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Another common priority among the commitment-making countries in sub-Saharan Africa is postpartum family planning (PPFP), another High Impact Practice with demonstrable effect on contraceptive use across many settings.
PPFP saves the lives of mothers, newborns, and children by providing contraceptive counseling and services during antenatal care, labor and delivery, and the postpartum period.
To evaluate the potential increase in demand for postpartum contraception, we examine the “demand curve” of maximum modern contraceptive prevalence in these countries (Figure 9) as well as the percentage of women who are postpartum at any given time.) as well as the percentage of women who are postpartum at any given time.
The demand curve was developed by Track20 to represent the likely maximum MCP that can be reached in a country given the level of demand. The curve is created by fitting an exponential curve to the maximum of all available DHS survey data on MCP and ideal number of children, an indicator that represents a broad range of social and cultural norms that influence the motivation to use, or not use, contraception.
Figure 9
Demand Curve
East & Southern Africa
West Africa
In all 15 countries for which we have analyzed commitments, the mean ideal number of children is high, ranging from 3.7 in Rwanda to 9.2 in Niger. It is generally higher among West African countries than East & Southern African countries. The gap between where a country sits on the graph and the curve is called the “potential use gap” and indicates where there is room for increased uptake of family planning. The larger the preferred family size, the more likely women are to use family planning to space births rather than limit them.
In Togo, for example, current modern contraceptive prevalence for married women is 17.3% and the mean ideal number of children of 4.3. The gap between the current MCP and the curve is about 25 percentage points. That should be considered the maximum increase in MCP possible for Togo given women’s current fertility desires.
The closer a country is to the curve, the less opportunity there is for modern contraceptive prevalence to increase and the more slowly MCP will grow. For countries sitting right on the curve or close to it, future growth in MCP may not be possible unless there are further changes in demand. This can happen if social norms change and women begin preferring smaller families. If the mean ideal number of children decreases, the demand for modern contraception will increase as more women seek to prevent unintended pregnancy.
The East & Southern African countries in our sample have a smaller proportion of postpartum women (less than 15% at any given time). Except in Rwanda, fewer than half of these postpartum women are using modern contraception.
While countries cannot expect all postpartum women to use family planning, there is nevertheless a significant opportunity to increase contraceptive choice and reduce maternal and newborn mortality through improved PPFP counseling and service delivery.
Figure 10
Proportion of Postpartum Women as Part of Women of Reproductive Age and Their Modern Cotraceptive Use
Using at 6 Months
Not Using at 6 Months
Rwanda and PPFP
Since 2015, the Rwanda Ministry of Health has worked with global partners such as the Maternal and Child Survival Program of the U.S. Agency for International Development (USAID) to expand postpartum family planning (PPFP) services.
The scale-up of PPFP interventions resulted in tremendous gains, with modern PPFP use at six months increasing from 38% in 2014 to 50% in 2019. Today, around 50% of postpartum women in Rwanda are using a modern method of contraception.
These results also suggest that while modern contraceptive use among postpartum women can significantly increase if family planning programs improve interventions, not all postpartum women will opt to use modern contraception.
For more information, analysis and reports:
For more information, analysis and reports:
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