The Causal Impact of Family Planning on Women’s Contraceptive Use and Birth Spacing

Photo by Martino Pietropoli via Unsplash.

Intervals of less than 24 months between pregnancies and births can adversely affect maternal and child health, particularly in Sub-Saharan Africa. While studies suggest that improving access to family planning services may also improve women’s contraceptive use and reduce fertility, high-quality evidence of the effect of family planning interventions on longer-term fertility and birth spacing has been lacking.

In a new journal article published in the Proceedings of the National Academy of Sciences, Mahesh Karra and coauthors present findings from a randomized controlled trial that assessed the impact of improved access to family planning on contraceptive use and pregnancy spacing in Lilongwe, Malawi. A total of 2,143 married women ages 18-35 who were either pregnant or had recently given birth were recruited for the trial and randomly assigned to an intervention group or a control group. The intervention group received four services over a two-year period: up to six family planning counseling sessions; free transportation to a family planning clinic; free family planning services at the clinic, or financial reimbursement for family planning services obtained elsewhere; and treatment for contraceptive-related side effects. 

Main findings:
  • Contraceptive use after two years of intervention exposure increased by 5.8 percentage points, mainly through increased use of contraceptive implants. 
  • The intervention group’s hazard of pregnancy was 43.5 percent lower 24 months after their initial birth.

The results highlight the positive impact of increased access to family planning on women’s contraceptive use. In addition, the authors show that exposure to the intervention increased the intervention group’s control over birth spacing and postpartum fertility, which in turn may contribute to women’s longer-term health and well-being.

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