Missed opportunity for initiation of modern contraception and associated factors among postpartum women in Kabale municipality, Southwestern Uganda: a cross-sectional study

Missed opportunity for initiation of modern contraception in the postpartum period occurs when postpartum women not using modern contraception attend maternal and child health clinics and depart without initiating any modern contraception method. Such missed opportunities can lead to unintended pregnancies in the postpartum period and hence poor maternal and child health outcomes. Despite the several studies done on postpartum contraception, there is paucity of information about missed opportunity for modern contraception initiation within 6months postpartum. This study aimed at assessing the prevalence of missed opportunity for modern contraception initiation and the associated factors among women between 6 weeks and 6 months post-partum in Kabale Municipality, one of the highly populated rural areas in Uganda. A cross-sectional survey with quantitative analysis was used. A total of 427 respondents from the 4 health facilities in the municipality that had functional young child clinics were interviewed during the months of January and February 2025. Data were collected using pretested structured interviewer-administered questionnaire and analyzed using SPSS version 25.0. Frequencies, chi square tests and logistic regression were the statistical tests used. Of the 427 participants, 45.7% (n = 195, 95% CI: 40.9–50.5) had not yet initiated any modern contraception method. Factors associated with the missed opportunity for modern contraception initiation were belief in the return of menses before the initiation of modern contraception (AOR:3.01, 95% CI: 1.74–5.19, p < 0.001), restrictions on the use of modern contraception by male partners (AOR: 3.02, 95% CI: 1.72–5.31, p < 0.001) and lack of postpartum contraception counselling after delivery(AOR:2.49, 95% CI: 1.43–4.33, p = 0.001). Approximately 1 out of every 2 women misses initiation of modern contraception within 6months postpartum in Kabale municipality. We recommend strengthening postpartum contraception counseling among couples during antenatal care, after delivery and postnatal care clinics.