Factors associated with early resumption of sexual intercourse among postnatal women in Uganda

The postnatal period (the time just after delivery and through the first six weeks of life) is especially critical for newborns and mothers as most deaths of mothers and babies occur within this period [1‐3]. This is an ideal time to deliver interventions that improve the health and survival of both the newborn and the mother [3]. Adong in her study about knowledge, perceptions and practices in pregnancy and childbirth in Uganda [4], reported that postnatal care services were poor or absent. In developed countries, virtually all women and their infants receive postpartum and postnatal care. Yet in developing countries, policies and programs have largely overlooked this critical time, hindering efforts to meet the Millennium Development Goals (MDGs) for maternal and child survival [3]. The World Health Organization (WHO) recommends that with limited resources, contact with the healthcare system postpartum would be at least during the first twenty four hours and before the end of the first week [2]. However, a review of postnatal services found that the nature and frequency of this care varies considerably [2, 5‐10]. Indeed, many women who give birth are discharged within hours after child birth without any indication where they can obtain further care or support [11].

Sexuality is one of the key components to address during postnatal period; it has long been a subject of secrecy and taboo in Africa [12]. This is particularly true of sensitive issues such as postnatal sexual intercourse. Perceived sexual problems in the post-partum period need to be addressed [13, 14]. These are dyspareunia, lack of vaginal lubrication, difficulty in achieving orgasm, vaginal loosening, loss of sexual desire and bleeding or irritation after sexual intercourse [15]. Resumption of sexual intercourse after giving birth has been shown to allow the men to “stay more at home” (not to get extramarital affairs) which reduces the risk of sexually transmitted infections like HIV/AIDS infections [16]. The consequences of early resumption of sexual intercourse on the other hand, include unwanted pregnancy which may be undesirable especially if no contraceptive method is used after six months postpartum [16]. Moreover, postpartum abstinence is perceived as being against natural human sexuality and results in practices that could endanger family relationships and health, especially in the era of HIV/ AIDS [8, 17].

African women tend to follow established community norms and traditions in making decisions that influence resumption of sexual intercourse after giving birth [18]. Studies have shown that early initiation of sexual intercourse was observed in women who had spontaneous vaginal delivery and in those who stayed at home with their mothers, than in-laws and aunts [15]. Standard guidelines published by Ministry of Health in Uganda recommend that, mothers abstain from sexual intercourse for at least 6 weeks after child birth as the risk of infecting the baby through breast milk is higher if the mother is newly HIV positive [19]. For example, the risk of mother-to-child HIV transmission was 2.9-fold higher during the postpartum period among those who had recently acquired HIV than among those with chronic HIV infection, and 2.3-fold higher during the pregnancy/postpartum periods combined [20]. Postpartum women may be at greater risk for infections due to vaginal lesions and abrasions following labour and delivery process [21]. Anecdotal reports indicate that some mothers request not to be discharged quickly from hospital following childbirth for fear of being forced to have sexual intercourse by their partners before they heal. Additionally it has been observed that some women return to hospital with gaping episiotomies in the postnatal period, one indication that they had engaged in sexual intercourse before the perineum was completely healed [19]. Women need adequate counseling to be prepared for resumption of sexual intercourse postpartum to avoid complications such as puerperal infection and unwanted pregnancies. The extent to which postnatal mothers adhere to recommended guidelines is not documented. The purpose of our study was to assess the timing of resumption of sexual intercourse after childbirth and factors associated with early resumption. Information generated could guide service providers on how to improve the information given to women and their partners during antenatal care and after childbirth regarding postpartum resumption of sexual intercourse.