Postpartum contraceptive use and unmet need for family planning in five low-income countries

Omrana Pasha, Shivaprasad S Goudar, Archana Patel, Ana Garces, Fabian Esamai, Elwyn Chomba, Janet L Moore, Bhalchandra S Kodkany, Sarah Saleem, Richard J Derman, Edward A Liechty, Patricia L Hibberd, K Hambidge, Nancy F Krebs, Waldemar A Carlo, Elizabeth M McClure, Marion Koso-Thomas, Robert L Goldenberg, Omrana Pasha, Shivaprasad S Goudar, Archana Patel, Ana Garces, Fabian Esamai, Elwyn Chomba, Janet L Moore, Bhalchandra S Kodkany, Sarah Saleem, Richard J Derman, Edward A Liechty, Patricia L Hibberd, K Hambidge, Nancy F Krebs, Waldemar A Carlo, Elizabeth M McClure, Marion Koso-Thomas, Robert L Goldenberg

Abstract

Background: During the post-partum period, most women wish to delay or prevent future pregnancies. Despite this, the unmet need for family planning up to a year after delivery is higher than at any other time. This study aims to assess fertility intention, contraceptive usage and unmet need for family planning amongst women who are six weeks postpartum, as well as to identify those at greatest risk of having an unmet need for family planning during this period.

Methods: Using the NICHD Global Network for Women's and Children's Health Research's multi-site, prospective, ongoing, active surveillance system to track pregnancies and births in 100 rural geographic clusters in 5 countries (India, Pakistan, Zambia, Kenya and Guatemala), we assessed fertility intention and contraceptive usage at day 42 post-partum.

Results: We gathered data on 36,687 women in the post-partum period. Less than 5% of these women wished to have another pregnancy within the year. Despite this, rates of modern contraceptive usage varied widely and unmet need ranged from 25% to 96%. Even amongst users of modern contraceptives, the uptake of the most effective long-acting reversible contraceptives (intrauterine devices) was low. Women of age less than 20 years, parity of two or less, limited education and those who deliver at home were at highest risk for having unmet need.

Conclusions: Six weeks postpartum, almost all women wish to delay or prevent a future pregnancy. Even in sites where early contraceptive adoption is common, there is substantial unmet need for family planning. This is consistently highest amongst women below the age of 20 years. Interventions aimed at increasing the adoption of effective contraceptive methods are urgently needed in the majority of sites in order to reduce unmet need and to improve both maternal and infant outcomes, especially amongst young women.

Study registration: Clinicaltrials.gov (ID# NCT01073475).

Figures

Figure 1
Figure 1
Fertility intentions, contraceptive usage and unmet need for family planning across the Global Network sites

References

    1. Ross JA, Winfrey WL. Contraceptive accessed Use, Intention to Use and Unmet Need during the Extended Postpartum Period. International Family Planning Perspectives. 2001;27(1):20–27. doi: 10.2307/2673801.
    1. World Health Organization. [WHO] Medical eligibility criteria for contraceptive use: 2008 Update. Geneva: World Health Organization; 2008. Report no. WHO/RHR/08.19. Available at . Accessed December 21, 2014.
    1. Cleland J, Bernstein S, Ezeh A, Faundes A, Glasier A, Innis J. Family planning: the unfinished agenda. Lancet. 2006;368(9549):1810–1827. doi: 10.1016/S0140-6736(06)69480-4.
    1. Rutstein SO. Effects of preceding birth intervals on neonatal, infant and under-five years mortality and nutritional status in developing countries: evidence from the demographic and health surveys. Int J Gynaecol Obstet. 2005;89(Suppl 1):S7–S24.
    1. Zhu BP, Rolfs RT, Nangle BE, Horan JM. Effect of the interval between pregnancies on perinatal outcomes. The New England Journal of Medicine. 1999;340(8):589–594. doi: 10.1056/NEJM199902253400801.
    1. Zhu BP, Haines KM, Le T, McGrath-Miller K, Boulton ML. Effect of the interval between pregnancies on perinatal outcomes among white and black women. American Journal of Obstetrics and Gynecology. 2001;185(6):1403–1410. doi: 10.1067/mob.2001.118307.
    1. Khoshnood B, Lee KS, Wall S, Hsieh HL, Mittendorf R. Short interpregnancy intervals and the risk of adverse birth outcomes among five racial/ethnic groups in the United States. Am J Epid. 1998;148(8):798–805. doi: 10.1093/oxfordjournals.aje.a009701.
    1. Shults RA, Arndt V, Olshan AF, Martin CF, Royce RA. Effects of short interpregnancy intervals on small-for-gestational age and preterm births. Epidemiology. 1999;10(3):250–254. doi: 10.1097/00001648-199905000-00010.
    1. Fuentes-Afflick E, Hessol NA. Interpregnancy interval and the risk of premature infants. Obstetrics and Gynecology. 2000;95(3):383–390. doi: 10.1016/S0029-7844(99)00583-9.
    1. DeFranco EA, Stamilio DM, Boslaugh SE, Gross GA, Muglia LJ. A short interpregnancy interval is a risk factor for preterm birth and its recurrence. Am J Obstet Gynecol. 2007;197(3):264.e1–264.e6. doi: 10.1016/j.ajog.2007.06.042.
    1. Shults RA, Arndt V, Olshan AF, Martin CF, Royce RA. Effects of short interpregnancy intervals on small-for-gestational age and preterm births. Epidemiology. 1999;10(3):250–254. doi: 10.1097/00001648-199905000-00010.
    1. Smith GC, Pell JP, Dobbie R. Interpregnancy interval and risk of preterm birth and neonatal death: retrospective cohort study. BMJ (British Medical Journal) 2003;327(7410):313. doi: 10.1136/bmj.327.7410.313.
    1. Klerman LV, Cliver S, Goldenberg RL. The impact of short interpregnancy intervals on pregnancy outcomes in a low-income population. American Journal of Public Health. 1998;88(8):1182–1185. doi: 10.2105/AJPH.88.8.1182.
    1. Kallan JE. Reexamination of interpregnancy intervals and subsequent birth outcomes: evidence from U.S. linked birth/infant death records. Social Biology. 1997;44(3-4):205–212.
    1. Conde-Agudelo A, Belizán JM, Breman R, Brockman SC, Rosas-Bermudez A. Effect of the interpregnancy interval after an abortion on maternal and perinatal health in Latin America. Int Journal Obstet Gynec. 2005;89(Suppl 1):S34–S40.
    1. Conde-Agudelo A, Rosas-Bermúdez A, Kafury-Goeta AC. Birth spacing and risk of adverse perinatal outcomes: a meta-analysis. JAMA. 2006;295(15):1809–1823. doi: 10.1001/jama.295.15.1809.
    1. Khoshnood B, Lee KS, Wall S, Hsieh HL, Mittendorf R. Short interpregnancy intervals and the risk of adverse birth outcomes among five racial/ethnic groups in the United States. Am J Epidemiol. 1998;148(8):798–805. doi: 10.1093/oxfordjournals.aje.a009701.
    1. Galway KB, Wolf B, Sturgis R. Child survival: risks and the road to health, Westinghouse Institute for Resourec Development, Columbia (MD) 1987.
    1. World Health Organization (WHO). Statement for collective action for postpartum family planning. Geneva: WHO; 2012. Available from: (accessed May 30, 2014)
    1. Gaffield ME, Egan S, Temmerman M. It's about time: WHO and partners release programming strategies for postpartum family planning. Glob Health Sci Pract. 2014;2(1):4–9. doi: 10.9745/GHSP-D-13-00156.
    1. Piaggio G, Ba'aqeel H, Bergsjo P, Carroli G, Farnot U, Lumbiganon P. et al.The practice of antenatal care: comparing four study sites in different parts of the world participating in the WHO Antenatal Care Randomised Controlled Trial. Paediatr Perinat Epidemiol. 1998;12(Suppl 2):116–141.
    1. Vernon R. Meeting the family planning needs of postpartum women. Stud Fam Plann. 2009;40(3):235–245. doi: 10.1111/j.1728-4465.2009.00206.x.
    1. RamaRao S, Lacuesta M, Costello M, Pangolibay B, Jones H. The link between quality of care and contraceptive use. Int Fam Plan Perspect. 2003;29(2):76–83. doi: 10.2307/3181061.
    1. Borda M, Winfrey W. Postpartum fertility and contraception: an analysis of findings from 17 countries. Baltimore, MD: Jhpiego; 2010. Available from: (accessed May 30, 2014)
    1. Gebreselassie, Tesfayi, Shea O. DHS Analytical Studies No. 14. Calverton, Maryland, USA: Macro International Inc; Rutstein, and Vinod Mishra. 2008. Contraceptive Use, Breastfeeding, Amenorrhea and Abstinence During the Postpartum Period: An Analysis of Four Countries.
    1. Islam MM, Al-Mamun A, Bairagi R. Fertility and its proximate determinants in Bangladesh: Evidence from 1993/94 Demographic and Health Survey. Asia Pac Popul J. 1998;13(3):3–22.
    1. Khan MA. Side effects and oral contraceptive discontinuation in rural Bangladesh. Contraception. 2001;64(3):161–167. doi: 10.1016/S0010-7824(01)00238-4.
    1. Ali M, Cleland J. Determinants of contraceptive discontinuation in six developing countries. J Biosocial Sci. 1999;31(3):343–360. doi: 10.1017/S0021932099003430.
    1. Winner B, Peipert JF, Zhao Q, Buckel C, Madden T, Allsworth JE, Secura GM. Effectiveness of long-acting reversible contraception. N Engl J Med. 2012;366(21):1998–2007. doi: 10.1056/NEJMoa1110855.
    1. Jackson E, Glasier A. Return of ovulation and menses in postpartum nonlactating women: a systematic review. Obstet Gynecol. 2011;117(3):657–662. doi: 10.1097/AOG.0b013e31820ce18c.
    1. Gross BA, Burger H. WHO Task Force on methods for the natural regulation of fertility. WHO Task Force on methods for the natural regulation of fertility. Breastfeeding patterns and return to fertility in Australian women. Aust N Z J Obstet Gynaecol. 2002;42(2):148–154. doi: 10.1111/j.0004-8666.2002.00148.x.
    1. Bouchard T, Fehring RJ, Schneider M. Efficacy of a new postpartum transition protocol for avoiding pregnancy. J Am Board Fam Med. 2013;26(1):35–44. doi: 10.3122/jabfm.2013.01.120126.
    1. Goudar SS, Carlo WA, McClure EM, Pasha O, Patel A, Esamai F. et al.The Maternal and Newborn Health Registry Study of the Global Network for Women's and Children's Health Research. Int J Gynaecol Obstet. 2012;118(3):190–193. doi: 10.1016/j.ijgo.2012.04.022.
    1. Withers MH, Tavrow P, Adinata NA. Do ambivalent women have an unmet need for family planning? A longitudinal study from Bali, Indonesia. Womens Health Issues. 2011;21(6):444–449. doi: 10.1016/j.whi.2011.04.031.
    1. Mayor S. Pregnancy and childbirth are leading causes of death in teenage girls in developing countries. BMJ. 2004;328(7449):1152.
    1. Grimes DA, Lopez LM, Schulz KF, Van Vliet HA, Stanwood NL. Immediate post-partum insertion of intrauterine devices. Cochrane Database Syst Rev. 2010. p. CD003036.
    1. Pakistan Demographic and Health Survey 2012-13. Islamabad, Pakistan, and Calverton, Maryland, USA: NIPS and ICF International; 2013. National Institute of Population Studies (NIPS) [Pakistan] and ICF International. Available from: (accessed May 30, 2014)
    1. Fabic MS, Choi Y. Assessing the quality of data regarding use of the lactational amenorrhea method. Stud Fam Plann. 2013;44(2):205–221. doi: 10.1111/j.1728-4465.2013.00353.x.

Source: PubMed

Sponsoren und Mitarbeiter

Krankheiten

Drogeninterventionen

3
Abonnieren