Integrating Family Planning Into Postpartum Care: Long-Acting Reversible Contraception

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By: Sarah Hodin, Project Coordinator II, Women and Health Initiative, Harvard T.H. Chan School of Public Health

Evidence suggests that long-acting reversible contraception (LARC)—including both intrauterine devices and progesterone-only contraceptive implants—is a highly effective, commonly used form of modern contraception globally. The postpartum period presents a critical opportunity to counsel women about their family planning options, including LARC. However, the majority of studies on postpartum LARC use to date have been conducted in high-income countries.

In a recent paper published in Maternal Health, Neonatology and Perinatology, Margo Harrison and Robert Goldenberg presented an overview of published research on immediate postpartum use of LARC in low- and middle-income countries (LMICs).

How many women use postpartum LARC in LMICs?

Few studies from low-resource settings have measured the prevalence of postpartum LARC use. Estimates from relatively small studies range from roughly 2% to 14% among women who use modern contraception:

Study Setting Estimated prevalence of postpartum LARC use among users of modern contraception
Mengesha et al. (2015) Debat District, Ethiopia 2%
Mody et al. (2014) Mumbai, India 3%
Mumah et al. (2015) Nairobi, Kenya Less than 8%*
Tappis et al. (2015) Sindh, Pakistan 8%
Kopp et al. (2017) Lilongwe, Malawi 14%

* Exact figure not provided

Limited evidence has demonstrated that while reported side effects are not uncommon, users of postpartum LARC generally report being highly satisfied with this method.

Barriers and unanswered questions

Barriers to postpartum LARC uptake included in the review were stock-outs, alternative methods of contraception and low quality and/or utilization of postpartum care. Other barriers to LARC use including partner-related factors and lack of knowledge about contraception have been described in the literature, but less is known about postpartum-specific barriers in LMICs.

The authors highlighted several research gaps related to LARC in LMICs that deserve further attention:

  1. Availability of LARC
  2. Evaluation of programs for large-scale implementation
  3. Effects of LARC on fertility and future pregnancy outcomes
  4. Cost-effectiveness
  5. Limitations and barriers to uptake

Does your work focus on family planning and maternal health? We want to hear from you!

Read the full paper, “Immediate postpartum use of long-acting reversible contraceptives in low- and middle-income countries.”

Learn more about family planning and maternal health.

Access key papers and resources related to postnatal care.