ASSESSMENT OF SOCIO-CULTURAL, ECONOMIC, AND HEALTH SYSTEM BARRIERS TO LONG-ACTING REVERSIBLE CONTRACEPTIVE (LARC) UPTAKE AMONG POSTPARTUM WOMEN

Despite the proven effectiveness of long-acting reversible contraceptives (LARCs), their uptake among postpartum women in low- and middle-income countries remains low. Barriers including socio-cultural norms, economic constraints, and weak health systems hinder access, particularly in contexts like Pakistan and Bangladesh. To assess the socio-cultural, economic, and health system barriers to postpartum LARC uptake among women in Abbottabad, Pakistan and selected areas in Bangladesh. A mixed-methods sequential explanatory study was conducted from February to April 2025. Quantitative data were collected via structured questionnaires from 265 postpartum women selected through stratified random sampling. Descriptive and inferential statistics, including chi-square tests and binary logistic regression, were used. This was followed by qualitative interviews with 25 participants (15 postpartum women, 10 health providers), analyzed thematically to enrich findings. LARC uptake was significantly influenced by misconceptions (e.g., infertility: 57.4%), spousal approval (45.7%), and religious discouragement (41.1%). Economically, transport costs (61.1%) and low household income (53.2%) were key deterrents. Health system limitations—such as lack of counselling during ANC/PNC (32%) and provider bias—also reduced uptake. Regression analysis identified ANC/PNC counselling as the strongest positive predictor (OR = 2.78, p < 0.001), while male approval (OR = 0.42, p = 0.001) and low income (OR = 0.52, p = 0.015) were significant negative predictors. Postpartum LARC use is constrained by interlinked socio-cultural, economic, and systemic barriers. Strengthening postpartum counselling, addressing gender dynamics, and reducing financial obstacles are critical for improving LARC uptake and advancing reproductive health equity in similar settings.