ArticleProceedings of the National Academy of Sciences of the United States of America2022
The causal effect of a family planning intervention on women's contraceptive use and birth spacing.
Article in Proceedings of the National Academy of Sciences of the United States of America, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 24 papers, 4 of them syntheses that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
24 citing papers in PubMed, 4 syntheses or guidelines pooled it.
- Nutrition and reproductive potential of women in low- and middle-income countries: a systematic review and meta-analysis.BMJ global health · 2025Pooled it
- Antenatal Care Interventions to Increase Contraceptive Use Following Birth in Low- and Middle-Income Countries: Systematic Review and Narrative Synthesis.Global health, science and practice · 2024Pooled it
- Pooled it
- Strategies for Improving Postpartum Contraception Compared With Routine Maternal Care: A Systematic Review and Meta-Analysis.International journal of public health · 2023Pooled it
- Can personalized digital counseling improve consumer search for modern contraceptive methods?Science advances · 2023Trial
- Article
- Gender bias in fertility choices: how son preference increases the risk of short birth intervals in India.Tropical medicine and health · 2026Article
- Impact of FP2020 Program on High-Risk Pregnancies and Under-Five Mortality in the Democratic Republic of the Congo: Evidence from a Quasi-Experimental Analysis Using Demographic and Health Surveys (2013-2023).Healthcare (Basel, Switzerland) · 2026Article
- Evaluating two models of postpartum family planning counseling on contraceptive uptake, knowledge, and intended use: evidence from a repeated cross-sectional study in Ghana.Reproductive health · 2026Article
- Hormonal contraception and hemoglobin levels in urban Malawi: a longitudinal analysis.Reproductive health · 2026Article
- Contraceptive uptake and characteristics in the immediate postpartum period among women attending Tygerberg Academic Hospital.PloS one · 2026Article
- Contraception to women's economic empowerment: A narrative review.World development · 2025Review
- Pregnancy Intentions and Maternal Health Behaviours: Observational Study in 18 African Countries.BJOG : an international journal of obstetrics and gynaecology · 2025Observational
- Effects of the Challenge Initiative's Community Health Volunteers (CHVs) on Public Sector Service Provision of Family Planning Services in Urban Sindh, Pakistan.International journal of environmental research and public health · 2025Article
- Geospatial analysis of area-level social and behavioral factors associated with short interpregnancy intervals in North Carolina, U.S.Preventive medicine reports · 2025Article
- Does prolonged postpartum insusceptibility undercut the impact of postpartum family planning programming in Sub-Saharan Africa?Reproductive health · 2025Article
- Successful strategies that address gender-related barriers and promote bodily autonomy within efforts to scale up and sustain postpregnancy contraception: a scoping review.BMJ global health · 2025Article
- Sexual and reproductive health awareness and practices among adolescents and adults in a rural farming community in Baja California, Mexico: a quantitative and qualitative cross-sectional study.Sexual and reproductive health matters · 2024Article
- Understanding the association between family planning and fertility reduction in Southeast Asia: a scoping review.BMJ open · 2024Article
- Factors associated with family planning use among refugee and host populations in Adjumani district, West Nile, Uganda: a comparative study.BMC public health · 2024Article
Corrections and comments
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Authors and funding
5 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Studies have suggested that improving access to family planning (FP) may improve contraceptive use and reduce fertility. However, high-quality evidence, particularly from randomized implementation trials, of the effect of FP programs and interventions on longer-term fertility and birth spacing is lacking. We conduct a nonblinded, randomized, controlled trial to assess the causal impact of improved access to FP on contraceptive use and pregnancy spacing in Lilongwe, Malawi. A total of 2,143 married women aged 18 to 35 who were either pregnant or had recently given birth were recruited through home visits between September 2016 and January 2017 and were randomly assigned to an intervention arm or a control arm. The intervention arm received four services over a 2-y period: 1) up to six FP counseling sessions; 2) free transportation to an FP clinic; 3) free FP services at the clinic or financial reimbursement for FP services obtained elsewhere; and 4) treatment for contraceptive-related side effects. Contraceptive use after 2 y of intervention exposure increased by 5.9 percentage points, mainly through an increased use of contraceptive implants. The intervention group’s hazard of pregnancy was 43.5% lower 24 mo after the index birth. Our results highlight the positive impact of increased access to FP on a woman’s contraceptive use. In addition, we show that exposure to the FP intervention led to a prolongation of birth intervals among intervention women relative to control women and increased her control over birth spacing and postpartum fertility, which, in turn, may contribute to her longer-term health and well-being.
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