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Reproductive Health
Published in: Reproductive Health 1/2021

Open Access 01-12-2021 | Contraception | Review

The unmet needs for modern family planning methods among postpartum women in Sub-Saharan Africa: a systematic review of the literature

Authors: Jumaine Gahungu, Mariam Vahdaninia, Pramod R. Regmi

Published in: Reproductive Health | Issue 1/2021

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Abstract

Background

Sub-Saharan Africa has the highest fertility rate in the world, with the highest unmet need for family planning (FP). Yet, there is a lack of knowledge about the determinants for non-utilisation of modern contraceptive methods among women of reproductive age. This systematic review of literature assessed factors affecting the unmet need and reasons for non-utilisation of modern contraceptive methods during the postpartum period in Sub-Saharan African women.

Methods

An online literature search was conducted in several databases: MEDLINE, Cochrane Review, PubMed, Elsevier's Science Direct and Web of Science. The search was completed by hand searching. Data were extracted and summarised using the Arksey and O’Malley methodology.

Results

In total, 19 studies were included; one qualitative study, seventeen quantitative, and one used a mixed-methods approach. Studies were conducted in Ethiopia (n = 11), Nigeria (n = 3), Kenya (n = 2), Malawi (n = 2) and Uganda (n = 1). Factors affecting the unmet need for modern contraceptive methods were described at three levels: (a) individual; (b) household; and (c) healthcare facility level. Reasons for non-use of FP included: fear of side effects; husband’s disapproval; the absence of menses; abstinence; and low perception of risk of pregnancy.

Conclusion

Unmet needs in postpartum FP in women from Sub-Saharan Africa were associated with health-system and socio-demographic determinants. We suggest that there is a need to improve the awareness of modern contraceptive methods through effective interventions. Further research is needed for under-studied countries in this continent.
Appendix
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Literature
1.
United Nations, Department of Economic and Social Affairs. World Family Planning; New York: UN. 2017.
2.
RamaRao S, Ishaku S, Liambila W, Mane B. Enhancing contraceptive choice for postpartum women in sub-Saharan Africa with the progesterone vaginal ring: a review of the evidence. Open Access J Contracept. 2015;6:117–23.PubMedPubMedCentralCrossRef
3.
Rossier C, Hellen J. Traditional birthspacing practices and uptake of family planning during the postpartum period in Ouagadougou: qualitative results. Int Perspect Sex Reprod Health. 2014;40(2):87–94.PubMedCrossRef
4.
Wulifan JK, Brenner S, Jahn A, De Allegri M. A scoping review on determinants of unmet need for family planning among women of reproductive age in low and middle income countries. BMC Women’s Health. 2015;16(1):2.CrossRef
5.
Cleland J, Shah IH, Daniele M. Interventions to improve postpartum family planning in low-and middle-income countries: program implications and research priorities. Stud Fam Plan. 2015;46(4):423–41.CrossRef
6.
United Nations. World contraceptive use. Geneva: United Nations; 2014.
7.
Sedgh G, Ashford LS, Hussain R. Unmet need for contraception in developing countries: examining women’s reasons for not using a method. New York: Guttmacher Institute; 2016.
8.
United Nations, Statement submitted by International Planned Parenthood Federation (IPPF), a non-governmental organization in consultative status with the Economic and Social Council; E/CN.9/2010/NGO/1; United Nations: Geneva; 2010.
9.
Singh S, Darroch J E. Adding it up: costs and benefits of contraceptive services. Guttmacher Institute and UNFPA. 2012.
10.
Lane C, Joof YM, Hassan AA, Pryor S. Promoting healthy timing and spacing of pregnancy with young married women in Northern Nigeria: a short report. Afr J Reprod Health. 2012;16(2):263–9.PubMed
11.
12.
Borda M, Winfrey W. Postpartum fertility and contraception: an analysis of findings from 17 countries. Baltimore: JHPIEGO; 2010.
13.
Adebowale SA, Palamuleni ME. Determinants of unmet need for modern contraception and reasons for non-use among married women in rural areas of Burkina Faso. Afr Popul Stud. 2014;28(1):499–514.CrossRef
14.
Pasha O, Goudar SS, Patel A, Garces A, Esamai F, Chomba E, Moore JL, Kodkany BS, Saleem S, Derman RJ, et al. Postpartum contraceptive use and unmet need for family planning in five low-income countries. Reprod Health. 2015;12(Suppl 2):S11.PubMedPubMedCentralCrossRef
15.
Wilopo SA, Setyawan A, Pinandari AW, Prihyugiarto T, Juliaan F, Magnani RJ. Levels, trends and correlates of unmet need for family planning among postpartum women in Indonesia: 2007–2015. BMC Women’s Health. 2017;17:120.PubMedPubMedCentralCrossRef
16.
Cleland J, Shah IH, Benova L. A fresh look at the level of unmet need for family planning in the postpartum period, its causes and program implications. Int Perspect Sex Reprod Health. 2015;41(3):155–62.PubMedCrossRef
17.
Ngianga-Bakwin K, Stones RW. Birth intervals and injectable contraception in sub-Saharan Africa. Contraception. 2005;71(5):353–6.PubMedCrossRef
18.
Ali MM, Cleland JG, Shah IH, World Health Organization. Causes and consequences of contraceptive discontinuation: evidence from 60 demographic and health surveys. Geneva: WHO; 2012.
19.
Haider TL, Sharma M. Barriers to family planning and contraception uptake in sub-Saharan Africa: a systematic review. Int Q Comm Health Educ. 2013;33(4):403–13.CrossRef
20.
Sedgh G, Hussain R, Bankole A, Singh S. Women with an unmet need for contraception in developing countries and their reasons for not using a method. Occasional Rep. 2007;37:5–40.
21.
Cronin P, Ryan F, Coughlan M. Undertaking a literature review: a step-by-step approach. Br J Nurs. 2008;17(1):38–43.PubMedCrossRef
22.
Pace R, Pluye P, Bartlett G, Macaulay AC, Salsberg J, Jagosh J, Seller R. Testing the reliability and efficiency of the pilot Mixed Methods Appraisal Tool (MMAT) for systematic mixed studies review. Int J Nurs Stud. 2012;49(1):47–53.PubMedCrossRef
23.
Aartman IH. The PICO (patient-intervention-comparison-outcome) question. Nederlands tijdschrift Voor Tandheelkunde. 2007;114(4):172–8.PubMed
24.
Huang X, Lin J, Demner-Fushman D. In Evaluation of PICO as a knowledge representation for clinical questions. J Am Med Inform Assoc. 2006;2006:359–63.
25.
Cooke A, Smith D, Booth A. Beyond PICO: the SPIDER tool for qualitative evidence synthesis. Qual Health Res. 2012;22:1435–43.PubMedCrossRef
26.
Davies KS. Formulating the evidence-based practice question: a review of the frameworks. Evid Based Libr Inf Pract. 2011;6(2):75–80.CrossRef
27.
Arksey H, O’Malley L. Scoping studies: towards a methodological framework. Int J Soc Res Method. 2005;8(1):19–32.CrossRef
28.
Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med. 2009;151(4):264–9.PubMedCrossRef
29.
30.
Whittemore R, Knafl K. The integrative review: updated methodology. J Adv Nurs. 2005;52(5):546–53.PubMedCrossRef
31.
Hewitt-Taylor J. The essential guide to doing a health and social care literature review. Oxon: Routledge; 2017.CrossRef
32.
Aveyard H, Payne SA, Preston NJ. A post-graduate’s guide to doing a literature review in health and social care. Oxford: Oxford University Press; 2016.
33.
Booth A, Clarke M, Dooley G, Ghersi D, Moher D, Petticrew M, Stewart L. The nuts and bolts of PROSPERO: an international prospective register of systematic reviews. Syst Rev. 2012;1:2.PubMedPubMedCentralCrossRef
34.
Boland A, Cherry G, Dickson R. Doing a systematic review: a student’s guide. London: Sage; 2017.
35.
Bramer WM, de Jonge GB, Rethlefsen ML, Mast F, Kleijnen J. A systematic approach to searching: an efficient and complete method to develop literature searches. J Med Libr Ass. 2018;106(4):531.
36.
Swift JK, Wampold BE. Inclusion and exclusion strategies for conducting meta-analyses. Psychother Res. 2018;28(3):356–66.PubMedCrossRef
37.
Hunter JE, Schmidt FL. Methods of meta-analysis: correcting error and bias in research findings. London: Sage; 2004.CrossRef
38.
39.
40.
41.
Abera Y, Mengesha ZB, Tessema GA. Postpartum contraceptive use in Gondar town, Northwest Ethiopia: a community based cross-sectional study. BMC Women’s Health. 2015;15:19.PubMedPubMedCentralCrossRef
42.
Abraha TH, Teferra AS, Gelagay AA. Postpartum modern contraceptive use in northern Ethiopia: prevalence and associated factors. Epidemiol Health. 2017;39:e2017012.PubMedPubMedCentralCrossRef
43.
Abraha TH, Belay HS, Welay GM. Intentions on contraception use and its associated factors among postpartum women in Aksum town, Tigray region, northern Ethiopia: a community-based cross-sectional study. Reprod Health. 2018;15(1):188.PubMedPubMedCentralCrossRef
44.
Gebremedhin AY, Kebede Y, Gelagay AA, Habitu YA. Family planning use and its associated factors among women in the extended postpartum period in Addis Ababa, Ethiopia. Contracept Reprod Med. 2018;3:1.PubMedPubMedCentralCrossRef
45.
Dona A, Abera M, Alemu T, Hawaria D. Timely initiation of postpartum contraceptive utilization and associated factors among women of child bearing age in Aroressa District, Southern Ethiopia: a community based cross-sectional study. BMC Public Health. 2018;18:1100.PubMedPubMedCentralCrossRef
46.
Berta M, Feleke A, Abate T, Worku T, Gebrecherkos T. Utilization and associated factors of modern contraceptives during extended postpartum period among women who gave birth in the last 12 months in Gondar Town Northwest Ethiopia. Ethiop J Health Sci. 2018;28(2):207–16.PubMedPubMedCentralCrossRef
47.
Tegegn M, Arefaynie M, Tiruye TY. Unmet need for modern contraceptives and associated factors among women in the extended postpartum period in Dessie town, Ethiopia. Contracept Reprod Med. 2017;2:21.PubMedPubMedCentralCrossRef
48.
Mengesha ZB, Worku AG, Feleke SA. Contraceptive adoption in the extended postpartum period is low in Northwest Ethiopia. BMC Pregnancy Childbirth. 2015;15:160.PubMedPubMedCentralCrossRef
49.
50.
Abraha TH, Gebrezgiabher BB, Aregawi BG, Belay DS, Tikue LT, Welay GM. Predictors of postpartum contraceptive use in rural Tigray region, northern Ethiopia: a multilevel analysis. BMC Public Health. 2018;1:1017.CrossRef
51.
Chinaeke EE, Fan-Osuala C, Bathnna M, Ozigbu CE, Olakunde B, Ramadhani HO, et al. Correlates of reported modern contraceptive use among postpartum HIV-positive women in rural Nigeria: an analysis from the MoMent prospective cohort study. Reprod Health. 2019;16:2.PubMedPubMedCentralCrossRef
52.
Idowu A, Ogunsola OO, Ogunlaja O. Knowledge, determinants and unmet needs for postpartum family planning use among women attending immunization clinic at Bowen University Teaching Hospital, Ogbomoso, Oyo State, Nigeria. Afr J Med Med Sci. 2015;44(1):43–51.PubMed
53.
Iliyasu Z, Galadanci HS, Danlami KM, Salihu HM, Aliyu MH. Correlates of postpartum sexual activity and contraceptive use in Kano, Northern Nigeria. Afr J Reprod Health. 2018;22(1):103–12.PubMed
54.
Bwazi C, Maluwa A, Chimwaza A, Pindani M. Utilization of postpartum family planning services between six and twelve months of delivery at Ntchisi District Hospital, Malawi. Health. 2014;6(14):1724–37.CrossRef
55.
Thindwa D, Landes M, van Lettow M, Kanyemba A, Nkhoma E, Phiri H, et al. Pregnancy intention and contraceptive use among HIV-positive Malawian women at 4–26 weeks post-partum: a nested cross-sectional study. PLoS ONE. 2019;14(4):e0215947.PubMedPubMedCentralCrossRef
56.
Achwoka D, Pintye J, McGrath CJ, Kinuthia J, Unger JA, Obudho N, Langat A, John-Stewart G, Drake AL. Uptake and correlates of contraception among postpartum women in Kenya: results from a national cross-sectional survey. Contraception. 2018;97(3):227–35.PubMedCrossRef
57.
Keesara S, Juma PA, Harper CC, Newmann SJ. Barriers to postpartum contraception: differences among women based on parity and future fertility desires. Cult Health Sex. 2018;20(3):247–61.PubMedCrossRef
58.
Sileo KM, Wanyenze RK, Lule H, Kiene SM. Determinants of family planning service uptake and use of contraceptives among postpartum women in rural Uganda. Int J Public Health. 2015;60(8):987–97.PubMedCrossRef
59.
Embafrash G, Mekonnen W. Level and correlates of unmet need of contraception among women in extended postpartum in Northern Ethiopia. Int J Reprod. 2019;2019:1–9.CrossRef
60.
Zapata LB, Murtaza S, Whiteman MK, Jamieson DJ, Robbins CL, Marchbanks PA, D’Angelo DV, Curtis KM. Contraceptive counseling and postpartum contraceptive use. Am J Obstet Gynecol. 2015;212(2):171-e1.PubMedCrossRef
61.
Hounton S, Winfrey W, Barros AJD, Askew I. Patterns and trends of postpartum family planning in Ethiopia, Malawi, and Nigeria: evidence of missed opportunities for integration. Glob Health Action. 2015;8(1):29738.PubMedCrossRef
62.
63.
Naanyu V, Baliddawa J, Peca E, Karfakis J, Nyagoha N, Koech B. An examination of postpartum family planning in western Kenya: “I want to use contraception but I have not been told how to do so.” Afr J Reprod Health. 2013;17(3):44–53.PubMed
64.
Shah NJ, Pradhan P, Reddy AS, Joseph B. Contraceptive practices in newly married women in sub-urban Bangalore. Health Population-Perspectives Issues. 2006;29(1):21–8.
65.
Boardman LA, Desimone M, Allen RH. Barriers to completion of desired postpartum sterilization. R I Med J. 2013;96(2):32–4.
66.
Stephenson R, Baschieri A, Clements S, Hennink M, Madise N. Contextual influences on modern contraceptive use in sub-Saharan Africa. Am J Public Health. 2007;97(7):1233–40.PubMedPubMedCentralCrossRef
67.
Borda MR, Winfrey W, McKaig C. Return to sexual activity and modern family planning use in the extended postpartum period: an analysis of findings from seventeen countries. Afr J Reprod Health. 2010;14(4):72–9.PubMed
68.
Gebreselassie T, Rutstein SO, Mishra V. Contraceptive use breastfeeding amenorrhea and abstinence during the postpartum period: an analysis of four countries. DHS Analytical Studies No. 14. Calverton, Maryland, USA: Macro International. 2008.
69.
Susuman AS, Bado A, Lailulo YA. Promoting family planning use after childbirth and desire to limit childbearing in Ethiopia. Reprod Health. 2014;11(1):53.CrossRef
70.
Issaka AI, Agho KE, Renzaho AMN. Prevalence of key breastfeeding indicators in 29 sub-Saharan African countries: a meta-analysis of demographic and health surveys (2010–2015). BMJ Open. 2017;7(10):e014145.PubMedPubMedCentralCrossRef
71.
Speizer IS, Fotso JC, Okigbo C, Faye CM, Seck C. Influence of integrated services on postpartum family planning use: a cross-sectional survey from urban Senegal. BMC Public Health. 2013;13(1):752.PubMedPubMedCentralCrossRef
72.
73.
Ndugwa RP, Cleland J, Madise NJ, Fotso J-C, Zulu EM. Menstrual pattern, sexual behaviors, and contraceptive use among postpartum women in Nairobi urban slums. J Urban Health. 2011;88(2):341–55.CrossRef
74.
Rutaremwa G, Kabagenyi A, Wandera SO, Jhamba T, Akiror E, Nviri HL. predictors of modern contraceptive use during the postpartum period among women in Uganda: a population-based cross-sectional study. BMC Public Health. 2015;15(1):262.PubMedPubMedCentralCrossRef
75.
Nigussie AT, Girma D, Tura G. Postpartum family planning utilization and associated factors among women who gave birth in the past 12 months, Kebribeyah Town, Somali Region, Eastern Ethiopia. J Women’s Health Care. 2016;5(340):2167–0420.
76.
Wakefiled MA, Loken B, Hornik RC. Use of mass media campaigns to change health behaviour. Lancet. 2010;376(9748):1261–7.CrossRef
77.
Harries J, Lince N, Constant D, Hargey A, Grossman D. The challenges of offering public second trimester abortion services in South Africa: health care providers’ perspectives. J Biosoc Sci. 2012;44(2):197–208.PubMedCrossRef
78.
Basinga P, Moore AM, Singh SD, Carlin EE, Birungi F, Ngabo F. Abortion incidence and postabortion care in Rwanda. Stud Fam Plann. 2012;43(1):11–20.PubMedCrossRef
79.
Evans E, Otieno-Masaba R, Eichleay M, McCarraher DO, Hainsworth G, Lane C, et al. Post-abortion care services for youth and adult clients in Kenya: a comparison of services, client satisfaction and provider attitudes. J Biosoc Sci. 2014;46(1):1.CrossRef
80.
Ayanore MA, Pavlova M, Groot W. Unmet reproductive health needs among women in some West African countries: a systematic review of outcome measures and determinants. Reprod Health. 2015;13(1):5.CrossRef
81.
Wai KM, Shibanuma A, Oo NN, Fillman TJ, Saw YM, Jimba M. Are husbands involving in their spouses’ utilization of maternal care services?: a cross-sectional study in Yangon, Myanmar. PLoS ONE. 2015;10(12):e0144135.PubMedPubMedCentralCrossRef
82.
Keogh SC, Urassa M, Kumogola Y, Kalongoji S, Kimaro D, Zaba B. Postpartum contraception in northern Tanzania: patterns of use, relationship to antenatal intentions, and impact of antenatal counseling. Stud Fam Plan. 2015;46(4):405–22.CrossRef
83.
84.
Sarnquist CC, Rahangdale L, Maldonado Y. Reproductive health and family planning needs among HIV-infected women in Sub-Saharan Africa. Curr HIV Res. 2013;11(2):160–8.PubMedCrossRef
85.
Ekabua JE, Ekabua KJ, Odusolu P, Iklaki CU, Agan TU, Etokidem AJ. Factors associated with contraceptive use and initiation of coital activity after childbirth. Open Acc J Contracept. 2010;1:85–91.CrossRef
86.
Barber SL. Family planning advice and postpartum contraceptive use among low-income women in Mexico. Int Fam Plan Perspect. 2007;33:6–12.PubMedCrossRef
87.
Lagro M, Liche A, Mumba T, Ntebeka R, van Roosmalen J. Postpartum care attendance at a rural district hospital in Zambia. Trop Doct. 2006;36(4):205–8.PubMedCrossRef
88.
Do M, Hotchkiss D. Relationships between antenatal and postnatal care and post-partum modern contraceptive use: evidence from population surveys in Kenya and Zambia. BMC Health Serv Res. 2013;13(1):6.PubMedPubMedCentralCrossRef
89.
Moore Z, Pfitzer A, Gubin R, Charurat E, Elliott L, Croft T. Missed opportunities for family planning: an analysis of pregnancy risk and contraceptive method use among postpartum women in 21 low-and middle-income countries. Contraception. 2015;92(1):31–9.PubMedCrossRef
90.
91.
Do M, Kurimoto N. Women’s empowerment and choice of contraceptive methods in selected African countries. Int Perspect Sex Reprod Health. 2012;38:23–33.PubMedCrossRef
92.
Alkema L, Kantorova V, Menozzi C, Biddlecom A. A National, regional, and global rates and trends in contraceptive prevalence and unmet need for family planning between 1990 and 2015: a systematic and comprehensive analysis. Lancet. 2013;381(9878):1642–52.PubMedCrossRef
Metadata
Title
The unmet needs for modern family planning methods among postpartum women in Sub-Saharan Africa: a systematic review of the literature
Authors
Jumaine Gahungu
Mariam Vahdaninia
Pramod R. Regmi
Publication date
01-12-2021
Publisher
BioMed Central
Keyword
Contraception
Published in
Reproductive Health / Issue 1/2021
Electronic ISSN: 1742-4755
DOI
https://doi.org/10.1186/s12978-021-01089-9

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