Postpartum family planning in Mozambique: Factors for use, decision-making, and the promise of community-based distribution

The benefits of family planning are well documented and unequivocal. Allowing women to space or limit pregnancies through access to modern contraceptive methods can empower women to achieve their desired fertility, prevent deaths and disability that result from pregnancy and unsafe abortion, and may lead to broader benefits, such as increased education and economic opportunities for women and their children. Postpartum family planning is defined as the prevention of pregnancy during the 12 months after childbirth, and it has the potential to improve the health of women, infants, and children in less developed countries. Research has shown that short birth-to-conception intervals are associated with adverse infant, child, and maternal outcomes. The World Health Organization recommends postpartum family planning as a critical component of health care that has the potential to meet women’s desire for contraception, and save millions of lives.Despite the importance of postpartum family planning, some countries continue to face challenges related to improving contraceptive use. Mozambique has had particular difficulty meeting its family planning goals. The fertility rate in Mozambique increased from 5.5 in 2003 to 5.9 in 2011, with the highest levels of fertility found in rural areas (TFR 6.6) and among the poorest (TFR 7.2) and least educated women (TFR 6.8). Estimates from 2011 show that only 13.2% of married Mozambican women age 15-49 years used modern methods of contraception, and the unmet need for family planning is relatively high at 12.8%. This dissertation establishes the factors associated with postpartum family planning use in Mozambique. The research then aims to describe the contraceptive decision-making processes of postpartum women participating in a community-based injectables project in rural Mozambique. Finally, this dissertation presents a policy analysis of the strategic financing options for the community-based health services delivery program in Mozambique, which is integrally tied to expanding access to postpartum family planning