Initiation of immediate postpartum family planning and its determinants among women delivering in health facilities: a cross-sectional study

INTRODUCTION: The immediate postpartum period represents a critical yet underutilized opportunity to prevent unintended and closely spaced pregnancies, particularly in low- and middle-income countries. In Rwanda, despite high rates of facility-based delivery, initiation of contraception before hospital discharge remains suboptimal. Evidence on how sociodemographic characteristics, childbirth-related factors, male partner presence during childbirth, and health provider practices jointly determine immediate postpartum family planning (IPPFP) uptake is limited. This study assessed IPPFP uptake, examined male partner involvement, and identified associated factors. METHODS: The study was conducted in the maternity units of Muhima District Hospital and King Faisal Hospital in Kigali, Rwanda. Quantitative data were collected from 480 women aged ≥ 18 years within 96 h postpartum. Qualitative in-depth interviews were conducted with five male partners to explore perspectives on postpartum contraceptive decision-making. Immediate postpartum family planning was defined as self-reported initiation of a modern contraceptive method before discharge. Quantitative data were analyzed using descriptive statistics, chi-square tests, and regression analysis, and qualitative data were analyzed thematically to complement quantitative findings. RESULTS: Overall, 60.6% (291/480) of women initiated a contraceptive method before discharge, with intrauterine devices being the most commonly chosen method (33.7%). Male partners were present during childbirth for 48.3% of women; however, partner presence was not significantly associated with IPPFP uptake (χ² = 1.409, p = 0.262). Qualitative findings from a small exploratory sample suggest that contraceptive decisions were largely made during pregnancy, driven by considerations such as maternal health, parity, and household economic capacity, rather than male partners' physical presence at childbirth. CONCLUSIONS: IPPFP uptake in these two urban Rwandan hospitals was moderate. Initiation of contraception before discharge was associated with selected sociodemographic and obstetric characteristics, although these associations were based on unadjusted analyses. Male partner presence during childbirth was not statistically associated with IPPFP uptake, and qualitative findings suggest that contraceptive decisions are often made earlier in pregnancy. Strengthening postpartum counseling and clinical assessment may improve informed decision-making. However, findings should be interpreted in light of the study's limited scope and design.