title: Interventions to Improve Postpartum Family Planning in Low- and Middle-Income Countries: Program Implications and Research Priorities.
abstract: This article provides programmatic guidance and identifies future research priorities through a review of interventions to improve postpartum contraception. Thirty-five interventions in low- and middle-income countries were identified and classified according to timing and nature of administration: antenatal, postnatal, both ante- and postnatal, and integration with other services. With the exception of single, short antenatal interventions, the evidence of impact is positive but incomplete. A major gap in knowledge concerns demand for, and means of promoting, immediate postpartum family planning services in Asia and Africa. Counseling before discharge is likely to have an impact on subsequent contraceptive uptake. Integration of family planning into immunization and pediatric services is justified, but policy and program obstacles remain. A case for relaxing the strict conditions of the lactational amenorrhea method (LAM) is strong, but qualitative evidence on the perspectives of women on pregnancy risks is required. Despite the gaps in knowledge, the evidence provides useful guidance for strategies to promote postpartum family planning, in ways that take different contexts into account.
authors.affiliation: Emeritus Professor of Medical Demography, Department of Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom. john.cleland@lshtm.ac.uk.
authors.forename: John
authors.initials: J
authors.lastname: Cleland
authors.affiliation: Doctoral student, Faculty of Epidemiology and Population Health, Department of Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom.
authors.forename: Iqbal H
authors.initials: IH
authors.lastname: Shah
authors.affiliation: Principal Research Scientist, Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
authors.forename: Marina
authors.initials: M
authors.lastname: Daniele
mesh_terms: D000568:Amenorrhea; D003268:Contraception Behavior; D003270:Contraceptive Agents / Q000627:therapeutic use*; D003906:Developing Countries; D005193:Family Planning Services; D005260:Female; D006801:Humans; D049590:Postpartum Period; D012106:Research
chemical_list: D003270:Contraceptive Agents