Interventions to Improve Postpartum Family Planning in Low‐ and Middle‐Income Countries: Program Implications and Research Priorities

Abstract

This article provides programmatic guidance and identifies future research priorities through a review of interventions to improve postpartum contraception. Thirty-five interventions in low- and middle-income countries were identified and classified according to timing and nature of administration: antenatal, postnatal, both ante- and postnatal, and integration with other services. With the exception of single, short antenatal interventions, the evidence of impact is positive but incomplete. A major gap in knowledge concerns demand for, and means of promoting, immediate postpartum family planning services in Asia and Africa. Counseling before discharge is likely to have an impact on subsequent contraceptive uptake. Integration of family planning into immunization and pediatric services is justified, but policy and program obstacles remain. A case for relaxing the strict conditions of the lactational amenorrhea method (LAM) is strong, but qualitative evidence on the perspectives of women on pregnancy risks is required. Despite the gaps in knowledge, the evidence provides useful guidance for strategies to promote postpartum family planning, in ways that take different contexts into account.

HIV status, fertility intentions, and contraception in the era of expanded access to antiretroviral therapy: A case study of rural Mozambique

“…Besides, the benefits of antenatal and early postnatal contraceptive advice for postpartum contraceptive uptake are still debated (e.g., Engin-Üstün et al, 2007; Glazer, Wolf, & Gorby, 2011; Smith, van de Spuy, Cheng, Elton, & Glasier, 2002). Yet postpartum contraception has considerable potential in preventing unwanted or mistimed early repeat pregnancies, especially in a context of rapidly eroding traditional post-partum practices (Cleland, Shah, & Daniele, 2015). Moreover, prenatal and perinatal periods, when many women are typically in frequent contact with health providers, offer ideal opportunities for effective family planning counselling (e.g., Rossier & Hellen, 2014).…”

Uptake and correlates of contraception among postpartum women in Kenya: results from a national cross-sectional survey

“…[21] Women in LMICs may be more receptive to FP discussions following delivery when there is a current or perceived future need for FP than during ANC. [20, 22] In our study, more than half of women reported never discussing FP within a healthcare setting, despite routinely attending ANC and PNC visits. Current Kenyan national guidelines include providing FP counseling throughout the continuum of care in ANC, intrapartum, and at each PNC visit; and as integrated service provision within HIV care.…”

“…A recent review of interventions to improve postpartum contraception found that interventions delivered after, rather than before, delivery are generally more successful but results are mixed. [20] Similarly, another observational study found no association between FP counseling in ANC and postpartum FP uptake. [21] Women in LMICs may be more receptive to FP discussions following delivery when there is a current or perceived future need for FP than during ANC.…”

Inequality in total fertility rates and the proximate determinants of fertility in 21 sub-Saharan African countries

“…While some previous research does emphasize the role of postpartum infecundability in fertility regulation in poor resource settings [26, 27], policies that deemphasize postpartum infecundability (including breastfeeding and lactation amenorrhea) in turn deemphasize important fertility regulation methods that the poorest are already trying to use. Efforts should be made to capitalize on these existing trends by the poorest quintile to foster breastfeeding programs that already work well.…”