Published in PLOS One on 2026-04-17, this study is presented as an attributed evidence briefing. The excerpts below are the original researchers’ words, reproduced under their Creative Commons Attribution licence. Health Signal has selected the abstract and, where needed, opening background paragraphs; the complete methods, results, limitations and references remain in the linked paper.
Original authors: Ritbano Ahmed Abdo, Endalew Gemechu Sendo, Erdaw Tachbele Betre, Kedir Hussen
Source: PLOS One • DOI 10.1371/journal.pone.0346885
Read the complete primary study ↗ · Creative Commons Attribution licence
From the researchers
Abstract
Reducing unintended pregnancies and improving maternal/child health relies heavily on postpartum family planning (PPFP). Despite their high effectiveness, the use of long-acting reversible contraceptives (LARC), such as intrauterine contraceptive device (IUCD) and implants, is inconsistent in Africa after childbirth. This systematic review and meta-analysis aimed to assess the prevalence and determinants of immediate and extended postpartum use of long-acting reversible contraceptives in Eastern and Western Africa.
We searched PubMed, the Cochrane Library, Hinari, and gray literature sources (Google Scholar) for studies published between January 1, 2015, and December 12, 2025. Eligible studies reported LARC uptake within 12 months of postpartum. Heterogeneity was assessed using the I² statistic, publication bias using Egger’s test, and study quality using the JBI 2020 checklist. Data were analyzed using Stata version 17 and R version 4.5.
Sixty-eight studies were included, most of which were from Eastern Africa. The pooled prevalence was 21.7% for immediate postpartum LARC (IPP-LARC) and 19.5% for extended postpartum LARC (EPP-LARC). Uptake was significantly associated with counseling during maternal and child health visits, partner involvement, prior family planning use, and good knowledge. Age ≥ 35 years and higher education level also favored immediate postpartum IUD use.
The uptake of postpartum LARCs remains low in Eastern and Western Africa. Strengthening FP counseling during MCH services, encouraging partner involvement, and improving knowledge are critical strategies to increase coverage and reduce unmet needs.
PROSPERO International Prospective Register of Systematic Reviews (ID: CRD420250577642).
Introduction
Maternal health conditions in Sub-Saharan Africa (SSA) remain a principal global health challenge, characterized by persistently high rates of maternal mortality and morbidity [1–3]. This public health crisis is critically fueled by unintended [4–6] and closely spaced pregnancies [7,8], which are potent risk factors for a series of adverse outcomes, including unsafe abortion, preterm delivery, and low infant birth weight [7,9–13]. The persistence of these conditions underscores profound deficiencies in reproductive healthcare systems and highlights the urgent need to strengthen contraceptive access and utilization as a foundational strategy for improving maternal survival.
The postpartum period is a particularly strategic interval for interventions [14,15]. During this time, nearly one-fourth of women in SSA experienced an unmet need for family planning, desiring to avoid pregnancy while not using contraception [16–18]. This gap represents a critical failure in service delivery, often described as a “missed opportunity” for facility-based childbirth. Despite direct contact with the healthcare system, many women are discharged without integrated counseling or contraceptive provision [19,20], perpetuating rapid, high-risk repeat pregnancies [19,21–26].
Long-acting reversible contraceptives (LARCs), including implants and intrauterine contraceptive device (IUCD) [27–31], are highly effective, safe for most women, and provide long-term, user-independent protection [32–35]. Their “forgettable” nature is especially advantageous in meeting the demands of the postpartum and infant-care periods [35–37]. Immediate postpartum initiation (within 48 h of delivery) leverages high motivation and existing clinical infrastructure [17], whereas extended postpartum use (up to 12 months) ensures sustained protection and supports the WHO-recommended birth-to-pregnancy interval of at least 24 months [38].
Reading this evidence
Use the full paper to check the study design, participant selection, comparator and outcome definitions before drawing a practical conclusion. An association does not by itself show cause and effect. A reported performance measure needs its denominator and uncertainty. A finding from a particular facility, sample or time period should retain that scope when it is discussed elsewhere.
This briefing makes the source accessible within the wider research & evidence desk. It does not assess an individual patient or certify a product. When considering relevance to another health system, examine the original authors’ account of context and limitations, then seek local implementation evidence. The related reporting below provides other studies to read alongside this one; it is a topic connection, rather than a claim that their results are directly comparable.
© 2026 Ritbano Ahmed Abdo, Endalew Gemechu Sendo, Erdaw Tachbele Betre, Kedir Hussen. Excerpts reproduced under CC BY. Selection, formatting and contextual notes by Health Signal. The researchers are the authors of the source study, not members of Health Signal’s staff.
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