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Table 2 Main findings of the included studies

From: The unmet needs for modern family planning methods among postpartum women in Sub-Saharan Africa: a systematic review of the literature

Authors

Findings (multivariate analysis)

Highlights of the study

Reasons for non-use of FP (if stated)

Abera et al. 2015 [41]

Age (CI: 1.04–6.04, p < 0.001)

Resumption of menses (CI:5.85–14.63; p < 0.0001)

Postpartum period (CI: 2.51–9.30; p = 0.034)

Antenatal care* service (CI: 2.57–17.00; p = 0.001)

Postnatal care** service (CI: 1.01–2.61; p = 0.042)

97.15% of postpartum women had a good intention about PPFP (51.1% for spacing and 46.1% for limiting)

71.4% had resumed sexual activity

Postpartum Contraceptive use (48.4%)

Low perceived risk of pregnancy (49.0%)

Husband not living at home (16.8%)

Medical problem (11.6%)

Fear of side effect (7.7%)

Spousal disapproval (6.3%)

Religion (4.7%)

Abraha et al. 2017 [42]

Women’s education (secondary, CI:1.29–14.00; p = 0.02 and tertiary, CI:1.14–25.45; p = 0.03)

Menses resumption (CI:3.14–13.39; p < 0.001)

Problems with previous contraceptive use (CI:0.16–0.72; p = 0.05)

Resumption of sexual activity (CI:3.74–24.27; p < 0.001)

Prenatal and postnatal FP counselling (CI:2.67–12.28; p < 0.001)

PNC service (CI:1.15–4.87; p = 0.02)

48% of postpartum women used modern contraceptives

28.9% had resumed sexual activity at 3-week postpartum

Absence of menses (65.7%)

Fear of side effect (11.10%)

A single mother (7.80%)

Spousal disapproval (7.20%)

Abraha et al. 2018 [43]

Knowledge of modern contraceptives (CI: 1.69, 15.82)

Postpartum resumption of sexual activity (CI: 1.34, 3.92)

Husband's approval of FP (CI: 2.02, 5.57)

84.3% of postpartum women intended to utilise modern contraceptives, of which 83.3% were for spacing and 6.7% for limiting

Only 43.7% of respondents attended PNC, that percentage was 98.1% for ANC

Not stated

Achwoka et al. 2018 [56]

Age (CI: 1.00–1.61; p = 0.05)

Women's education (CI:1.01–1.04; p = 0.004)

Assisted delivery in a health facility (CI:1.06–1.49; p = 0.008)

PF discussion during PNC (CI: 1.10–1.42; p = 0.001)

PF discussion during ANC/ PNC (CI: 1.18–1.51; p < 0.001)

77% of the participants needed PPFP, 30% of whom were not currently using any modern FP

Only 63% of last pregnancies were desired

Not stated

Gebremedhin et al. 2018 [44]

Marriage (CI: 0.03–0.22)

Menses resumption (CI: 1.37–3.41)

Postpartum period (CI: 1.18–4.75)

History of previous PF use (CI: 0.07–0.18)

39.10% of participants did not know the number of children they wish to have

54.5% were not counselled about FP during their ANC

Not stated

Dona et al. 2018 [45]

Return of menses (CI: 1.47–3.81)

FP communication with husband (CI: 1.09–2.41)

ANC (CI: 1.23—3.01)

PNC (CI: 1.23- 2.94)

Postpartum contraceptive use was at 31.7%

68.7% of participants delivered their last birth at home

Resumption of menses (46%)

Distance to the health facilities (38%)

Husband’s disapproval (19%)

Lack of their preferred methods (11%)

Berta et al. 2018 [46]

Resumption of menses (CI: 2.33–6.35)

Resumption of sex (CI: 1.80–5.58)

Postpartum period (CI: 1.11–5.55) Knowledge on FP (CI: 2.23–11.24)

Husband’s approval (CI: 1.16–3.82)

Participants’ reproductive intention was for 41.8% for spacing and 33.7% for limiting

Non-menstruating (30.9%)

Side effects (11.1%)

Husband's disapproval (10.6%)

Breastfeeding (14.3%)

Bwazi et al. 2014 [54]

Women's education (p = 0.004)

Age (p = 0.050)

Side effects (p = 0.001)

Knowledge of the PPFP services (p < 0.001)

Duration of lactation amenorrhoea (p < 0.001)

Sexual activity resumption (p < 0.001)

Desired number of children (p = 0.020)

Number of children (Primiparous) (p < 0.001)

Clarity of FP information (p = 0.014)

Husband's approval (p < 0.001)

Husband’s assistance (p < 0.001)

Spousal discussion on FP (p < 0.001)

Counselling on FP (p = 0.026)

23% of women had five or more children

38% of women and 33% of their husbands wanted five or more children

22.2% had at least one abortion

Menstruating women (11.40%)

Unwilling to use FP (5.20%)

Fear of infant death (22%)

A single mother (3%)

Thindwa et al. 2019 [55]

Age (CI: 1.8–9.9)

Parity (CI: 1.8–39.5)

Partner of unknown HIV-status (CI: 1.2–4.0)

41.8% of respondents had an unplanned index pregnancy among whom 35% had an unmet need for FP, and 65% had a contraceptive failure

49.6% of women who did not desire any future child were not using contraception

Not stated

Chinaeke et al. 2019 [51]

Disclosure of women’s HIV status to their partner/relative (CI: 1.2–3.3; p = 0.01)

Mentor Mother (CI:0.3–0.8; p < 00.01)

FP counselling (CI: 1.1–4.8; p = 0.03)

87.5% of the postpartum women had received FP counselling

49.9% of respondents were not using modern contraceptive methods

Not stated

Embafrash and Mekonnen 2019 [59]

Postpartum period (CI: 4.24–15.71)

Low perception of pregnancy risk (CI: 1.04–3.09)

Rural residence (CI: 2.57–19.95)

Unmet need for contraception was 36.7% of which spacing was 29.6% and limiting 7.1%

74.8% of respondents had resumed sexual intercourses and 23.7% of them were denied of PF counselling by health providers

Non-menstruating (69.6%)

Side effects (13.5%)

Abstinence (8.7%)

Husband's disapproval (5.2%)

Breastfeeding (4.5%)

Religion (2.4%)

Refusal to remove implants by health providers

Idowu et al. 2015 [52]

Postpartum family planning awareness (CI: 0.0084–0.276; p < 0.001)

46% of respondents had an unmet need for spacing and 56% for limiting

Lack of awareness (17%)

Fear of side effects (17.4%)

Distance to the health facility (13%) Husband's disapproval (15%)

Preferred method not available (13.1%)

Low perceived risk of pregnancy (12.7%); Poverty (12.3%)

Iliyasu et al. 2018 [53]

Women’s education (CI:1.03–6.69; p = 0.043)

Baby’s age/postpartum period (CI:1.06–3.49; p = 0.031)

Resumption of sexual intercourse (CI:0.088–0.38; p = 0.001)

Resumption of menses (CI:0.21–0.75; p = 0.004)

67.9% of women resumed sexual activity two months of delivery, of whom 34.4% were not using any modern contraceptive methods

33% were in polygamous unions

Not stated

Keesara et al. 2018 [57]

Qualitative study and the themes are presented

88% of interviewed women were on contraceptive methods by three-months postpartum

Fear of side-effects

Husband's disapproval (25%)

Fear of infertility

Tegegn et al. 2017 [47]

Knowledge of Lactational Amenorrhea Method (CI: 4.10, 15.02; p = 0.001)

Low women's education (CI: 1.22–7.57; p = 0.017)

ANC service (CI:1.11–5.79; p = 0.050)

PNC service (CI:2.13–6.19; p = 0.0001)

44% of respondents had an unmet need for contraception of which 43% for limiting and 57% for spacing

The current infant was unwanted by 7.9% of participants

Low perceived risk of pregnancy (47%)

Fear of side effect (16%)

Abstinence (9%)

Lack of their preferred Method (8%)

Mengesha et al. 2015 [48]

Urban residence (CI: 2.93–11.63)

Husband’s education (CI: 1.49–5.97)

PNC services (CI: 1.06–4.52)

Assisted delivery by health provider (CI: 1.01–3.51)

Postpartum contraception use was 10.3% of which 30.1% was for limiting

Home delivery was at 81.1%

Not stated

Gejo et al. 2019 [49]

Women's education (CI: 0.09–0.74)

Sex resumption (CI: 1.53–11.52)

Menses resumption (CI: 3.07–23.23)

Postpartum period (CI: 0.11–0.64)

73.9% of respondents were on contraception (85.29% of them for spacing and 7.72% for limiting)

Absence of menses (32.29%)

Absence of spouse (20.8%)

Sileo et al. 2015 [58]

Women’s education (CI: 1.05–3.95; P = 0.04)

Prior use of contraceptives (CI: 1.42–83.05; p = 0.02)

discussion on contraceptive use with partner (CI: 1.34—2.44; p < 0.001)

74.8% of participants were not using any effective contraceptive method

63.5% reported being victims of emotional abuse and 45.8% of physical abuse

Not stated

Abraha et al. 2018 [50]

Wealth (CI:1.1–3.2; p < 0.001)

Partner/husband's education (CI: 1.1–2.6; p < 0.001)

PNC service (CI:1.9–4.3; p < 0.001)

Distance to the health facility (CI: 2.7–4.6; p < 0.01)

ANC service (CI: 1.9–4.2); p < 0.01)

49.3% attended the four ANC visits recommended by WHO

96.90% of respondents and 68.1% of their partners had tested for HIV

13.5% had complications during the puerperium period

Not stated

  1. ANC  antenatal care, PNC postnatal care