Postpartum Abstinence and Birth Intervals in Africa: Their Variations and Implications for Replacement Contraceptive Use

Jacob Adetunji, Bill and Melinda Gates Foundation

Before the advent of modern family planning, postpartum abstinence and prolonged breastfeeding were major means of spacing births in many parts of sub-Saharan Africa. Using DHS data from 25 sub-Saharan African countries that have implemented at least three standard surveys, this paper investigates the extent to which the duration of postpartum abstinence has changed, and whether the change is reflected in observed trends in birth intervals, breastfeeding and contraceptive behavior of women in these countries. The analysis shows that median postpartum abstinence declined from an average of 11 months in the earliest surveys to about 9 months in the latest surveys, or an average of 0.1 month decrease per year. The largest declines were in Nigeria (8 months), Burkina Faso and Togo (7.5 months). There was an increase of about two months in both Rwanda and Uganda. Despite the decreases in the duration of postpartum abstinence, the average birth interval lengths have increased in sub-Saharan Africa by an average of 3.5 months to 36 months. Median duration of breastfeeding has remained stable in the region – which implies that there is some replacement contraceptive use in the region. The policy and research implications of these findings are discussed.

Keywords: Family Planning and Contraception

See extended abstract.