ArticleContraception2016
Postpartum uptake of contraception in rural northern Malawi: A prospective study.
Article in Contraception, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 15 papers, 1 of them a synthesis that pooled it.
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The trial behind it
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Who cites it
15 citing papers in PubMed, 1 synthesis or guideline pooled it, 20 citations in OpenAlex.
- Pooled it
- Predictors of postpartum modern contraceptive use intentions among pregnant women in urban Ghana: a cross-sectional study.The Pan African medical journal · 2026Article
- A bivariate Poisson regression to analyse impact of outlier women on correlation between female schooling and fertility in Malawi.BMC women's health · 2024Article
- Article
- Individual and facility-level factors associated with women's receipt of immediate postpartum family planning counseling in Ethiopia: results from national surveys of women and health facilities.BMC pregnancy and childbirth · 2021Article
- Postpartum Family Planning Use and Its Determinants among Women of the Reproductive Age Group in Low-Income Countries of Sub-Saharan Africa: A Systematic Review and Meta-Analysis.International journal of reproductive medicine · 2021Review
- Modern contraceptive use among postpartum women living with HIV attending mother baby care points in Kabarole District, Uganda.BMC women's health · 2020Article
- Predictors of puerperal menstruation.PloS one · 2020Article
- Determinants of Postpartum Contraception Use Among Teenage Mothers in Eastern Uganda: A Cross-Sectional Study.Open access journal of contraception · 2020Article
- The Role of Culture in Maintaining Post-Partum Sexual Abstinence of Swazi Women.International journal of environmental research and public health · 2019Article
- Quality and Cost Interventions During the Extended Perinatal Period to Increase Family Planning Use in Kinshasa, DRC: Results From an Initial Study.Global health, science and practice · 2018Article
- Influences on birth spacing intentions and desired interventions among women who have experienced a poor obstetric outcome in Lilongwe Malawi: a qualitative study.BMC pregnancy and childbirth · 2018Article
- Use of traditional and modern contraceptives among childbearing women: findings from a mixed methods study in two southwestern Nigerian states.BMC public health · 2018Article
- Patterns of Contraceptive Adoption, Continuation, and Switching after Delivery among Malawian Women.PloS one · 2017Article
- Dual Method Use among Postpartum HIV-Infected and HIV-Uninfected Malawian Women: A Prospective Cohort Study.Infectious diseases in obstetrics and gynecology · 2017Article
Corrections and comments
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Authors and funding
3 authors at 1 institution in 2 countries.
Funding
Abstract
objectivesCross-sectional estimates of contraceptive use do not provide understanding of time to postpartum uptake. This paper uses a range of Malawian data sources: a prospective study to explore time to uptake of contraception and a cross-sectional survey to assess whether sexually active postpartum women whose fecundity has returned use contraception, and whether abstaining/amenorrheic women report using contraception. STUDY
designA demographic surveillance site (DSS) in Malawi was used to identify 7393 women aged 15-49 years eligible for a 1-year prospective study of contraception using provider-recorded data on patient-held records (2012-2013). This provided a reliable record of time to uptake of postpartum contraception. The average timing of resumption of sexual activities after postpartum abstinence and return of menses was estimated from a population-based sexual behaviour survey in the DSS (2010-2011).
resultsOf 4678 women recruited to the prospective contraception study, 442 delivered an infant during the observation period. Of these, 28.4% used modern contraception within 6 months of delivery. However, at 6-9 months after delivery, only 28.0% women had started menstruation and resumed sexual activities; of these, 77.6% used contraception. Amongst abstaining/amenorrheic women, a quarter reported contraceptive use.
conclusionsThe low uptake of postpartum contraception is likely due to many women abstaining and/or experiencing amenorrhea. Self-reports of contraceptive use amongst abstaining/amenorrheic women bring into question the quality of cross-sectional surveys and demonstrate that contraceptive use by women at low risk of pregnancy could contribute to the Malawi paradox of high contraceptive use and high fertility. Given relatively low risk of pregnancy in the postpartum period in this context, a focus on long-acting/permanent methods may be more effective to avert unintended pregnancies. IMPLICATIONS: There has been increasing interest in the utility of postpartum contraceptive programmes to assist women to space births. Our findings suggest that, although uptake of contraception is low, this is partly due to postpartum abstinence and amenorrhea. Provision of long-acting/permanent methods will be more effective for women after delivery.
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