Thanks for writing this! As others have said, thank you for trying to do this valuable work even if it didn’t work out.
I haven’t read everything so sorry if you mention this elsewhere but I’m confused about:
-‘Of the three studies we found that measure the effects of facility-based postpartum family planning programming on pregnancy rates, two found no effect (Rohr et al. 2024; Coulibaly et al. 2021), and one found only a 0.7% decrease in short-spaced pregnancies (Guo et al. 2022). This suggests that facility-based programs may have limited to no effect on reducing unintended pregnancies despite increasing contraceptive uptake.’
Why might programs increase contraceptive uptake but not reduce unintended pregnancies? Is it mainly because many who take the contraceptives are in the postpartum insusceptibility period anyway?
Thanks for the kind words! This is a great question. There’s a lot of uncertainty here but here’s a few thoughts:
Postpartum insusceptibility is likely a decent chunk of it—i.e. some women have “redundant” protection where they were already 100% protected from pregnancy, so the modern contraception does nothing in the short term, or they were mostly protected and the modern contraception only adds a small marginal benefit
For some of the studies, there was a higher contraceptive uptake at 12 months postpartum in the intervention group than the control but the contraceptive uptake in intervention and control groups was similar at 2 years postpartum—it seems that some PPFP interventions are primarily shifting contraceptive uptake sooner, where postpartum insusceptibility is a particularly strong factor.
Behavior related to family planning is really complex and can be unpredictable/unexpected. For example, the women who start using contraception because of a program are likely not a representative sample of the population; in fact, they may be skewed towards people who are at a lower risk of getting pregnant, because they’re more careful in other ways.
Thanks for writing this! As others have said, thank you for trying to do this valuable work even if it didn’t work out.
I haven’t read everything so sorry if you mention this elsewhere but I’m confused about:
-‘Of the three studies we found that measure the effects of facility-based postpartum family planning programming on pregnancy rates, two found no effect (Rohr et al. 2024; Coulibaly et al. 2021), and one found only a 0.7% decrease in short-spaced pregnancies (Guo et al. 2022).
This suggests that facility-based programs may have limited to no effect on reducing unintended pregnancies despite increasing contraceptive uptake.’
Why might programs increase contraceptive uptake but not reduce unintended pregnancies? Is it mainly because many who take the contraceptives are in the postpartum insusceptibility period anyway?
Thanks for the kind words! This is a great question. There’s a lot of uncertainty here but here’s a few thoughts:
Postpartum insusceptibility is likely a decent chunk of it—i.e. some women have “redundant” protection where they were already 100% protected from pregnancy, so the modern contraception does nothing in the short term, or they were mostly protected and the modern contraception only adds a small marginal benefit
For some of the studies, there was a higher contraceptive uptake at 12 months postpartum in the intervention group than the control but the contraceptive uptake in intervention and control groups was similar at 2 years postpartum—it seems that some PPFP interventions are primarily shifting contraceptive uptake sooner, where postpartum insusceptibility is a particularly strong factor.
Behavior related to family planning is really complex and can be unpredictable/unexpected. For example, the women who start using contraception because of a program are likely not a representative sample of the population; in fact, they may be skewed towards people who are at a lower risk of getting pregnant, because they’re more careful in other ways.