The unmet needs for modern family planning methods among postpartum women in Sub-Saharan Africa: a systematic review of the literature.

Abstract

Background: Sub-Saharan Africa has the highest fertility rate in the world, with the highest unmet need for family planning (FP). Yet, there is a lack of knowledge about the determinants for non-utilisation of modern contraceptive methods among women of reproductive age. This systematic review of literature assessed factors affecting the unmet need and reasons for non-utilisation of modern contraceptive methods during the postpartum period in Sub-Saharan African women. Methods: An online literature search was conducted in several databases: MEDLINE, Cochrane Review, PubMed, Elsevier's Science Direct and Web of Science. The search was completed by hand searching. Data were extracted and summarised using the Arksey and O’Malley methodology. Results: In total, 19 studies were included; one qualitative study, seventeen quantitative, and one used a mixed-methods approach. Studies were conducted in Ethiopia (n=11), Nigeria (n=3), Kenya (n=2), Malawi (n=2) and Uganda (n=1). Factors affecting the unmet need for modern contraceptive methods were described at three levels: a) individual; b) household; and c) healthcare facility level. Reasons for non-use of FP included: fear of side effects; husband’s disapproval; the no-return of menses; abstinence; and low perception of risk of pregnancy. Conclusion: Unmet needs in postpartum FP in women from Sub-Saharan Africa were associated with health-system and socio-demographic determinants. We suggest that there is a need to improve the awareness of modern contraceptive methods through effective interventions. Further research is needed for under-studied countries on this continent.