The extended postpartum period in Haiti is characterized by a high unmet need for family planning. Approximately 21% of births in Haiti occur within short intervals of less than 24 months, and another 34% occur between 24 and 35 months. The World Health Organization recommends that women have an interval of at least 24 months before attempting to become pregnant to reduce the risk of adverse maternal, perinatal, and infant outcomes.
Data from 1,305 women within one year post-delivery were used to examine prospective unmet need for family planning. In this analysis, unmet need is defined prospectively with regard to the woman’s desired timing for her next pregnancy. Prospective analysis yields higher rates of unmet need than are observed if the woman is asked about the last birth. Within this group, only 23% of postpartum women are using any method of family planning within the first year after giving birth. Consistent with findings elsewhere, only 2% of Haitian women during this 12-month postpartum period desire another birth within two years.
The majority of postpartum women do not use any method of family planning. As many as 75% of women were not using a method during the ninth through twelfth month postpartum. Uptake of family planning across the postpartum period is very low among women under 35 years of age. Birth intervals are short among younger women, and their levels of unmet need for family planning are high. Postpartum women 15 to 19 years old are a critical group to reach for the uptake of family planning during the postpartum period.
The relationship between family planning use and the use of antenatal care has important implications for women’s access to crucial maternal health services. Ensuring that postpartum women have access to high-quality postpartum services, including family planning and counseling about birth spacing and limiting options, is an important strategy in reducing both maternal and early childhood mortality rates. Postpartum family planning also offers healthcare providers the opportunity to counsel young women about their fertility intentions, and for those who want another child, to counsel about healthy intervals for spacing the next pregnancy.
The ACCESS-FP program focuses on meeting the family planning and reproductive health needs of women in the postpartum period. Interventions are designed to complement those of the ACCESS Program in the promotion and scale-up of postpartum family planning through community and clinical interventions. ACCESS-FP seeks to reposition family planning through integration with maternal, newborn, and child health programs.