Family Planning Needs during the First Two Years Postpartum in Madagascar

The study examines key findings related to birth and pregnancy spacing, fertility return, unmet need for and use of family planning, and contact with key services for women during the period from the last birth through two years postpartum. Research findings demonstrate improved perinatal outcomes for infants born 36-59 months after a preceding birth, and experts recommend an interval of at least 24 months before couples attempt to become pregnant to reduce the risk of adverse maternal, perinatal, and infant outcomes. In Madagascar, over half (51%) of all non-first births are spaced at less than the recommended 24-month interpregnancy interval, putting women and their infants at increased risk for poor maternal and perinatal outcomes. The study finds that among Malagasy women within two years postpartum, 65% have an unmet need for family planning, 30% are using a method of family planning, and only 5% of women desire another pregnancy within two years. The unmet need for family planning decreases as the number of months post-delivery increases, from 81% among women 0-5 months postpartum to 53% among women 12-23 months postpartum. The analysis also examines the method mix for postpartum family planning users, finding that the largest proportion (48%) use injectables, followed by the pill (13%), the lactational amenorrhea method (9%), implants (4%), condoms (3%), IUDs (1%), and female sterilization (1%). The remaining 21% use traditional methods (withdrawal and periodic abstinence). The study highlights the importance of increasing access to family planning services for women in Madagascar, particularly during the first two years postpartum. It also emphasizes the need to address the high unmet need for family planning and to promote the use of modern family planning methods, such as injectables and implants, to reduce the risk of pregnancy and improve maternal and perinatal outcomes. In Madagascar, only 35% of all births occur at a health facility, while 64% occur at home. The study finds that overall, 33% of postpartum women who delivered at a health facility are using a modern method of family planning, compared with only 18% of women who delivered at home. This highlights the need to increase access to family planning services in health facilities and to promote the use of modern family planning methods among postpartum women. The analysis demonstrates that women in Madagascar have a significant unmet need for family planning during the two years after a birth. Total unmet need decreases during this period, in part due to the higher proportion of women starting contraception as time elapses after a birth. The risk of pregnancy peaks in the middle of the two-year postpartum period, and the study highlights the need to address this risk and to promote the use of modern family planning methods to reduce the risk of pregnancy and improve maternal and perinatal outcomes.