Contraceptive use, intention to use and unmet need during the extended postpartum period

Context: The year after a woman gives birth presents a rising risk of an un wanted conception and an often frustrated desire for contraceptive protecti on. At present, contraceptive use levels during this period fall short, res ulting in unplanned pregnancies and unwanted childbearing. Methods: Data from 27 surveys conducted as part of the Demographic and Heal th Surveys series between 1993 and 1996 are analyzed to assess intentions t o practice contraception and unmet need for it, both in the first year afte r birth. Unmet need is partly redefined here to focus on future wishes rath er than on past pregnancies and births. Results: Across the 27 countries, there is much unsatisfied interest in, an d unmet need for, contraception. Unweighted country averages indicate that two-thirds of women who are within one year of their last birth have an unm et need for contraception, and nearly 40% say they plan to use a method in the next 12 months but are not currently doing so. Moreover, of all unmet n eed, on average nearly two-fifths falls among women who have given birth wi thin the past year. Similarly, nearly two in five women intending to use a method are within a year of their last birth. The two groups-those with an unmet need and those intending to use a method-overlap; their common member s include nearly ail of those intending to use a method and about two-third s of those with an unmet need (which is the larger group of the two). Only trivial proportions of both of these groups want another birth within two y ears. Between 50% and 60% of pregnant women make prenatal visits or have co ntact with health care providers at or soon after delivery, and additional contacts occur for infant care and other health services. Conclusions: Women who have recently given birth need augmented attention f rom family planning and reproductive health programs if they are to reduce their numbers of unwanted births and abortions and to lengthen subsequent b irth intervals. Prenatal visits, delivery services and subsequent health sy stem contacts are promising avenues for reaching postpartum women with an u nmet need for and a desire to use family planning services.