Postpartum Family Planning

Postpartum family planning (PPFP) is the prevention of unintended and closely spaced pregnancies through the first 12 months following childbirth. Not only do pregnancies during this period hold the greatest risk for mother and infants, the first 12 months after childbirth also present the greatest opportunities for women and their infants to come in contact with a health worker and receive PPFP services. Postpartum women are among those with the greatest unmet need for FP, yet they do not receive the attention or FP services they need and desire to support longer birth intervals and reduce unintended pregnancy and its consequences.

  • According to an analysis of DHS data from 27 countries, 65% of women who are 0–12 months postpartum want to avoid a pregnancy in the next 12 months but are not using contraception.[1]
  • FP can avert more than 30% of maternal deaths and 10% of child mortality if couples spaced their pregnancies more than two years apart.[2] Closely spaced pregnancies within the first year postpartum are the riskiest for mother and baby, resulting in increased risks for adverse outcomes such as preterm, low birth weight, and small for gestational age. Pregnancy occurring within six months of the last delivery holds a 7.5-fold increased risk for induced abortion and a 1.6-fold increased risk of stillbirth.[3]
  • Risk of mortality in children is highest for very short birth-to-pregnancy intervals (<12 months). If all couples waited 24 months to conceive again, under five mortality would decrease by 13%. If couples waited 36 months, the decrease would be 25%.[4]
  • Postpartum women (and their health care providers) may not realize that they are at risk of pregnancy even if they are breastfeeding. A study in Egypt found that 15% of breastfeeding women, who were not using lactational amenorrhea method (LAM), conceived prior to resumption of menses.[5]

Given recent calls in the international community to invest in FP as a key life-saving and development intervention, PPFP has an important role to play in strategies to reduce unmet need. WHO recommends that health systems miss no opportunities to make FP an essential component of health care that is provided during the antenatal period, immediately after delivery, and during the first year postpartum.[6] Antenatal care, labor and delivery care, postpartum care, and well-child/immunization care provide appropriate settings for the integration of PPFP care.

As shown in the graphic in Annex B, the immediate postpartum period (immediately following the delivery of the placenta or prior to discharge from the facility) is an appropriate time for such methods as IUD, tubal ligation, or LAM. Providing a contraceptive method prior to discharge from a facility is more convenient for the woman and her family, is less expensive, and reduces loss to follow-up. Other methods can be provided throughout the postpartum period in the community and home, as well as in the facility.

Key PPFP Resources:

[1] Ross J. and Winfrey W. 2001. Contraceptive use, intention to use and unmet need during the extended postpartum period. International Family Planning Perspectives. 27(1): 20–27.

[2] Cleland J. et al. 2006. Family planning: The unfinished agenda. The Lancet. 368(9549): 1810–1827.

[3] DaVanzo J. et al. 2007. Effects of interpregnancy interval and outcome of the preceding pregnancy on pregnancy outcomes in Matlab, Bangladesh. BJOG. 114(9): 1079–1087.

[4] Rutstein S.O. 2008. Further Evidence of the Effects of Preceding Birth Intervals on Neonatal, Infant, and Under-Five-Years Mortality and Nutritional Status in Developing Countries: Evidence from the Demographic and Health Surveys. DHS Working Papers. Calverton, MD: Macro International, Demographic and Health Research Division.

[5] Shaaban O.M. and Glasierr A. 2008. Pregnancy during breastfeeding in rural Egypt. Contraception. 77(5):350–354

[6] WHO. 2012. From Evidence to Policy: Expanding Access to Family Planning. WHO Policy Brief. Geneva, Switzerland.