title: Missed opportunities for family planning: an analysis of pregnancy risk and contraceptive method use among postpartum women in 21 low- and middle-income countries.
abstract: OBJECTIVE
  To analyze data from recent Demographic and Health Surveys (DHS) conducted in 21 low- and middle-income countries (LMICs) to examine patterns of interpregnancy intervals, unmet need, pregnancy risk and family planning method use and method mix among women 0-23 months postpartum.
  
  
  METHODS
  Secondary analysis of postpartum women aged 15-49 years in 22 DHS surveys from 21 LMICs conducted between 2005 and 2012. We applied an adapted unmet need definition for postpartum women to look at prospective fertility preferences. We also constructed a new composite pregnancy risk indicator for postpartum women who have been sexually active since their last birth.
  
  
  RESULTS
  In 9 of 22 surveys, 50% or more of nonfirst births occur at interpregnancy intervals that are too short. Overall prospective unmet need for family planning by postpartum women has not changed demonstrably since a 2001 analysis and is universally high: 61% of all postpartum women across the 21 countries have an unmet need for family planning. In 10 of 22 surveys, pregnancy risk rises steadily throughout the 2 years after birth. In the remaining 12 surveys, the risk of pregnancy peaks at 6-11 months after birth. Even when postpartum women are using family planning, they rely overwhelmingly on short-acting methods (51-96% in 21 of 22 surveys).
  
  
  CONCLUSIONS
  Our approach of estimating pregnancy risk by postpartum timing confirms a high probability for pregnancies to be less than optimally spaced within 2 years of a prior birth and suggests that special consideration is needed to effectively reach this population with the right messages and services.
  
  
  CONCLUSIONS
  Using recent, multicountry data for women within 2 years postpartum in LMICs, this paper updates existing estimates of high prospective unmet need for family planning and presents a new composite pregnancy risk analysis based on postpartum women's actual practices to demonstrate the magnitude of missed opportunities for programmatic intervention for the postpartum population.
authors.affiliation: ICF International, 530 Gaither Road, Suite 500, Rockville, MD 20850-5971, USA. Electronic address: Zhuzhi.Moore@icfi.com.
authors.forename: Zhuzhi
authors.initials: Z
authors.lastname: Moore
authors.affiliation: Maternal and Child Survival Program, 1776 Massachusetts Avenue, Northwest Suite 300, Washington, DC 20036, USA. Electronic address: Anne.Pfitzer@jhpiego.org.
authors.forename: Anne
authors.initials: A
authors.lastname: Pfitzer
authors.affiliation: Maternal and Child Survival Program, 1776 Massachusetts Avenue, Northwest Suite 300, Washington, DC 20036, USA. Electronic address: Rehana.Gubin@jhpiego.org.
authors.forename: Rehana
authors.initials: R
authors.lastname: Gubin
authors.affiliation: Maternal and Child Survival Program, 1776 Massachusetts Avenue, Northwest Suite 300, Washington, DC 20036, USA. Electronic address: Elaine.Charurat@jhpiego.org.
authors.forename: Elaine
authors.initials: E
authors.lastname: Charurat
authors.affiliation: FHI 360, 1825 Connecticut Avenue Northwest, Washington, DC 20009, USA. Electronic address: lelliott@fhi360.org.
authors.forename: Leah
authors.initials: L
authors.lastname: Elliott
authors.affiliation: ICF International, 530 Gaither Road, Suite 500, Rockville, MD 20850-5971, USA. Electronic address: Trevor.Croft@icfi.com.
authors.forename: Trevor
authors.initials: T
authors.lastname: Croft
mesh_terms: D000293:Adolescent; D000328:Adult; D003267:Contraception / Q000379:methods / Q000706:statistics & numerical data*; D003906:Developing Countries / Q000706:statistics & numerical data*; D005193:Family Planning Services; D005260:Female; D006301:Health Services Needs and Demand / Q000639:trends*; D006306:Health Surveys; D006801:Humans; D008875:Middle Aged; D049590:Postpartum Period; D011247:Pregnancy; D018873:Pregnancy Rate; D011446:Prospective Studies; D018570:Risk Assessment; D013997:Time Factors; D055815:Young Adult
keywords: Demographic and Health Surveys; Family planning; Interpregnancy intervals; Postpartum contraception; Pregnancy risk; Unmet need