Postpartum contraception and female empowerment in sub-Saharan Africa
Background: Family planning is the delay, spacing, and prevention of pregnancies for controlling fertility rates. Postpartum contraception (PCC) is the initiation of any family planning method within 12 months of a pregnancy outcome (World Health Organization, 2013). In Zambia it is estimated 21.1% of women have an unmet need for FP (Central Statistical Office (CSO)[Zambia] Ministry of Health (MOH) [Zambia] & International, 2014). Current guidelines suggest women wait 24 months between pregnancies; postpartum contraception is recommended to be initiated as soon as possible after a pregnancy outcome (Marston, 2007). Objective: Objectives are to: 1) assess trends of PPC in Zambia using cross-sectional data from 2001 to 2018, 2) identify the association between female empowerment and PPC use in Zambia and, 3) explore the role of PEPFAR funding on increased PPC use in sub-Saharan Africa. Methods: Presented in a three-paper format, all papers utilized secondary data from Demographic Health Surveys (DHS) collected from 2001 to 2019 in sub-Saharan Africa. Paper 1 assessed trends in PPC use in Zambia from 2001 to 2018; along with event study modeling to assess the impact of two nation-wide initiatives for long-acting reversible contraception on PPC in rural Zambia. Paper 2 utilized the 2018 round of DHS data from Zambia, and latent class analysis (LCA) was utilized for female empowerment measured at the individual and spousal levels. Paper 3 utilized DHS rounds from five sub-Saharan African countries from 2001 to 2019 to assess whether PEPFAR funding was associated with PPC and female empowerment over time using difference-in-differences and logistic regression modeling. Conclusion: Results provide insight to trends and factors associated with PPC use, including the role of nation-wide programs and foreign aid.