Contraceptive Use, Intention to Use and Unmet Need During the Extended Postpartum Period

Context

The year after a woman gives birth presents a rising risk of an unwanted conception and an often frustrated desire for contraceptive protection. At present, contraceptive use levels during this period fall short, resulting in unplanned pregnancies and unwanted childbearing.

Methods

Data from 27 surveys conducted as part of the Demographic and Health Surveys series between 1993 and 1996 are analyzed to assess intentions to practice contraception and unmet need for it, both in the first year after birth. Unmet need is partly redefined here to focus on future wishes rather than on past pregnancies and births.

Results

Across the 27 countries, there is much unsatisfied interest in, and unmet need for, contraception. Unweighted country averages indicate that two-thirds of women who are within one year of their last birth have an unmet need for contraception, and nearly 40% say they plan to use a method in the next 12 months but are not currently doing so. Moreover, of all unmet need, on average nearly two-fifths falls among women who have given birth within the past year. Similarly, nearly two in five women intending to use a method are within a year of their last birth. The two groups—those with an unmet need and those intending to use a method—overlap; their common members include nearly all of those intending to use a method and about two-thirds of those with an unmet need (which is the larger group of the two). Only trivial proportions of both of these groups want another birth within two years. Between 50% and 60% of pregnant women make prenatal visits or have contact with health care providers at or soon after delivery, and additional contacts occur for infant care and other health services.

Conclusions

Women who have recently given birth need augmented attention from family planning and reproductive health programs if they are to reduce their numbers of unwanted births and abortions and to lengthen subsequent birth intervals. Prenatal visits, delivery services and subsequent health system contacts are promising avenues for reaching postpartum women with an unmet need for and a desire to use family planning services.