Postpartum family-planning barriers and catalysts in Burkina Faso and the Democratic Republic of Congo: a multiperspective study

Abstract

PurposeTo address the high unmet need for postpartum family planning (PPFP) in resource-limited settings, particularly in sub-Saharan Africa, this study aimed to identify PPFP-related barriers and catalysts to inform policies and programs to increase access to postpartum contraception.MethodsUsing qualitative methodology, we explored the perspectives of women, adolescent girls, men, religious and community leaders, service providers, and decision makers from three rural communities in Burkina Faso and three rural–urban communities in the Democratic Republic of Congo. Both countries have high unmet need for PPFP and are priority countries of the French Muskoka Fund for Maternal and Child Health.ResultsPerceived catalysts included negative traditional views on the consequences borne by closely spaced children and their mothers; a 6-week postpartum visit dedicated to PPFP (albeit poorly attended); political will and enabling policies for FP; and support from certain religious leaders and men. Main reported barriers were the lack of male engagement; out-of-pocket copayment for contraceptives; reliance on amenorrhea for pregnancy prevention without knowing its limits; misconceptions about modern contraceptives, including prerequisites for the lactational amenorrhea method; sexual abstinence supported by religious and traditional norms for up to 3–6 months, although women reported earlier resumption of sexual activity; low prioritization of scheduled postpartum visits by women; and limited availability of readily accessible methods, PPFP counseling materials, and clinic days and scheduled visits dedicated to contraceptive services.ConclusionBased on results found to be most actionable, the following interventions have the potential to optimize access to PPFP services: counseling women on postpartum-pregnancy risks and options at different points in time before and after childbirth through the use of appropriate information, education, and counseling materials; integrating PPFP services into existing maternal and child health visits; making contraceptives readily available and affordable; and meaningfully engaging male partners.

Dynamics of Long-Acting and Reversible Contraceptive Adoption During the First Year Postpartum: A Secondary Analysis of the Yam Daabo Cluster Randomized-Controlled Trial in Burkina Faso and DR Congo

“…In Burkina Faso, it was at 3 months postpartum for LARC and 2 for SARC, which contrasted with a much later adoption in DR Congo at more than 5 months postpartum for LARC and more than 8 for SARC. Our Yam Daabo formative research already revealed that women appeared to rarely attend the 6-week postpartum visit [15], which is con rmed by this secondary analysis. These ndings may have important implications to inform the revision of policies and practices in both countries and particularly DR Congo: under routine care, the 6-week postpartum visit dedicated to PPFP should be delayed to better match women's timing for PPFP adoption.…”

Discontinuation and switching of postpartum contraceptive methods over twelve months in Burkina Faso and the DRC: a secondary analysis of the Yam-Daabo trial

“…So, one of the common reason for discontinuation given by women is their partner's opposition. This has already been reported in several studies [20][21][22][23][24] as one of the inhibitors for contraception use by women in general and especially by married women. The opposition from partners calls for more targeted action towards men to gain a better commitment from them to facilitate the use of contraceptive methods by women.…”

“…Reason of contraception discontinuation or switching: lastly, regarding the reason of contraception discontinuation or switching, some women did not indicate their reasons for the discontinuation and switching of methods (17 women in total, similar repartition between the study's group). This lack of clear reason raises questions, especially in an African context, marked by misconceptions about contraception, as shown in the rst phase of this trial [20]. A literature review by Blackstone et al, published in 2017 regarding factors in uencing contraceptive use in sub-Saharan Africa between 2005 and 2015 showed that negative factors prohibiting or reducing contraceptive use were women's misconceptions of contraceptive side-effects, male partner disapproval, and social/cultural norms surrounding fertility.…”

Discontinuation and Switching of Postpartum Contraceptive Methods Over Twelve Months in Burkina Faso and the DRC: A Secondary Analysis of the Yam-Daabo trial

“…Another reason for discontinuation given by women is the partner's opposition. This has already been reported in several studies [20][21][22][23] as one of the inhibitors for contraception use by women in general and especially by married women. The opposition from partners calls for more targeted action towards men to gain a better commitment from them to facilitate the use of contraceptive methods by women.…”

“…lastly, regarding the reason of contraception discontinuation or switching, some women did not indicate their reasons for the discontinuation and switching of methods (17 women in total, similar repartition between the study's group). This lack of clear reason raises questions, especially in an African context, marked by misconceptions about contraception, as shown in the rst phase of this trial [20]. In Benin, for example, Chae et al showed in 2014 that, among married women with unmet needs, opposition to contraceptive methods is one of the main reasons for not using contraception.…”