PMID- 31665032
OWN - NLM
STAT- MEDLINE
DCOM- 20200423
LR  - 20230906
IS  - 1742-4755 (Electronic)
IS  - 1742-4755 (Linking)
VI  - 16
IP  - 1
DP  - 2019 Oct 29
TI  - A systematic review and meta-analysis of postpartum contraceptive use among women 
      in low- and middle-income countries.
PG  - 154
LID - 10.1186/s12978-019-0824-4 [doi]
LID - 154
AB  - 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.
FAU - Dev, Rubee
AU  - Dev R
AUID- ORCID: 0000-0003-1853-9728
AD  - Sun Yat-sen Global Health Institute, Sun Yat-sen University, Guangzhou, 
      Guangdong, China. meetrubss@hotmail.com.
FAU - Kohler, Pamela
AU  - Kohler P
AD  - Department of Psychosocial and Community Health & Department of Global Health, 
      University of Washington, Seattle, WA, USA.
FAU - Feder, Molly
AU  - Feder M
AD  - Cardea Services, Seattle, WA, USA.
FAU - Unger, Jennifer A
AU  - Unger JA
AD  - Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, 
      USA.
FAU - Woods, Nancy F
AU  - Woods NF
AD  - Department of Biobehavioral Nursing and Health Informatics, University of 
      Washington, Seattle, WA, USA.
FAU - Drake, Alison L
AU  - Drake AL
AD  - Department of Global Health, University of Washington, Seattle, WA, USA.
LA  - eng
GR  - K01 AI116298/AI/NIAID NIH HHS/United States
PT  - Journal Article
PT  - Meta-Analysis
PT  - Review
PT  - Systematic Review
DEP - 20191029
PL  - England
TA  - Reprod Health
JT  - Reproductive health
JID - 101224380
SB  - IM
MH  - Contraception Behavior/*statistics & numerical data
MH  - Counseling
MH  - *Developing Countries
MH  - Family Planning Services/*standards
MH  - Female
MH  - Humans
MH  - Postpartum Period/*psychology
MH  - *Poverty
MH  - Pregnancy
PMC - PMC6819406
OTO - NOTNLM
OT  - Barriers
OT  - Contraceptives
OT  - Low income
OT  - Middle income
OT  - Postpartum
OT  - Predictors
COIS- The authors declare that they have no competing interests.
EDAT- 2019/10/31 06:00
MHDA- 2020/04/24 06:00
PMCR- 2019/10/29
CRDT- 2019/10/31 06:00
PHST- 2019/01/08 00:00 [received]
PHST- 2019/10/09 00:00 [accepted]
PHST- 2019/10/31 06:00 [entrez]
PHST- 2019/10/31 06:00 [pubmed]
PHST- 2020/04/24 06:00 [medline]
PHST- 2019/10/29 00:00 [pmc-release]
AID - 10.1186/s12978-019-0824-4 [pii]
AID - 824 [pii]
AID - 10.1186/s12978-019-0824-4 [doi]
PST - epublish
SO  - Reprod Health. 2019 Oct 29;16(1):154. doi: 10.1186/s12978-019-0824-4.