A systematic review and meta-analysis of postpartum contraceptive use among women in low- and middle-income countries
Abstract Background Short birth intervals increase risk for adverse maternal and infant outcomes including preterm birth, low birth weight (LBW), and infant mortality. Although postpartum family planning (PPFP) is an increasingly high priority for many countries, uptake and need for PPFP varies in l...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2019-10-01
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| Series: | Reproductive Health |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12978-019-0824-4 |
| _version_ | 1818972632439062528 |
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| author | Rubee Dev Pamela Kohler Molly Feder Jennifer A. Unger Nancy F. Woods Alison L. Drake |
| author_facet | Rubee Dev Pamela Kohler Molly Feder Jennifer A. Unger Nancy F. Woods Alison L. Drake |
| author_sort | Rubee Dev |
| collection | DOAJ |
| description | Abstract Background Short birth intervals increase risk for adverse maternal and infant outcomes including preterm birth, low birth weight (LBW), and infant mortality. Although postpartum family planning (PPFP) is an increasingly high priority for many countries, uptake and need for PPFP varies in low- and middle-income countries (LMIC). We performed a systematic review and meta-analysis to characterize postpartum contraceptive use, and predictors and barriers to use, among postpartum women in LMIC. Methods PubMed, EMBASE, CINAHL, PsycINFO, Scopus, Web of Science, and Global Health databases were searched for articles and abstracts published between January 1997 and May 2018. Studies with data on contraceptive uptake through 12 months postpartum in low- and middle-income countries were included. We used random-effects models to compute pooled estimates and confidence intervals of modern contraceptive prevalence rates (mCPR), fertility intentions (birth spacing and birth limiting), and unmet need for contraception in the postpartum period. Results Among 669 studies identified, 90 were selected for full-text review, and 35 met inclusion criteria. The majority of studies were from East Africa, West Africa, and South Asia/South East Asia. The overall pooled mCPR during the postpartum period across all regions was 41.2% (95% CI: 15.7–69.1%), with lower pooled mCPR in West Africa (36.3%; 95% CI: 27.0–45.5%). The pooled prevalence of unmet need was 48.5% (95% CI: 19.1–78.0%) across all regions, and highest in South Asia/South East Asia (59.4, 95% CI: 53.4–65.4%). Perceptions of low pregnancy risk due to breastfeeding and postpartum amenorrhea were commonly associated with lack of contraceptive use and use of male condoms, withdrawal, and abstinence. Women who were not using contraception were also less likely to utilize maternal and child health (MCH) services and reside in urban settings, and be more likely to have a fear of method side effects and receive inadequate FP counseling. In contrast, women who received FP counseling in antenatal and/or postnatal care were more likely to use PPFP. Conclusions PPFP use is low and unmet need for contraception following pregnancy in LMIC is high. Tailored counseling approaches may help overcome misconceptions and meet heterogeneous needs for PPFP. |
| first_indexed | 2024-12-20T15:11:21Z |
| format | Article |
| id | doaj.art-0f32fd9797c44935bd789ce188e905c7 |
| institution | Directory Open Access Journal |
| issn | 1742-4755 |
| language | English |
| last_indexed | 2024-12-20T15:11:21Z |
| publishDate | 2019-10-01 |
| publisher | BMC |
| record_format | Article |
| series | Reproductive Health |
| spelling | doaj.art-0f32fd9797c44935bd789ce188e905c72022-12-21T19:36:19ZengBMCReproductive Health1742-47552019-10-0116111710.1186/s12978-019-0824-4A systematic review and meta-analysis of postpartum contraceptive use among women in low- and middle-income countriesRubee Dev0Pamela Kohler1Molly Feder2Jennifer A. Unger3Nancy F. Woods4Alison L. Drake5Sun Yat-sen Global Health Institute, Sun Yat-sen UniversityDepartment of Psychosocial and Community Health & Department of Global Health, University of WashingtonCardea ServicesDepartment of Obstetrics and Gynecology, University of WashingtonDepartment of Biobehavioral Nursing and Health Informatics, University of WashingtonDepartment of Global Health, University of WashingtonAbstract Background Short birth intervals increase risk for adverse maternal and infant outcomes including preterm birth, low birth weight (LBW), and infant mortality. Although postpartum family planning (PPFP) is an increasingly high priority for many countries, uptake and need for PPFP varies in low- and middle-income countries (LMIC). We performed a systematic review and meta-analysis to characterize postpartum contraceptive use, and predictors and barriers to use, among postpartum women in LMIC. Methods PubMed, EMBASE, CINAHL, PsycINFO, Scopus, Web of Science, and Global Health databases were searched for articles and abstracts published between January 1997 and May 2018. Studies with data on contraceptive uptake through 12 months postpartum in low- and middle-income countries were included. We used random-effects models to compute pooled estimates and confidence intervals of modern contraceptive prevalence rates (mCPR), fertility intentions (birth spacing and birth limiting), and unmet need for contraception in the postpartum period. Results Among 669 studies identified, 90 were selected for full-text review, and 35 met inclusion criteria. The majority of studies were from East Africa, West Africa, and South Asia/South East Asia. The overall pooled mCPR during the postpartum period across all regions was 41.2% (95% CI: 15.7–69.1%), with lower pooled mCPR in West Africa (36.3%; 95% CI: 27.0–45.5%). The pooled prevalence of unmet need was 48.5% (95% CI: 19.1–78.0%) across all regions, and highest in South Asia/South East Asia (59.4, 95% CI: 53.4–65.4%). Perceptions of low pregnancy risk due to breastfeeding and postpartum amenorrhea were commonly associated with lack of contraceptive use and use of male condoms, withdrawal, and abstinence. Women who were not using contraception were also less likely to utilize maternal and child health (MCH) services and reside in urban settings, and be more likely to have a fear of method side effects and receive inadequate FP counseling. In contrast, women who received FP counseling in antenatal and/or postnatal care were more likely to use PPFP. Conclusions PPFP use is low and unmet need for contraception following pregnancy in LMIC is high. Tailored counseling approaches may help overcome misconceptions and meet heterogeneous needs for PPFP.http://link.springer.com/article/10.1186/s12978-019-0824-4BarriersContraceptivesPredictorsPostpartumLow incomeMiddle income |
| spellingShingle | Rubee Dev Pamela Kohler Molly Feder Jennifer A. Unger Nancy F. Woods Alison L. Drake A systematic review and meta-analysis of postpartum contraceptive use among women in low- and middle-income countries Reproductive Health Barriers Contraceptives Predictors Postpartum Low income Middle income |
| title | A systematic review and meta-analysis of postpartum contraceptive use among women in low- and middle-income countries |
| title_full | A systematic review and meta-analysis of postpartum contraceptive use among women in low- and middle-income countries |
| title_fullStr | A systematic review and meta-analysis of postpartum contraceptive use among women in low- and middle-income countries |
| title_full_unstemmed | A systematic review and meta-analysis of postpartum contraceptive use among women in low- and middle-income countries |
| title_short | A systematic review and meta-analysis of postpartum contraceptive use among women in low- and middle-income countries |
| title_sort | systematic review and meta analysis of postpartum contraceptive use among women in low and middle income countries |
| topic | Barriers Contraceptives Predictors Postpartum Low income Middle income |
| url | http://link.springer.com/article/10.1186/s12978-019-0824-4 |
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