Programmatic aspects of postpartum family planning in developing countries: A qualitative analysis of key informant interviews in Kenya and Ethiopia

Department of Obstetrics and Gynecology, Boston Boston University Medical Center, 850 Harrison Ave., Boston, MA 02118, USA.
African Journal of Reproductive Health 09/2013; 17(3):54-6.
Source: PubMed


To achieve the improved maternal and child outcomes of birth spacing, family planning in the postpartum period is essential. The objective of this study is to determine the perceptions regarding programmatic aspects of postpartum family planning by key informants in 17 countries determined to have high unmet need for postpartum family planning. We present interim data from structured interviews of key informants in Kenya and Ethiopia. Important themes included the need for documentation of contraceptive use to aid in commodity assessment and delivery, need for additional informational materials, and challenges of delivering services to those women who deliver away from a health care facility.

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    • "In addition, frequently voiced criticism, mainly by men, was related to how FP services primarily target women while husbands and partners often feel excluded or their initiatives unappreciated [19, 35, 40]. Taken together, service providers' incompetence, occasional stock outs of contraceptives, and the inadequacy of a client's preferred FP method were brought up as common reasons for unmet need for FP [39, 41, 50]. "
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    ABSTRACT: Poor access and low contraceptive prevalence are common to many Low- and Middle-Income Countries (LMICs). Unmet need for family planning (FP), defined as the proportion of women wishing to limit or postpone child birth, but not using contraception, has been central to reproductive health efforts for decades and still remains relevant for most policy makers and FP programs in LMICs. There is still a lag in contraceptive uptake across regions resulting in high unmet need due to various socioeconomic and cultural factors. In this mixed method scoping review we analyzed quantitative, qualitative and mixed method studies to summarize those factors influencing unmet need among women in LMICs. We conducted our scoping review by employing mixed method approach. We included studies applying quantitative and qualitative methods retrieved from online data bases (PubMed, JSTOR, and Google Scholar). We also reviewed the indexes of journals specific to the field of reproductive health by using a set of keywords related to unmet contraception need, and non-contraception use in LMICs. We retrieved 283 articles and retained 34 articles meeting our inclusion criteria. Of these, 26 were quantitative studies and 8 qualitative studies. We found unmet need for FP to range between 20 % and 58 % in most studies. Woman’s age was negatively associated with total unmet need for FP, meaning as women get older the unmet need for FP decreases. The number of children was found to be a positively associated determinant for a woman’s total unmet need. Also, woman’s level of education was negatively associated – as a woman’s education improves, her total unmet need decreases. Frequently reported reasons for non-contraception use were opposition from husband or husbands fear of infidelity, as well as woman’s fear of side effects or other health concerns related to contraceptive methods. Factors associated with unmet need for FP and non-contraception use were common across different LMIC settings. This suggests that women in LMICs face similar barriers to FP and that it is still necessary for reproductive health programs to identify FP interventions that more specifically tackle unmet need.
    Full-text · Article · Jan 2016 · BMC Women's Health
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    ABSTRACT: The postpartum period is a critical time to address high unmet family planning need and to reduce the risks of closely spaced pregnancies. Practical tools are included in the new resource for integrating postpartum family planning at points when women have frequent health system contact, including during antenatal care, labor and delivery, postnatal care, immunization, and child health care.
    Full-text · Article · Feb 2014 · Global Health: Science and Practice
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    ABSTRACT: Globally, most postpartum pregnancies are unplanned, mainly as a result of low level of knowledge and fear of contraceptive use especially in low-income settings. The aim of this study was to evaluate the effect of prenatal contraceptive counselling on postpartum contraceptive use and pregnancy outcomes after one year. Sixteen health centres were equally and randomly allocated to control and intervention arms. Mothers were consecutively recruited during their first antenatal clinic consultations. In the intervention arm Village Health Team members made home visits and provided prenatal contraceptive advice and made telephone consultations with health workers for advice while in the control arm mothers received routine antenatal care offered in the health centres. Data were collected in 2014 in the two districts of Kiryandongo and Masindi. This data was collected 12-14 months postpartum. Mothers were asked about their family planning intentions, contraceptive use and screened for pregnancy using human Chorionic Gonadotropin (hCG) levels. Socio-demographic and obstetric indices were recorded. Our primary outcomes of interests were current use of modern contraceptive, decision to use a modern contraceptive method and pregnancy status. Multilevel analysis using the xtmelogit stata command was used to determine differences between intervention and control groups. A total of 1,385 women, 748 (control) and 627 (intervention) were recruited. About 80% initiated breastfeeding within six hours of delivery 78.4% (control) and 80.4% (intervention). About half of the mothers in each arm had considered to delay the next pregnancy 47.1% (control) and 49% (intervention). Of these 71.4% in the control and 87% in the intervention had considered to use a modern contraceptive method, only 28.2% of the control and 31.6% in the intervention were current modern contraceptive users signifying unmet contraceptive needs among immediate postpartum mothers. Regarding pregnancy, 3.3% and 5.7% of the women were found to be pregnant in the control and intervention arms respectively. There were no statistical differences between the control and intervention arms for all primary outcomes of interests. Prenatal contraceptive counseling did not affect postpartum contraceptive use among immediate postpartum mothers in Masindi and Kiryandongo districts. Interventions aiming at improving postpartum contraceptive use should focus on addressing unmet contraceptive needs.
    Full-text · Article · Sep 2015 · Pan African Medical Journal
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