BACKGROUND Short birth intervals increase risk for adverse maternal and infant outcomes including preterm birth, low birth weight (LBW), and infant mortality. Although postpartum family planning (PPFP) is an increasingly high priority for many countries, uptake and need for PPFP varies in low- and middle-income countries (LMIC). We performed a systematic review and meta-analysis to characterize postpartum contraceptive use, and predictors and barriers to use, among postpartum women in LMIC. METHODS PubMed, EMBASE, CINAHL, PsycINFO, Scopus, Web of Science, and Global Health databases were searched for articles and abstracts published between January 1997 and May 2018. Studies with data on contraceptive uptake through 12 months postpartum in low- and middle-income countries were included. We used random-effects models to compute pooled estimates and confidence intervals of modern contraceptive prevalence rates (mCPR), fertility intentions (birth spacing and birth limiting), and unmet need for contraception in the postpartum period. RESULTS Among 669 studies identified, 90 were selected for full-text review, and 35 met inclusion criteria. The majority of studies were from East Africa, West Africa, and South Asia/South East Asia. The overall pooled mCPR during the postpartum period across all regions was 41.2% (95% CI: 15.7-69.1%), with lower pooled mCPR in West Africa (36.3%; 95% CI: 27.0-45.5%). The pooled prevalence of unmet need was 48.5% (95% CI: 19.1-78.0%) across all regions, and highest in South Asia/South East Asia (59.4, 95% CI: 53.4-65.4%). Perceptions of low pregnancy risk due to breastfeeding and postpartum amenorrhea were commonly associated with lack of contraceptive use and use of male condoms, withdrawal, and abstinence. Women who were not using contraception were also less likely to utilize maternal and child health (MCH) services and reside in urban settings, and be more likely to have a fear of method side effects and receive inadequate FP counseling. In contrast, women who received FP counseling in antenatal and/or postnatal care were more likely to use PPFP. CONCLUSIONS PPFP use is low and unmet need for contraception following pregnancy in LMIC is high. Tailored counseling approaches may help overcome misconceptions and meet heterogeneous needs for PPFP.

中文翻译：

---

对低收入和中等收入国家妇女产后避孕药使用情况的系统回顾和荟萃分析。

背景 较短的出生间隔会增加不良孕产妇和婴儿结局的风险，包括早产、低出生体重 (LBW) 和婴儿死亡率。尽管产后计划生育 (PPFP) 对许多国家来说越来越重要，但低收入和中等收入国家 (LMIC) 对 PPFP 的采用和需求各不相同。我们进行了系统回顾和荟萃分析，以描述中低收入国家产后妇女的产后避孕药使用情况以及预测因素和使用障碍。方法 检索 PubMed、EMBASE、CINAHL、PsycINFO、Scopus、Web of Science 和 Global Health 数据库，查找 1997 年 1 月至 2018 年 5 月期间发表的文章和摘要。有关低收入和中等收入人群产后 12 个月避孕药具采用率数据的研究国家也包括在内。我们使用随机效应模型来计算现代避孕普及率 (mCPR)、生育意愿（生育间隔和生育限制）以及产后未满足的避孕需求的汇总估计值和置信区间。结果 在确定的 669 项研究中，选择了 90 项进行全文审查，35 项符合纳入标准。大多数研究来自东非、西非和南亚/东南亚。所有地区产后期间的总体汇总 mCPR 为 41.2%（95% CI：15.7-69.1%），西非的汇总 mCPR 较低（36.3%；95% CI：27.0-45.5%）。所有地区未满足需求的总体发生率为 48.5%（95% CI：19.1-78.0%），其中南亚/东南亚最高（59.4，95% CI：53.4-65.4%）。由于母乳喂养和产后闭经而导致的低妊娠风险的认知通常与缺乏避孕措施和使用男用避孕套、戒断和禁欲有关。不采取避孕措施的女性也不太可能利用孕产妇和儿童健康 (MCH) 服务并居住在城市环境中，并且更有可能担心方法的副作用并获得不充分的 FP 咨询。相比之下，在产前和/或产后护理中接受 FP 咨询的女性更有可能使用 PPFP。结论 中低收入国家 PPFP 使用率较低，怀孕后未满足的避孕需求较高。量身定制的咨询方法可能有助于克服误解并满足 PPFP 的不同需求。