Starting contraception soon after a birth may not work for all women who want to space pregnancies

Postpartum contraceptive use is important in helping women avoid the health risks of closely spaced births. However, according to “A Fresh Look at the Level of Unmet Need for Family Planning in the Postpartum Period, Its Causes and Program Implications,” a Comment by John Cleland of the London School of Hygiene and Tropical Medicine et al., recommendations made on the best timing of contraceptive uptake for new mothers in developing countries must take into account the duration of protection against pregnancy provided by breast-feeding–induced amenorrhea. In countries where the duration of amenorrhea is short, the authors say, recommending immediate or early postpartum initiation of use is valid; however, in countries where amenorrhea typically lasts for around 12 months, as in most of Sub-Saharan Africa, early adoption of family planning provides redundant protection. In addition, high proportions of women in many African countries discontinue their initial method within the first year of use without switching to another; thus, amenorrhea and contraceptive use may end at about the same time, leaving women at risk of unintended pregnancy. In such countries, the authors argue, women should be given the choice of postponing use of contraceptives until amenorrhea ends, along with accurate information on the associated risk of pregnancy.