Reassessing Unmet Need for Family Planning in the Postpartum Period

Rossier, Clémentine; Bradley, Sarah; Ross, John A.; Winfrey, William

doi:10.1111/j.1728-4465.2015.00037.x

Cited by 77 publications

(96 citation statements)

References 11 publications

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“…Yet the opportunity is often missed. Data from 57 low‐ and middle‐income countries demonstrated that 62% of women giving birth in the preceding year did not initiate contraception immediately postpartum . Even in high‐income countries, provision of effective contraception after delivery is often sub‐optimal.…”

Section: Introductionmentioning

confidence: 99%

Contraception after pregnancy

Glasier

Bhattacharya

Evers

et al. 2019

Acta Obstet Gynecol Scand

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Whatever the outcome, pregnancy provides the opportunity to offer effective contraception to couples motivated to avoid another pregnancy. This narrative review summarizes the evidence for health providers, drawing attention to current guidelines on which contraceptive methods can be used, and when they should be started after pregnancy, whatever its outcome. Fertility returns within 1 month of the end of pregnancy unless breastfeeding occurs. Breastfeeding, which itself suppresses fertility after childbirth, influences both when contraception should start and what methods can be used. Without breastfeeding, effective contraception should be started as soon as possible if another pregnancy is to be avoided. Interpregnancy intervals of at least 6 months after miscarriage and 1‐2 years after childbirth have long been recommended by the World Health Organization in order to reduce the chance of adverse pregnancy outcome. Recent research suggests that this may not be necessary, at least for healthy women <35 years old. Most contraceptive methods can be used after pregnancy regardless of the outcome. Because of an increased risk of venous thromboembolism associated with estrogen‐containing contraceptives, initiation of these methods should be delayed until 6 weeks after childbirth. More research is required to settle the questions over the use of combined hormonal contraception during breastfeeding, the use of injectable progestin‐only contraceptives before 6 weeks after childbirth, and the use of both hormonal and intrauterine contraception after gestational trophoblastic disease. The potential impact on the risk of ectopic pregnancy of certain contraceptive methods often confuses healthcare providers. The challenges involved in providing effective, seamless service provision of contraception after pregnancy are numerous, even in industrialized countries. Nevertheless, the clear benefits demonstrate that it is worth the effort.

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Section: Introductionmentioning

confidence: 99%

Contraception after pregnancy

Glasier

Bhattacharya

Evers

et al. 2019

Acta Obstet Gynecol Scand

View full text Add to dashboard Cite

show abstract

“…During the year following the birth of a child, 40% of women are estimated to have an unmet need for contraception [2]. Fewer than 50% of women in 30 of the 43 countries with recent Demographic and Health Surveys (DHS) used any method of contraception during 9-11 months postpartum, and in 12 of these countries the use was below 20% [3].…”

Section: Introductionmentioning

confidence: 99%

Institutionalizing postpartum intrauterine device (IUD) services in Sri Lanka, Tanzania, and Nepal: study protocol for a cluster-randomized stepped-wedge trial

Canning

Shah

Pearson

et al. 2016

BMC Pregnancy Childbirth

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BackgroundDuring the year following the birth of a child, 40% of women are estimated to have an unmet need for contraception. The copper IUD provides safe, effective, convenient, and long-term contraceptive protection that does not interfere with breastfeeding during the postpartum period. Postpartum IUD (PPIUD) insertion should be performed by a trained provider in the early postpartum period to reduce expulsion rates and complications, but these services are not widely available. The International Federation of Obstetricians and Gynecologists (FIGO) will implement an intervention that aims to institutionalize PPIUD training as a regular part of the OB/GYN training program and to integrate it as part of the standard practice at the time of delivery in intervention hospitals.MethodsThis trial uses a cluster-randomized stepped wedge design to assess the causal effect of the FIGO intervention on the uptake and continued use of PPIUD and of the effect on subsequent pregnancy and birth. This trial also seeks to measure institutionalization of PPIUD services in study hospitals and diffusion of these services to other providers and health facilities. This study will also include a nested mixed-methods performance evaluation to describe intervention implementation.DiscussionThis study will provide critical evidence on the causal effects of hospital-based PPIUD provision on contraceptive choices and reproductive health outcomes, as well as on the feasibility, acceptability and longer run institutional impacts in three low- and middle-income countries.Trial registrationTrial registered on March 11, 2016 with ClinicalTrials.gov, NCT02718222.Electronic supplementary materialThe online version of this article (doi:10.1186/s12884-016-1160-0) contains supplementary material, which is available to authorized users.

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“… De facto LAM use (women protected by LAM but not declaring it as a method) could be integrated into the present analysis as another traditional method as many women give breastfeeding or amenorrhea as reasons for not using modern contraception in sub‐Saharan Africa (Sedgh and Hussein ), but these women also overwhelmingly abstain postpartum (Rossier et al. ), and thus are mostly already accounted for.…”

mentioning

confidence: 99%