.
The proportion of schoolgirls and student users (21.5%) furthermore confirms that contraceptive needs concern young women still in schooling. International data show that the median age at first sexual intercourse generally lies between 16 and 19 years for girls and between 17 and 19 years for boys, which coincides with the school or immediate post-school period and contributes to making a need for contraception emerge early
| [21] | World Health Organization. (2022). Trends in maternal mortality 2000-2020: Estimates by WHO, UNICEF, UNFPA, World Bank Group and UNDESA/Population Division. WHO. |
[21]
. In Africa, several surveys indicate comparable ages at first intercourse, often close to 16 years for girls; in Chad, for example, the mean age at first sexual intercourse is estimated at 15.9 years in girls and 18.8 years in boys. These elements shed light on the presence of young people in school settings among users of modern methods and underline the importance of sex education measures and services adapted to adolescents and young adults.
Marital situation: In our study, 90.7% of the users were married. This high rate could be explained by the fact that socially these women are free from any judgment if ever they contract a pregnancy, they can present themselves without embarrassment in health structures. On the other hand unmarried women would very quickly be exposed to the prejudices of society in the event of pregnancy outside marriage. The study by Ralisata et al
| [29] | Ravolamanana, L. R., et al. (2000). Contraception by levonorgestrel subcutaneous implants at the CHU of Mahajanga: Preliminary results. Medicine in Sub-Saharan Africa. |
[29]
had also found a predominance of married women users of contraception with respectively 66.1% and 82%. Recent analyses by FP2030
| [6] | FP2030FP2030, & Track20. (2023). Youth Opportunity Brief - Senegal: Modern contraception and unmet need among adolescent girls and young women. |
| [26] | FP2030. (2024). Senegal: Overview of family planning indicators. |
[6, 26]
and the Ouagadougou Partnership
| [7] | Ouagadougou Partnership. (2024). Senegal: Country profile and progress toward FP2030 objectives. |
[7]
show that, despite the progress in modern contraceptive prevalence in Senegal, strong unmet needs persist among adolescent girls and young single women, particularly in urban settings. Our results, in line with these observations, indicate that FP services remain still largely oriented toward women in union, and underline the necessity of strengthening the offer and accessibility for young unmarried women.
Information sources: Health workers constituted the main sources of information on family planning (32.7%), followed by the husband (8.4%) then the parents (2.8%). At the African scale we find roughly the same results.
Keita’s study showed that health workers constituted the main source of information then friends and spouses with respectively 56.5%, 27.4% and 7%, confirming the pivotal role of the health system in the dissemination of family planning messages
| [22] | Keita, S. (1998). Epidemiological profile, tolerance and acceptability in family planning in Ouagadougou: About four contraceptive methods (Medical thesis). University of Ouagadougou. |
[22]
. In the study by Saizonou et al, in Benin
| [23] | Saizonou, J., Makoutodé, P., Mongbo, V., Affo, A., Zannou, F. R., & Atade, W. (2021). Determinants of the use of postpartum family planning services in a health zone of Benin. African Journal of Public Health, 3(1), 125-136. |
[23]
, the source of family planning information most cited was health centers (71.85%), thus showing women’s dependence vis-à-vis health structures for access to information. A study by El Rabi Ousni
| [24] | El Rabi Ousni. (2000). Access to modern contraceptive methods in public health structures (End-of-study dissertation). |
[24]
showed that in their majority, women obtained modern contraceptive methods from the public sector (56%), of which 46% from health centers.
Recent evaluations of youth-friendly reproductive health services in Senegal nevertheless underline that the impact of this centrality depends on the quality of counseling, the availability of methods and the capacity of providers to respect the informed choice of users
| [25] | Pathfinder International. (2023). Senegal: Evaluation of youth-friendly reproductive health services. |
| [26] | FP2030. (2024). Senegal: Overview of family planning indicators. |
| [27] | Countdown 2030. (2024). Reproductive, maternal, neonatal and child health indicators: Senegal. |
[25-27]
. Our results support these analyses, by showing that health workers play a determining role in orienting contraceptive choices, which pleads for a strengthening of their training on listening, neutrality and taking into account women’s preferences and constraints.
Number of children: In our study, the population using family planning was constituted mainly of multiparous women (49.5%), followed by primiparous women (40.2%), whereas nulliparous women represented only 10.3%. The mean number of children was two, and nearly 90% of women had at least one living child. These results indicate that the resort to contraception is made mainly after entry into motherhood, in a logic of spacing or limiting births.
This configuration is consistent with numerous studies carried out in Senegal and in the sub-region, which show that the use of modern methods increases with parity. Several works thus describe low use among nulliparous women, then a progression of contraceptive practice among women having one, two or more children
| [11] | Sanogo, D., RamaRao, S., Jones, H., Ndiaye, P., Mbow, B., & Diop, C. B. (2003). Improving quality of care and use of contraceptives in Senegal. African Journal of Reproductive Health, 7(2), 57-73. |
| [12] | Sao, O. B. (2008). Assessment of quality of care in the family planning unit of the reference health center of Commune V of Bamako (Medical thesis). Bamako. |
| [13] | Ba, MG, et al. (1999). A 5-year clinical evaluation of Norplant implants in Senegal. Contraception, 59(2), 91-95. |
| [28] | Kon, B., Lankoandé, J., Ouedraogo, C., Ouedraogo, A., Bonan, B., & Toure, B. (1999). Contraception by levonorgestrel subcutaneous implants: African experience from Burkina Faso. Scientific communication. |
[11, 12, 13, 28]
. Analyses in the general population also confirm that modern contraceptive prevalence is higher among women who already have several children, whereas unmet needs remain significant among primiparous women and women having a low number of children
| [6] | FP2030FP2030, & Track20. (2023). Youth Opportunity Brief - Senegal: Modern contraception and unmet need among adolescent girls and young women. |
| [15] | National Agency for Statistics and Demography (ANSD), & ICF. (2023). Senegal: Continuous Demographic and Health Survey 2019-2023. ANSD/ICF. |
[6, 15]
. Moreover, international studies have shown that infant morbidity and mortality tend to increase from the third or fourth birth onward, which reinforces the relevance of limitation and spacing strategies in large families
| [29] | Ravolamanana, L. R., et al. (2000). Contraception by levonorgestrel subcutaneous implants at the CHU of Mahajanga: Preliminary results. Medicine in Sub-Saharan Africa. |
[29-3]
. The results of our study, which highlight a statistically significant association between parity and contraceptive use (p = 0.011), fit within this logic: the higher the parity, the more likely women are to resort to a modern method.
Obesity and contraception: In our study 29.4% of the patients were overweight and 25.5% were obese. These proportions show that an important share of contraceptive users already presents excess weight. Comparable results were reported by Sonou et al.
| [30] | Sonou, A., et al. (2018). Absolute cardiovascular risk of women using hormonal contraception in Porto-Novo. Cardiovascular Journal of Africa. |
[30]
in Benin, who found 26.9% overweight and 23.2% obesity among women using hormonal contraception, which confirms that obesity is frequent among users of modern methods in West Africa.
In our series, obese women resorted to different methods: some used Depo injectable, others Jadelle, Implanon or the copper intrauterine device. This diversity of practices reflects the necessity of offering a range of methods adapted to risk profiles. The literature underlines that, in obese women, microprogestin contraceptions, injectable progestins, implants and the levonorgestrel IUD are generally considered usable, subject to an overall cardiovascular risk assessment
| [32] | Cuzzucoli, L., Cuzzucoli, M., & Cuzzucoli, A. (2020). Contraception and obesity. Liège Medical Journal, 75(2), 75-82. |
| [33] | World Health Organization. (2025). Oral contraceptives: Fact sheet. WHO. |
| [34] | Vidal. (2024). Obesity, contraception and pregnancy; Contraception: Updated recommendations. VIDAL. |
[32-34]
. On the other hand, the use of combined estrogen-progestin oral contraceptives must be considered with caution. In a woman older than 35 years with a BMI greater than 30 kg/m² or presenting other cardiovascular risk factors (hypertension, smoking, diabetes, dyslipidemia), recent recommendations favor non-combined methods, notably the copper or levonorgestrel IUD, progestin-only contraceptives, definitive methods and mechanical methods
| [32] | Cuzzucoli, L., Cuzzucoli, M., & Cuzzucoli, A. (2020). Contraception and obesity. Liège Medical Journal, 75(2), 75-82. |
| [34] | Vidal. (2024). Obesity, contraception and pregnancy; Contraception: Updated recommendations. VIDAL. |
| [35] | Le Goff, S., Lédé, N., & Bader, G. (2008). Obesity and reproduction: Literature review. Gynecology, Obstetrics & Fertility, 36(5), 343-350. |
[32, 34, 35]
. Several authors also recall that the risk of venous thrombosis is multiplied in obese women using estrogen-progestins, and that this risk increases gradually with BMI
| [33] | World Health Organization. (2025). Oral contraceptives: Fact sheet. WHO. |
| [36] | Kharbanda, E. O., Parker, E. D., Sinaiko, A. R., Daley, M. F., Margolis, K. L., Becker, M., et al. (2014). Initiation of oral contraceptives and changes in blood pressure and body mass index in healthy adolescents. Journal of Pediatrics, 165(5), 1029-1033. |
[33, 36]
. Moreover, studies have shown significant weight gain under injectable progestin contraception, particularly in obese adolescents, which must be discussed with the patients when choosing the method
| [32] | Cuzzucoli, L., Cuzzucoli, M., & Cuzzucoli, A. (2020). Contraception and obesity. Liège Medical Journal, 75(2), 75-82. |
| [33] | World Health Organization. (2025). Oral contraceptives: Fact sheet. WHO. |
[32, 33]
. In the United States, the risk of oral contraceptive failure was also statistically correlated with BMI, women with excess weight or obesity presenting more unplanned pregnancies under the pill
| [36] | Kharbanda, E. O., Parker, E. D., Sinaiko, A. R., Daley, M. F., Margolis, K. L., Becker, M., et al. (2014). Initiation of oral contraceptives and changes in blood pressure and body mass index in healthy adolescents. Journal of Pediatrics, 165(5), 1029-1033. |
[36]
.
In our study, 12.1% of the patients were hypertensive, which testifies to a non-negligible frequency of this cardiovascular risk factor among contraceptive users. Higher results were reported in Benin, where Sonou et al
| [31] | Ciangura, C., & Bachelot, A. (2021). Contraception in the context of obesity. Medicine/Science, 37(10), 882-887. |
[31]
found around one quarter of hypertensive women in a population using hormonal contraception, confirming that hypertension constitutes an important issue in West Africa. These data underline the necessity of systematically screening cardiovascular risk factors, in particular arterial hypertension, before any contraceptive prescription.
In our series, hypertensive women resorted to different methods: some used Depo injectable, others the intrauterine device, Implanon or Jadelle. This profile illustrates both the diversity of contraceptive choices and the importance of adapting the method to the patient’s cardiovascular background. The literature shows that, in adult women suffering from arterial hypertension, the use of combined oral contraceptives is associated with an increase in the risk of acute cardiovascular events, notably myocardial infarction and ischemic stroke
| [37] | Perol, S., et al. (2019). Arterial hypertension and contraception. The Medical Press, 48. |
| [38] | Sidibe, K. M. (1999). Epidemiological approach to family planning at the health center of Commune IV of Bamako (Medical thesis). Bamako. |
[37, 38]
.
The use of combined hormonal contraception is also accompanied by a moderate but real rise in blood pressure, both systolic and diastolic, with an incidence of newly appeared hypertension estimated between 0.6% and 8.5% depending on the series
| [37] | Perol, S., et al. (2019). Arterial hypertension and contraception. The Medical Press, 48. |
| [38] | Sidibe, K. M. (1999). Epidemiological approach to family planning at the health center of Commune IV of Bamako (Medical thesis). Bamako. |
[37, 38]
. Recent recommendations therefore do not recommend the prescription of estrogen-progestin contraceptives in hypertensive women, whether controlled or not, and this whatever the mode of administration (oral route, transdermal patch or vaginal ring), because of the risk of additional increase in blood pressure
| [32] | Cuzzucoli, L., Cuzzucoli, M., & Cuzzucoli, A. (2020). Contraception and obesity. Liège Medical Journal, 75(2), 75-82. |
| [34] | Vidal. (2024). Obesity, contraception and pregnancy; Contraception: Updated recommendations. VIDAL. |
[32, 34]
.
A modest increase in blood pressure (of the order of 5 to 7 mmHg) has been observed in certain users of estrogen-progestins, and frank arterial hypertension appears in a limited but non-negligible proportion of them
| [31] | Ciangura, C., & Bachelot, A. (2021). Contraception in the context of obesity. Medicine/Science, 37(10), 882-887. |
| [38] | Sidibe, K. M. (1999). Epidemiological approach to family planning at the health center of Commune IV of Bamako (Medical thesis). Bamako. |
[31,38]
. In this context, progestin-only methods (microprogestin pill, implants, injectables) and intrauterine devices are generally preferred in women presenting hypertension or high cardiovascular risk, provided that their tolerance profile is assessed individually.
Thus, the proportion of hypertensive women observed in our study reinforces the idea that family planning must be closely articulated with the management of chronic diseases. A systematic screening for hypertension, an evaluation of overall cardiovascular risk and individualized advice on the safest methods constitute indispensable prerequisites before contraceptive prescription in these patients.
Postpartum and contraception: In our study, twenty-three patients were in the postpartum period, of whom five presented amenorrhea. It emerges that women who had already had the return of menses were proportionally more numerous to resort to a contraceptive method than those still in amenorrhea. This situation suggests that many women continue to assimilate postpartum amenorrhea to sufficient protection against pregnancy, whatever the moment of the postnatal period. Works carried out in other contexts confirm this observation. In Benin, Saizonou and collaborators showed that more than half of postpartum women declared not yet having had the return of menses, and that a large part of them had not initiated a contraceptive method, illustrating the persistence of an underestimated “window at risk”
| [23] | Saizonou, J., Makoutodé, P., Mongbo, V., Affo, A., Zannou, F. R., & Atade, W. (2021). Determinants of the use of postpartum family planning services in a health zone of Benin. African Journal of Public Health, 3(1), 125-136. |
[23]
. In Uganda, Sileo et al. highlighted that women who had already had the return of menses had resort to contraception about eight times higher than those who were still in amenorrhea, which shows to what extent the resumption of menstruation is perceived as the trigger signal of contraceptive need
| [39] | Sileo, K. M., Wanyenze, R. K., Lule, H., & Kiene, S. M. (2015). Determinants of family planning service uptake and use of contraceptives among postpartum women in sub-Saharan Africa: A systematic review. BMC Public Health, 15, 1312. |
[39]
. In Rwanda, Dulli et al.
| [41] | Haute Autorité de Santé. (2019). Contraception in postpartum women. |
[41]
observed that nearly half of women waited for the return of menses before using family planning services, despite a real risk of pregnancy upstream.
These results, compared with our own data, indicate that the postpartum period remains largely underexploited as an opportunity for prevention of closely spaced pregnancies. They join recent recommendations which recommend systematically integrating contraceptive counseling into postnatal follow-up, from the maternity ward then during vaccination and child growth consultations
| [40] | Dulli, L. S., Eichleay, M., Rademacher, K., Sortijas, S., & Nsengiyumva, T. (2016). Meeting postpartum women's family planning needs through integrated family planning and immunization services: Results of a cluster-randomized trial in Rwanda. Global Health: Science and Practice, 4(1), 73-86. |
[40]
. In this context, additional efforts are necessary to explain to women that the occurrence of a pregnancy is possible before the return of menses, in particular when breastfeeding is not exclusive or decreases in frequency. The promotion and provision of methods compatible with breastfeeding (progestin pills, implants, IUDs) in immediate and late postpartum, as well as clear counseling on the calendar of fertility return, are essential levers for reducing unplanned pregnancies in the year following childbirth.
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