Postpartum Fertility and Contraception: An Analysis of Findings from 17 Countries

Abstract

The ACCESS-FP Program funded by the U.S. Agency for International Development (USAID) created several country-level analyses that describe postpartum return to fertility and family planning use among women in the first year postpartum. This paper brings together these analyses into a comparative report. The authors hope that the similarities across the analyses will provide policy and program managers with general lessons that can be applied anywhere. Where similarities do not exist the authors hope that policy and program managers will look carefully at country-specific context to inform their decisions. The general perspective of this report is that family planning or other behaviors to reduce fertility in the extended postpartum period are intended to reduce the percentage of birth intervals that are dangerously short. The literature review will discuss the literature regarding fertility-reducing behaviors including family planning in the extended postpartum period. In the data and methods section that follows the literature review there will be discussion of the data used definitions of key variables and methodological issues. The first data analysis section presents graphs and charts describing levels of fully breastfeeding return to menses return to sexual activity and use of family planning services. Detailed tables from which the graphs are drawn are presented in an appendix. The fertility-influencing behaviors or outcomes will be related to the prevalence of dangerously short birth intervals in the hopes of identifying the country-level behaviors that are most associated with healthy birth intervals. In general the working hypothesis of this paper is that greater use of family planning in the extended postpartum period fully breastfeeding and slower return to sexual activity will be associated with longer birth intervals. In 2005 a World Health Organization (WHO) technical consultation specified that after a live birth the recommended interval before attempting the next pregnancy should be at least 24 months in order to reduce the risk of adverse maternal perinatal and infant outcomes. The second analysis section of the paper presents data on the relationship between family planning and the use of maternal health services. The working hypothesis of this section is that women who use maternal health services are more likely to use family planning services in the extended postpartum period than women who do not use maternal health services. A corollary of this is that countries with greater use of maternal health services should have higher levels of family planning use in the extended postpartum period. (Excerpts)