The Effect of Improved Access to Family Planning on Postpartum Women: Protocol for a Randomized Controlled Trial

Although the World Health Organization recommends women wait at least two years after a live birth before becoming pregnant again, an estimated 25 percent of birth intervals in low-income countries do not meet this recommendation. As a result, the need for postpartum family planning services (PPFP) that enable women to adequately space births is high, but few studies have so far evaluated the impact such services have on contraceptive use, birth spacing and other measures of health and well-being.

In a new journal article published in JMIR Research Protocols, HCI Associate Director Mahesh Karra and David Canning describe a randomized controlled trial they conducted to identify the causal impact of a PPFP intervention on contraceptive use, pregnancy and birth spacing in urban Malawi. While the analysis of the primary trial results is ongoing, the authors anticipate their findings will demonstrate that the benefits of improving access to family planning extend beyond the fertility and health domains.

As part of the trial, 2,143 married women aged 18 to 35 years, who were either pregnant or had recently given birth were randomly assigned to either an intervention group or a control group. The women in the intervention group received a package of PPFP services over a two-year period, including a brochure and up to six home visits from trained family planning counselors; free transportation to a high-quality family planning clinic; and financial reimbursement for family planning services, consultations and referrals for services. Women from both the intervention and control groups were surveyed about their contraceptive use and fertility and birth spacing outcomes several times throughout the study period.

In conducting this trial, the authors aim to provide the first causal estimate of the impact of PPFP on birth spacing and risk of subsequent pregnancy in sub-Saharan Africa, and perhaps globally. Evidence from the trial can be used to inform policymakers of the benefits and effectiveness of family planning, thereby leading to policies that improve the availability of and access to reproductive health services in Malawi and other similar settings.