Abstract
BackgroundShort birth intervals increase risk for adverse maternal and infant outcomes including preterm birth, low birth weight (LBW), and infant mortality. Although postpartum family planning (PPFP) is an increasingly high priority for many countries, uptake and need for PPFP varies in low- and middle-income countries (LMIC). We performed a systematic review and meta-analysis to characterize postpartum contraceptive use, and predictors and barriers to use, among postpartum women in LMIC.MethodsPubMed, EMBASE, CINAHL, PsycINFO, Scopus, Web of Science, and Global Health databases were searched for articles and abstracts published between January 1997 and May 2018. Studies with data on contraceptive uptake through 12 months postpartum in low- and middle-income countries were included. We used random-effects models to compute pooled estimates and confidence intervals of modern contraceptive prevalence rates (mCPR), fertility intentions (birth spacing and birth limiting), and unmet need for contraception in the postpartum period.ResultsAmong 669 studies identified, 90 were selected for full-text review, and 35 met inclusion criteria. The majority of studies were from East Africa, West Africa, and South Asia/South East Asia. The overall pooled mCPR during the postpartum period across all regions was 41.2% (95% CI: 15.7–69.1%), with lower pooled mCPR in West Africa (36.3%; 95% CI: 27.0–45.5%). The pooled prevalence of unmet need was 48.5% (95% CI: 19.1–78.0%) across all regions, and highest in South Asia/South East Asia (59.4, 95% CI: 53.4–65.4%). Perceptions of low pregnancy risk due to breastfeeding and postpartum amenorrhea were commonly associated with lack of contraceptive use and use of male condoms, withdrawal, and abstinence. Women who were not using contraception were also less likely to utilize maternal and child health (MCH) services and reside in urban settings, and be more likely to have a fear of method side effects and receive inadequate FP counseling. In contrast, women who received FP counseling in antenatal and/or postnatal care were more likely to use PPFP.ConclusionsPPFP use is low and unmet need for contraception following pregnancy in LMIC is high. Tailored counseling approaches may help overcome misconceptions and meet heterogeneous needs for PPFP.
Highlights
Short birth intervals increase risk for adverse maternal and infant outcomes including preterm birth, low birth weight (LBW), and infant mortality
Starting contraception after delivery is important to prevent unintended pregnancies and short birth intervals, which are related to adverse health outcomes for the mother and child
15 low- and middle-income countries (LMIC) were included, representing a total of 74,001 postpartum women; the majority (n = 23) of studies were conducted in subSaharan Africa (8 in West Africa and 15 in East Africa), 7 in South Asia/South East Asia, 1 in Middle East/North Africa, and 4 in multiple regions
Summary
Short birth intervals increase risk for adverse maternal and infant outcomes including preterm birth, low birth weight (LBW), and infant mortality. Short birth intervals increase risks of adverse maternal and infant outcomes, such as low-birth weight and infant mortality [1, 2]. The majority (91%) of postpartum women in low- and middle-income countries (LMIC) report a desire to prevent pregnancy for at least a year following a birth [8]; yet, use of family planning (FP) methods reported previously is low [9,10,11] and risk of unintended pregnancy is high in the postpartum period [12,13,14]. Even among women who use modern FP methods, use of highly effective, long-acting reversible contraception (LARC), including intra-uterine devices (IUDs) and implants, is low (< 15%) [15, 16]
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