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Rural-Urban Differences in the Association Between Reproductive Coercion and Postpartum Family Planning.
Studies in Family Planning
|April 4, 2026
Summary
Reproductive coercion (RC) delays postpartum family planning (PPFP) uptake for rural Ethiopian women. Urban women initiated PPFP faster, irrespective of RC, highlighting contextual barriers to contraception access.
Area of Science:
- Reproductive Health
- Public Health
- Sociology
Background:
- Timely postpartum family planning (PPFP) is crucial for reproductive autonomy and healthy birth spacing.
- Reproductive coercion (RC) may impede women's ability to access contraception after childbirth, but its impact is understudied.
- Understanding how RC interacts with socioeconomic factors like residence is vital for effective PPFP interventions.
Purpose of the Study:
- To investigate the association between pre-pregnancy reproductive coercion (RC) and the initiation of postpartum family planning (PPFP) among Ethiopian women.
- To examine how place of residence (urban vs. rural) modifies the relationship between RC and PPFP uptake.
- To identify barriers to timely contraceptive use in the postpartum period.
Main Methods:
- Prospective cohort study of 1,481 pregnant Ethiopian women followed for 12 months postpartum (2021-2023).
- Time-to-event analysis using Kaplan-Meier estimators and parametric survival models to assess contraceptive uptake.
- Stratified analyses by residence (urban/rural) to evaluate effect modification by RC exposure.
Main Results:
- Approximately 14.3% of women experienced pre-pregnancy RC.
- Overall, 46.7% adopted a modern contraceptive method within 12 months postpartum.
- Rural women exposed to RC had a 40% lower hazard of initiating PPFP compared to unexposed rural women (aHR: 0.60).
- No significant association between RC and PPFP uptake was found among urban women.
- Urban women initiated PPFP more rapidly than rural women, regardless of RC exposure.
Conclusions:
- Pre-pregnancy reproductive coercion is associated with delayed postpartum family planning initiation, particularly in rural Ethiopian settings.
- Residence significantly modifies the impact of RC on PPFP uptake, suggesting structural barriers in rural areas.
- Addressing RC within PPFP programs and strengthening health systems are essential to overcome barriers and support women's reproductive goals.
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