Counseling during Maternal and Infant Health Visits and Postpartum Contraceptive use in Uttar Pradesh, India.

CONTEXT: Women have a high unmet need for contraception in the year following a birth. It is important to examine whether providing family planning counseling as part of antenatal, intrapartum and postpartum maternal and infant health services is associated with postpartum contraceptive use. METHODS: Survey data from 2,733 women aged 15-49 from six cities in Uttar Pradesh, India, who had had a birth between 2011 and 2014 were used to examine associations between exposure to family planning information at maternal and infant health visits and contraceptive use in the postpartum period. Discrete-time event history multinomial logit models were used to examine any contraceptive use and method choice among modern method users in the 12 months following the last birth. RESULTS: Forty-six percent of women reported having used a modern contraceptive in the 12 months following their last birth during the study period; another 18% had used a traditional method. Among women who had delivered at a health facility, those who had received family planning counseling at that time were more likely than others to have used a modern method postpartum rather than no method or a traditional method (relative risk ratios, 2.0 and 2.3, respectively). Receiving a postpartum home visit by a community health worker that included family planning counseling was positively associated with modern method use rather than use of no method (1.3). CONCLUSION: Providing postpartum family planning counseling at the time of an institutional birth and during maternal health visits could increase women's uptake of a modern contraceptive method in urban Uttar Pradesh. International Perspectives on Sexual and Reproductive Health, 2016, 42(4): 167-178. The benefits of family planning for the health and well-being of mothers and children--mainly through longer birth intervals--are well-established. (1,2) Longer birth intervals are associated with lower risks of such negative outcomes as neonatal, infant and child mortality; low birth weight; (1,3,4) maternal mortality and morbidity; (1,5) and unwanted and unplanned pregnancy. (6) Spacing pregnancies at least two years apart could reduce global maternal mortality and morbidity by 20%, and global childhood mortality by nearly 10%. (1) Use of family planning in the first year following a birth can help women achieve their spacing goals. Because of its salience to unplanned pregnancy, and to maternal and infant health in developing countries, postpartum family planning has emerged as a compelling concern of global significance. Yet, women face a high level of unmet need for contraception in the first year following a birth--a period referred to in the literature as the extended postpartum period. (*)(7,8) According to a study of 27 countries in Asia, Africa and Latin America conducted in the early 1990s, nearly two-thirds of postpartum women had an unmet need for contraception. (7) A similar, more recent study of 21 countries found a similar level of unmet need among postpartum women (61%). (9) Other studies suggest that postpartum women prefer longer intervals between births and would practice contraception sooner if they had better information on their risk of getting pregnant after a birth or were offered more options to achieve their desired birth interval. (10-12) Postpartum women differ from other women at risk of unintended pregnancy. First, most new mothers who are breast-feeding believe that they cannot conceive; (13,14) however, their risk of pregnancy--and, therefore, need for contraception--is similar to that of women who are not breast-feeding. Second, regardless of their breastfeeding status, women are amenorrheic following a birth for an unpredictable amount of time, which makes their postpartum fecundity uncertain. (14) Third, the duration of postpartum abstinence varies widely among women and is influenced by social norms; (14) thus, many women do not use contraceptives soon after birth. …