Background: During the post-partum period, most women wish to delay or prevent future pregnancies. Despite
this, the unmet need for family planning up to a year after delivery is higher than at any other time. This study
aims to assess fertility intention, contraceptive usage and unmet need for family planning amongst women who
are six weeks postpartum, as well as to identify those at greatest risk of having an unmet need for family planning
during this period.
Methods: Using the NICHD Global Network for Women’s and Children’s Health Research’s multi-site, prospective,
ongoing, active surveillance system to track pregnancies and births in 100 rural geographic clusters in 5 countries
(India, Pakistan, Zambia, Kenya and Guatemala), we assessed fertility intention and contraceptive usage at day 42
post-partum.
Results: We gathered data on 36,687 women in the post-partum period. Less than 5% of these women wished to
have another pregnancy within the year. Despite this, rates of modern contraceptive usage varied widely and
unmet need ranged from 25% to 96%. Even amongst users of modern contraceptives, the uptake of the most
effective long-acting reversible contraceptives (intrauterine devices) was low. Women of age less than 20 years,
parity of two or less, limited education and those who deliver at home were at highest risk for having unmet
need.
Conclusions: Six weeks postpartum, almost all women wish to delay or prevent a future pregnancy. Even in sites
where early contraceptive adoption is common, there is substantial unmet need for family planning. This is
consistently highest amongst women below the age of 20 years. Interventions aimed at increasing the adoption of
effective contraceptive methods are urgently needed in the majority of sites in order t