title: Outreach and integration programs to promote family planning in the extended postpartum period.
abstract: BACKGROUND
  WHO recommends birth spacing to improve the health of the mother and child. One strategy to facilitate birth spacing is to improve the use of family planning during the first year postpartum.
  
  
  OBJECTIVE
  To determine from the literature the effectiveness of postpartum family-planning programs and to identify research gaps.
  
  
  METHODS
  PubMed and the Cochrane Central Register of Controlled Trials were systematically searched for articles published between database inception and March 2013. Abstracts of conference presentations, dissertations, and unpublished studies were also considered.
  
  
  METHODS
  Published studies with birth spacing or contraceptive use outcomes were included.
  
  
  METHODS
  Standard abstract forms and the US Preventive Services Task Force grading system were used to summarize and assess the quality of the evidence.
  
  
  RESULTS
  Thirty-four studies were included. Prenatal care, home visitation programs, and educational interventions were associated with improved family-planning outcomes, but should be further studied in low-resource settings. Mother-infant care integration, multidisciplinary interventions, and cash transfer/microfinance interventions need further investigation.
  
  
  CONCLUSIONS
  Programmatic interventions may improve birth spacing and contraceptive uptake. Larger well-designed studies in international settings are needed to determine the most effective ways to deliver family-planning interventions.
authors.affiliation: Department of Obstetrics and Gynecology, Boston Medical Center, Boston, USA. Electronic address: sarita.sonalkar@bmc.org.
authors.forename: Sarita
authors.initials: S
authors.lastname: Sonalkar
authors.affiliation: Department of Reproductive Medicine, University of California San Diego, San Diego, USA.
authors.forename: Sheila
authors.initials: S
authors.lastname: Mody
authors.affiliation: Department of Reproductive Health and Research, WHO, Geneva, Switzerland.
authors.forename: Mary E
authors.initials: ME
authors.lastname: Gaffield
mesh_terms: D003267:Contraception; D005193:Family Planning Services / Q000458:organization & administration*; D005260:Female; D006801:Humans; D010353:Patient Education as Topic / Q000379:methods*; D049590:Postpartum Period; D011247:Pregnancy; D011295:Prenatal Care / Q000379:methods; D016730:Program Development
keywords: Birth spacing; Family planning; Postpartum period; Programmatic interventions; Rapid repeat birth; Systematic review; Teen pregnancy