# Spatial Distribution and Determinants of Early Resumption of Postpartum Sexual Intercourse among Postpartum Women in Ethiopia: A Multilevel Analysis

## TL;DR

This study explores when postpartum women in Ethiopia resume sexual activity and identifies factors and regions where this happens earlier.

## Contribution

The study reveals non-random spatial patterns and significant predictors of early postpartum sexual resumption in Ethiopia.

## Key findings

- Early resumption of postpartum sexual intercourse was not randomly distributed spatially.
- Factors like not being married, child's sex, religion, breastfeeding, and multiparity were significantly associated with early resumption.

## Abstract

Postpartum sexual health and practice need to be integrated into the current maternal healthcare services to address sexual health problems. However, postpartum sexual practice has received little attention and is not often discussed by healthcare providers during prenatal and postnatal care, even though evidence is scarce on the spatial distribution of early resumption of postpartum sexual intercourse in Ethiopia.

The current study aimed to demonstrate the median time to resumption of postpartum sexual intercourse and the spatial distribution of early resumption of postpartum sexual intercourse in Ethiopia.

A cross-sectional study was employed based on the Ethiopian demographic and health survey 2016 data, and 6456 postpartum period women were included. Arc GIS version 10.7 and SaTScan version 9.6 software were used. Mixed-effect analysis was done by STATA version 14 software. Bivariate analysis was done, and variables with a p value < 0.2 were taken as candidates for multilevel multivariable logistic regression. Intra Class Correlation Coefficient (ICC), Proportion Change in Variance (PCV), and Median Odds Ratio (MOR) were used for model comparison, and Adjusted Odds Ratio (AOR) with respect to a 95% confidence interval was used for declaring statistical significance. In the multivariable analysis, a p value ≤ 0.05 was considered as a cut point of statistical significance with the outcome variable.

The spatial distribution of early resumption of postpartum sexual intercourse was not random. Not married (Adjusted Odds Ratio (AOR = 0.31; 95% CI 0.25, 0.39), sex of child female (AOR = 0.87; 95% CI 0.81,0.93), protestant in religion (AOR = 0.68; 95% CI 0.58, 0.79), ever breastfeeding (AOR = 1.35; 95% CI 1.12, 1.63), and multiparity (AOR = 1.16; 95%, 1.03, 1.30) were variables significantly associated with early resumption of postpartum sexual intercourse.

The spatial distribution of early resumption of postpartum sexual intercourse was not random. We need to give attention to those hotspot areas and factors significantly associated with early resumption of postpartum sexual intercourse. Reproductive and maternal health program managers and policymakers need to pay attention to those hotspot areas and significant variables to achieve the Sustainable Development Goal.