Uptake of contraception during postpartum amenorrhoea: Understandings and preferences of poor, urban women in Bangladesh

Salway, Sarah; Nurani, Sufia

doi:10.1016/s0277-9536(98)00154-3

Cited by 19 publications

(13 citation statements)

References 25 publications

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“…Regardless of menstrual status, women 0-5 months postpartum who are exclusively breastfeeding are unlikely to have ovulatory cycles; for these women, ovulation returns later in the first year or once other foods are introduced [16]. Research has shown that postpartum women misunderstand the return to fecundity [18,[26][27][28]. This is true even among self-reported LAM users: a recent analysis of DHS data showed that many did not adhere to all three criteria for LAM effectiveness at the time of the survey [29].…”

Section: Discussionmentioning

confidence: 99%

Missed opportunities for family planning: an analysis of pregnancy risk and contraceptive method use among postpartum women in 21 low- and middle-income countries

et al. 2015

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Objectives: To analyze data from recent Demographic and Health Surveys (DHS) conducted in 21 low-and middle-income countries (LMICs) to examine patterns of interpregnancy intervals, unmet need, pregnancy risk and family planning method use and method mix among women 0-23 months postpartum. Study design: Secondary analysis of postpartum women aged 15-49 years in 22 DHS surveys from 21 LMICs conducted between 2005 and 2012. We applied an adapted unmet need definition for postpartum women to look at prospective fertility preferences. We also constructed a new composite pregnancy risk indicator for postpartum women who have been sexually active since their last birth. Results: In 9 of 22 surveys, 50% or more of nonfirst births occur at interpregnancy intervals that are too short. Overall prospective unmet need for family planning by postpartum women has not changed demonstrably since a 2001 analysis and is universally high: 61% of all postpartum women across the 21 countries have an unmet need for family planning. In 10 of 22 surveys, pregnancy risk rises steadily throughout the 2 years after birth. In the remaining 12 surveys, the risk of pregnancy peaks at 6-11 months after birth. Even when postpartum women are using family planning, they rely overwhelmingly on short-acting methods (51-96% in 21 of 22 surveys). Conclusion: Our approach of estimating pregnancy risk by postpartum timing confirms a high probability for pregnancies to be less than optimally spaced within 2 years of a prior birth and suggests that special consideration is needed to effectively reach this population with the right messages and services. Implications: Using recent, multicountry data for women within 2 years postpartum in LMICs, this paper updates existing estimates of high prospective unmet need for family planning and presents a new composite pregnancy risk analysis based on postpartum women's actual practices to demonstrate the magnitude of missed opportunities for programmatic intervention for the postpartum population.

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Section: Discussionmentioning

confidence: 99%

Missed opportunities for family planning: an analysis of pregnancy risk and contraceptive method use among postpartum women in 21 low- and middle-income countries

et al. 2015

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“…One of the most compelling enquiries concerns the views of women in Matlab district and the slums of Dhaka, Bangladesh, in the 1990s. 25,26 These women considered the postpartum phase to be one of extreme vulnerability for the mother FIGURE 1. Differences in absolute percentage points in modern method use between breast-feeding and non-breast-feeding women at 0-11 months postpartum who had resumed sex and menstruation, by region and country…”

Section: Estimating Unmet Need For Contraception Among Postpartum Womenmentioning

confidence: 99%

A Fresh Look at the Level of Unmet Need for Family Planning in the Postpartum Period, Its Causes and Program Implications

Cleland¹,

Shah²,

Beňová³

2015

IPSRH

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One central rationale for the promotion of family planning is the potential benefit to the health of mothers and children. The achievement of adequate spacing between pregnancies is a major pathway through which contraceptive practice can render benefits. Pregnancies conceived less than 20 months following a prior birth are at considerably higher risk of prematurity, low birth weight, fetal death and early neonatal death. 1 The importance of this link is underscored by the facts that neonatal deaths account for 44% of all childhood deaths and that prematurity is the most common cause. 2 In addition to the 2.9 million neonatal deaths that occur each year, 99% in low-and middleincome countries, an almost equal number of stillbirths occur. 3 An analysis of Demographic and Health Survey (DHS) data from 52 countries showed that the adverse effects of inadequate spacing extend beyond the neonatal period. 4 Expressed in terms of interbirth intervals, children born within 24 months of an elder sibling have a 60% increased risk of dying before their first birthday and those born 2-3 years after an elder sibling have a 10% increased risk, compared with those born after an interval of 3-5 years. For children between the ages of one and five years, the balance of evidence suggests that intervals of less than two years are associated with a 40% increased risk of dying. A systematic review confirmed that the health of mothers is also affected by inadequate spacing. 5 Specifically, short intervals are associated with uterine rupture and uteroplacental bleeding disorders. Despite the steep rise in contraceptive use in developing countries, interbirth intervals have increased in length only slightly over the past 25 years; according to recent surveys, 25% of second and higher-order children are born within two years of a sibling, compared with about 29% a decade earlier. 6Though this evidence underlines the importance of postpartum family planning for the health of both mothers and children, the topic suffered a prolonged era of benign neglect that has only recently been remedied. In 2013, the World Health Organization issued new guidelines for this component of contraceptive services and the U.S. Agency for International Development is funding projects to provide postpartum services. 7,8 One factor that helped to revitalize this agenda was a study of women in 27 countries by Ross and Winfrey in which the proportion who wanted to postpone another child for at least two years but were using no method of contraception was, on average, at the very high level of 65% in the first year following childbirth. 9 Indeed, their analysis suggested that 39% of all unmet need for contraception arose from women who had given birth in the previous 12 months. For decades, the concept of unmet need has been the main way of prioritizing populations for delivery of family planning services, and thus Ross and Winfrey's article had a major impact. However, their findings are perplexing because it is well established that most couples wish to space su...

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“…3 In a study conducted on 272 postpartum women attending a private medical college in Lucknow, a city in Uttar Pradesh, India, 28% women were sexually active within 6 weeks postpartum and only 54.4% used contraception the most common being condoms. 4 In a study done in Bangladesh 5 that examined the understanding and preferences of postpartum contraception, the authors found that women perceive that modern methods of contraception are "strong" and potentially damaging to their own and their new-born's health and majority of women are reluctant to adopt family planning methods soon after birth, particularly during postpartum amenorrhoea. Thus the reasons for poor rates of spacing methods of contraception need to be urgently explored.…”

Section: Introductionmentioning

confidence: 99%

Knowledge and attitude towards contraceptive methods for spacing and decision making factors regarding its use in postpartum women

Sharma

Dorairajan

Chinnakali

2015

Int J Reprod Contracept Obstet Gynecol

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INTRODUCTIONThe family planning program in our country has been in place for more than four decades. The permanent methods and limiting the family size has been successful but contraception for spacing is lagging behind. Utilization of spacing method of contraception varied from 13.8% in a study done in north India 1 to 26% in a study on more than 1 lakh women across 28 districts. 2Regardless of the education 75% of women were found to be sexually active by 3 months after delivery.3 In a study conducted on 272 postpartum women attending a private medical college in Lucknow, a city in Uttar Pradesh, India, 28% women were sexually active within 6 weeks postpartum and only 54.4% used contraception the most common being condoms. ABSTRACTBackground: Though the permanent methods have been successful in our country the spacing methods lag behind and unwanted unplanned pregnancies continue to be high. This study was undertaken to explore the knowledge level, attitude and the factors influencing the potential use of spacing contraception among recently delivered women. Methods: This cross sectional study was carried out in a teaching institution using a structured questionnaire among recently delivered women willing to participate in the study. Results: Among the 404 women studied 74% were primipara. The level of awareness about spacing contraception was 70% though only 30% knew the correct use. The most frequent source of information was social circle and friends. Two thirds of women felt the need for spacing but 65.8% were not willing to adopt any modern method for fear of side effects and want of husband approval. Bivariate analysis showed that prenatal counselling (X 2 =41.33 P<0.001) and higher education (X

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Uptake of contraception during postpartum amenorrhoea: Understandings and preferences of poor, urban women in Bangladesh

Cited by 19 publications

References 25 publications

Missed opportunities for family planning: an analysis of pregnancy risk and contraceptive method use among postpartum women in 21 low- and middle-income countries

Missed opportunities for family planning: an analysis of pregnancy risk and contraceptive method use among postpartum women in 21 low- and middle-income countries

A Fresh Look at the Level of Unmet Need for Family Planning in the Postpartum Period, Its Causes and Program Implications

Knowledge and attitude towards contraceptive methods for spacing and decision making factors regarding its use in postpartum women

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