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

Abstract

Purpose

To 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.

Methods

Using 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.

Results

Perceived 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.

Conclusion

Based 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.

Keywords:

• postpartum contraception
• barriers
• enablers
• sub-Saharan Africa
• Burkina Faso
• Democratic Republic of Congo

Acknowledgments

Work on this research project was initiated within the WHO Department of Reproductive Health and Research (RHR). The Government of France generously provided funding for this research grant in the context of the Muskoka Initiative on Maternal and Child Health. We are thankful to Asa Cuzin-Kihl for the overall coordination of the project and her technical input, and to Suzanne Reier for coordinating talks with donors and partners and for contributing to the initial design of the study.

Author contributions

NTT and MEG conceived the initial study concept and designed the study protocol and study instruments. SK, WMEY, DMK, and FL contributed to the final study protocol and study instruments. NTT and WMEY wrote the manuscript, with contributions from SK, MEG, FL, JK, and DMK. All authors contributed toward data analysis, drafting and revising the paper, gave final approval of the version to be published, and agree to be accountable for all aspects of the work.

Disclosure

The authors report no conflicts of interest in this work.