Patterns and trends of postpartum family planning in Ethiopia, Malawi, and Nigeria: evidence of missed opportunities for integration

Abstract

BackgroundThe first 12 months following childbirth are a period when a subsequent pregnancy holds the greatest risk for mother and baby, but also when there are numerous contacts with the healthcare system for postnatal care for mother and baby (immunisation, nutrition, etc.). The benefits and importance of postpartum family planning are well documented. They include a reduction in risk of miscarriage, as well as mitigation of (or protection against) low birth weight, neonatal and maternal death, preterm birth, and anaemia.ObjectivesThe objectives of this paper are to assess patterns and trends in the use of postpartum family planning at the country level, to determine whether postpartum family planning is associated with birth interval and parity, and to identify the health services most closely associated with postpartum family planning after adjusting for socio-economic characteristics.DesignData were used from Demographic and Health Surveys that contain a reproductive calendar, carried out within the last 10 years, from Ethiopia, Malawi, and Nigeria. All women for whom the calendar was completed and who gave birth between 57 and 60 months prior to data collection were included in the analysis. For each of the births, we merged the reproductive calendar with the birth record into a survey for each country reflecting the previous 60 months. The definition of the postpartum period in this paper is based on a period of 3 months postpartum. We used this definition to assess early adoption of postpartum family planning. We assessed variations in postpartum family planning according to demographic and socio-economic variables, as well as its association with various contact opportunities with the health system [antenatal care (ANC), childbirth in facilities, immunisation, etc.]. We did simple descriptive analysis with tabular, graphic, and ‘equiplot’ displays and a logistic regression controlling for important background characteristics.ResultsOverall, variation in postpartum use of modern contraception was not affected over the years by age or marital status. One contrast to this is in Ethiopia, where the data show a significant increase in uptake of postpartum contraception among adolescents from 2005 to 2011. There are systematic and pervasive equity issues in the use of modern postpartum family planning by education level, place of residence, and wealth quintile, especially in Ethiopia where the gaps are very large. Disaggregation of data also point to significant sub-national variations. After adjusting for socio-economic variables, the most consistent health sector services associated with modern postpartum contraception are institutional childbirth and child immunisation. ANC is less likely to be associated with the use of modern postpartum family planning.ConclusionPostpartum use of modern family planning has remained very low over the years, including for childbearing adolescents. Our results indicate that improving postpartum family planning requires policies and strategies to address the inequalities caus...

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

“…[8–12, 24] Postpartum FP use in LMICs has also been associated with urban residence,[8] being married,[12] greater wealth and education,[10–12] achievement of desired family size and current fertility desire. [24] In contrast to our study, a study conducted in five LMICs found that younger postpartum women (<20 years old) were 24% more likely than women ≥30 years to have an unmet need for FP.…”

Patterns of Contraceptive Adoption, Continuation, and Switching after Delivery among Malawian Women

“…Sexually active women reporting modern contraceptive use increased from 66% at the time of the 3-month survey to 86% at the time of the 6-month survey and 91% at the 12-month survey. Demographic and Health Surveys (DHS) data from Malawi shows that approximately 14% of women are using modern methods of contraception by 3 months after delivery, though this was higher among urban women[7]. The women included in this analysis had high levels of education and were mostly from urban areas in Lilongwe district, which has been shown to have higher postpartum family planning use than most districts in Malawi[8].…”

The role of maternal health care services as predictors of time to modern contraceptive use after childbirth in Northwest Ethiopia: Application of the shared frailty survival analysis

“…Despite this, the vast majority of postpartum women in developing countries missed the opportunities at each points of contacts [8,10]. With this, postpartum women are among those with the greatest unmet need for family planning than other periods [6,10,11].…”

“…Despite this, the vast majority of postpartum women in developing countries missed the opportunities at each points of contacts [8,10]. With this, postpartum women are among those with the greatest unmet need for family planning than other periods [6,10,11]. In Ethiopia, unmet need for family planning in the postpartum period is also much higher than women outside of the extended postpartum period; while 16.2% women, in general, do have unmet need for family planning [12], the unmet need in the first year after childbirth reaches as high as 44 percent [13].…”