Immediate postpartum use of long-acting reversible contraceptives in low- and middle-income countries

Globally, data show that many women of reproductive age desire to use modern family planning methods. Many of these women do not have access to modern contraceptives, which is termed their ‘unmet need’ for contraception. In low- and middle-income countries where total fertility rates can be high and many women have undesired fertility, or wish to increase their inter-pregnancy intervals, access to modern contraceptives is often inadequate. The puerperium is a unique time for interventions to offer modern contraceptive methods. Having just given birth, women may desire contraceptives to prevent short-interval pregnancy, or further pregnancy, altogether. In high-, middle-, and low-income countries there has been an increased interest in the placement of long-acting reversible contraceptives at or immediately after delivery, regardless of delivery mode. These methods can provide women with highly effective contraception for years, can be manufactured at low cost, are generally well tolerated with a good safety profile, and do not require the user to remember to take them. Oral contraceptives and injectable medications require the patient to present to the clinic during a specific timeframe for follow-up care or a refill, and the clinic may not be proximate, affordable, or have the desired contraceptive in stock. This document will review the currently published literature on the use of immediate postpartum long-acting reversible contraceptives (placed within two days of delivery) in low- and middle-income countries to report on the prevalence of use and satisfaction rates, and note the lack of data on cost and economic implications. We will also explore data on how future maternal, neonatal, and infant outcomes may be influenced by increased peripartum long-term contraceptive use.