Effects of family planning counseling delivered during maternal healthcare on postpartum modern contraceptive uptake in low- and middle-income countries: a systematic review and meta-analysis
Authors: Khan Md Nuruzzaman , Chowdhury Atika Rahman , Rana Md Shohel , Hossain Rashed , Hassen Tahir Ahmed , Chojenta Catherine , Harris Melissa L. 
Published: September 2024

AbstractBackgroundPostpartum modern contraception is crucial for preventing unintended pregnancies, reducing short inter-pregnancy intervals, and improving maternal and child health outcomes. Family planning counseling, when engaging with maternal healthcare services, may enhance modern contraceptive uptake in the postpartum period. However, evidence in low- and middle-income countries (LMICs) has yielded conflicting findings. We aimed to explore the effects of family planning counseling delivered as part of maternal healthcare on postpartum modern contraceptive uptake in LMICs.MethodsThe following six databases were searched in April 2024: PubMed, Web of Science, Embase, Global Health, Medline, and Scopus. Studies that examined the association between family planning counseling and modern contraception uptake in the postpartum period were included. The findings of the included studies were summarized narratively and through a random-effects meta-analysis when data supported. Trim and fill estimates and subgroup analyses were conducted to address publication bias and heterogeneity, respectively.ResultsA total of 61 studies were included, of which 42 studies were considered for quantitative synthesis and the remaining 19 studies included in a narrative synthesis. We found that women who received family planning counseling during maternal healthcare visits were 2.75 times (95% CI, 2.11-3.58) more likely to use modern contraception during the postpartum period compared to those who did not receive family planning counseling. Although we observed significant publication bias and heterogeneity, addressing these issues through trim and fill estimation and subgroup analyses, respectively, produced estimates consistent with the summary findings. A narrative synthesis of an additional 19 studies also supports the effectiveness of family planning counseling during maternal healthcare visits on postpartum modern contraception uptake.ConclusionIntegrating family planning counseling into maternal healthcare can significantly increase modern contraceptive use in the postpartum period, as such effectively reducing unintended and short interval pregnancy as well as adverse maternal and child health outcomes. Policymakers should prioritize training healthcare providers and developing standardized protocols for effective counseling.Research in contextEvidence Before the StudyPostpartum contraception is essential for improving maternal and child health, but evidence from LMICs on the impact of family planning counselling during maternal healthcare on contraceptive uptake has been mixed. While some studies show a positive association, others do not, and no comprehensive meta-analysis had been conducted on this topic. This highlights a critical research gap, emphasizing the need for a thorough study to resolve these conflicting findings and inform policy and program development.Added Value of the StudyOur study is the largest to date, synthesizing evidence from 61 studies across LMICs. We found that women receiving family planning counselling during maternal healthcare visits were 2.75 times more likely to use modern contraception postpartum. We addressed publication bias and heterogeneity, providing robust evidence of the intervention’s effectiveness.Implication of the Study FindingsOur findings highlight the importance of integrating family planning counselling into maternal healthcare services in LMICs. Policymakers should invest in training healthcare providers and standardizing protocols to improve postpartum contraceptive uptake, reduce unintended pregnancies, and enhance maternal and child health outcomes.