Family Planning, Contraceptive Use, and Birth Spacing, Health News, ET HealthWorld

Massachusetts: A study of the impact of family planning on women’s postpartum contraceptive use and birth spacing of 2,143 married women aged 18-35 in Lilongwe, Malawi, who were pregnant or had recently given birth, found that women who received free family planning services over 2 years increased contraceptive use by 5.9 percentage points.

They were also 43.5% less likely to be pregnant again within 24 months compared to the control group. The findings suggest that family planning can improve women’s long-term reproductive health outcomes, including healthy spacing between pregnancies, according to the research authors.

Short intervals between pregnancies and births can adversely affect maternal and child health (MCH) and are associated with high levels of infant mortality and low birth weight, particularly in sub-Saharan Africa. For these reasons, the World Health Organization (WHO) recommends that women wait at least 24 months after a live birth before trying to get pregnant again. However, family planning (FP) use during the postpartum period is low, and many women in low- and middle-income countries become pregnant within this 2-year window. Improving access to postpartum FP has the potential to reduce these high-risk short birth intervals, but unmet FP needs in the postpartum period and the risk of short birth intervals remain high, particularly in sub-Saharan Africa.

Although there is a substantial empirical literature on FP, recent reviews of the impact of FP programs and interventions found few high-quality studies that assessed short-term intervention impact ( within a year of exposure to the intervention) and even fewer studies that assessed outcomes. beyond the use of contraceptives, such as pregnancy and childbirth. In Egypt, an intervention that provided women with lactational amenorrhea with emergency contraception in advance, as a back-up contraceptive method, was found to be effective in reducing pregnancies after 6 months. In another study that was also conducted in Egypt, women who received immediate postpartum insertion of an intrauterine device (IUD) were found to have lower pregnancy rates 1 year after insertion compared to to women who received an insertion 6 weeks after delivery.

Other randomized controlled trials of FP services have found similarly mixed results. Findings from the community-level experience of Navrongo in Ghana revealed program impacts on both contraceptive use and longer-term fertility; however, the balance between the treatment and control communities has not been achieved, and recent studies have shown that the effects of the intervention waned over time. Two program evaluations in Ethiopia and Kenya that assessed FP services that were integrated into microcredit and HIV programs, respectively, found no intervention effects.

Finally, studies from the well-known Matlab MCH-PF program in Bangladesh have shown significant and sustained reductions in fertility and longer birth intervals among women in program areas. However, the findings of the Matlab program have been widely debated, with critics noting that bundling FP with other MCH services makes it difficult to disentangle independent impacts of FP. Additionally, the potential non-random selection of intervention and comparison domains raised questions about the extent to which causal inferences can be made from the program.

More recently, a cluster-randomized controlled trial of a postpartum FP intervention in Burkina Faso found a significant effect on modern contraceptive use after 1 year of exposure to the intervention, but no effect after 2 years. of exposure. A randomized trial of a similar intervention in the Democratic Republic of the Congo found no effect on overall contraceptive use, but a shift in method mix toward contraceptive implants was observed after one year of exposure to intervention.

A cluster-randomised controlled trial in Nepal, which improved women’s access to FP counseling during pregnancy and gave women the option of receiving IUD insertions in the immediate postpartum period, found positive effects on modern contraceptive use 1 year after exposure to the intervention. However, these results were not maintained after 2 years of exposure to the intervention, with effects seen only on the contraceptive method mix, primarily through an increase in IUDs and a reduction in other methods. Notably, these three randomized trials reported effects only on contraceptive use, but not on pregnancy or birth spacing.

A recent evaluation of an integrated postpartum FP intervention in Bangladesh, which had intervention and comparison areas but was not randomized, found a significantly lower risk of short birth intervals in intervention areas during the first 36 months of exposure to the intervention.

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