***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVES To analyze data from recent Demographic and Health Surveys ( DHS ) conducted in 21 low- and middle-income countries ( LMICs ) to examine patterns of interpregnancy intervals , unmet need , pregnancy risk and family planning method use and method mix among women 0 - 23 months postpartum . STUDY DESIGN Secondary analysis of postpartum women aged 15 - 49 years in 22 DHS surveys from 21 LMICs conducted between 2005 and 2012 . We applied an adapted unmet need definition for postpartum women to look at prospect i ve fertility preferences . We also constructed a new composite pregnancy risk indicator for postpartum women who have been sexually active since their last birth . RESULTS In 9 of 22 surveys , 50 % or more of nonfirst births occur at interpregnancy intervals that are too short . Overall prospect i ve unmet need for family planning by postpartum women has not changed demonstrably since a 2001 analysis and is universally high : 61 % of all postpartum women across the 21 countries have an unmet need for family planning . In 10 of 22 surveys , pregnancy risk rises steadily throughout the 2 years after birth . In the remaining 12 surveys , the risk of pregnancy peaks at 6 - 11 months after birth . Even when postpartum women are using family planning , they rely overwhelmingly on short-acting methods ( 51 - 96 % in 21 of 22 surveys ) . CONCLUSION Our approach of estimating pregnancy risk by postpartum timing confirms a high probability for pregnancies to be less than optimally spaced within 2 years of a prior birth and suggests that special consideration is needed to effectively reach this population with the right messages and services . IMPLICATION S Using recent , multicountry data for women within 2 years postpartum in LMICs , this paper up date s existing estimates of high prospect i ve unmet need for family planning and presents a new composite pregnancy risk analysis based on postpartum women 's actual practice s to demonstrate the magnitude of missed opportunities for programmatic intervention for the postpartum population Objectives To determine the knowledge and attitudes on modern contraceptive use  of women living in an inner city area of Osogbo . Material s and methods Three hundred and fifty nine women of childbearing age were studied utilizing a community-based , descriptive , cross-sectional study design . A multistage r and om sampling technique was used in recruiting respondents to the study . A four-part question naire was applied dually , by interviewers and by respondents ’ self administration , and the data was analyzed using the SPSS software version 17.0 . Results The mean age of respondents was 28.6 ± 6.65 years . The majority ( 90.3 % ) of respondents were aware of modern methods of family planning ( FP ) , 76.0 % cl aim ed awareness of where to obtain FP services , and 74.9 % knew of at least five methods . However , only 30.6 % had ever used contraceptives , while only 13.1 % were current users . The most frequently used method was the male condom . The commonly perceived barriers accounting for low use of FP methods were fear of perceived side effects ( 44.0 % ) , ignorance ( 32.6 % ) , misinformation ( 25.1 % ) , superstition ( 22.0 % ) , and culture ( 20.3 % ) . Some reasons were proffered for respondents ’ nonuse of modern contraception . Predictors of use of modern contraceptives include the awareness of a place of FP service provision , respondents ’ approval of the use of contraceptives , higher education status , and being married . Conclusion Most of the barriers reported appeared preventable and removable and may be responsible for the reported low point prevalence of use of contraceptives . It is recommended that community-based behavioral-change communication programs be instituted , aim ed at improving the perceptions of women with respect to bridging knowledge gaps about contraceptive methods and to changing deep-seated negative beliefs related to contraceptive use in Nigeria Background During the post-partum period , most women wish to delay or prevent future pregnancies . Despite this , the unmet need for family planning up to a year after delivery is higher than at any other time . This study aims to assess fertility intention , contraceptive usage and unmet need for family planning amongst women who are six weeks postpartum , as well as to identify those at greatest risk of having an unmet need for family planning during this period . Methods Using the NICHD Global Network for Women ’s and Children ’s Health Research ’s multi-site , prospect i ve , ongoing , active surveillance system to track pregnancies and births in 100 rural geographic clusters in 5 countries ( India , Pakistan , Zambia , Kenya and Guatemala ) , we assessed fertility intention and contraceptive usage  at day 42 post-partum . Results We gathered data on 36,687 women in the post-partum period . Less than 5 % of these women wished to have another pregnancy within the year . Despite this , rates of modern contraceptive usage varied widely and unmet need ranged from 25 % to 96 % . Even amongst users of modern contraceptives , the uptake of the most effective long-acting reversible contraceptives ( intrauterine devices ) was low . Women of age less than 20 years , parity of two or less , limited education and those who deliver at home were at highest risk for having unmet need . Conclusions Six weeks postpartum , almost all women wish to delay or prevent a future pregnancy . Even in sites where early contraceptive adoption is common , there is substantial unmet need for family planning . This is consistently highest amongst women below the age of 20 years . Interventions aim ed at increasing the adoption of effective contraceptive methods  are urgently needed in the majority of sites in order to reduce unmet need and to improve both maternal and infant outcomes , especially amongst young women . Study registration Clinical trials.gov ( ID # NCT01073475 Objectives : The objectives of this study were to determine patterns of contraceptive utilization among sexually active HIV-1-seropositive women postpartum and to identify correlates of hormonal contraception uptake . Goal : The goal of this study was to improve delivery of family planning services to HIV-1-infected women in re source -limited setting s. Study Design : HIV-1-infected pregnant women were followed prospect ively in a perinatal HIV-1 transmission study . Participants were referred to local clinics for contraceptive counseling and management . Results : Among 319 HIV-1-infected women , median time to sexual activity postpartum was 2 months and 231 ( 72 % ) women used hormonal contraception for at least 2 months during follow-up , initiating use at approximately 3 months postpartum ( range , 1–11 months ) . Overall , 101 ( 44 % ) used  DMPA  , 71 ( 31 % ) oral contraception , and 59 ( 25 % ) switched methods during follow-up . Partner notification , infant mortality , and condom use were similar between those using and not using contraception . Conclusions : Using existing the healthcare infrastructure , it is possible to achieve high levels of postpartum hormonal contraceptive utilization among HIV-1-seropositive women Despite renewed interest in postpartum family planning programs , the question of the time at which women should be expected to start contraception after a birth remains unanswered . Three indicators of postpartum unmet need consider women to be fully exposed to the risk of pregnancy at different times : right after delivery ( prospect i ve indicator ) , after six months of amenorrhea ( intermediate indicator ) , and at the end of amenorrhea ( classic indicator ) . DHS data from 57 countries in 2005 - 13 indicate that 62 percent ( prospect i ve ) , 43 percent ( intermediate ) , and 32 percent ( classic ) of women in the first year after a birth have an unmet need for contraception  ( 40 percent when including abstinence ) . While the protection afforded by postpartum abstinence and lactational amenorrhea lowers unmet need , further analysis shows that women also often rely on these methods without being actually protected . Programs should acknowledge these methods ' widespread use and inform women about their limits . Also , the respective advantages of targeting the postnatal period , the end of six months of amenorrhea/exclusive breastfeeding , or the resumption of sexual intercourse to offer contraceptive services should be tested Abstract Objective To determine the influence of multiple contraceptive counselling sessions during antenatal care on use of modern postpartum contraception . Method A total of 216 eligible pregnant women were r and omised into antenatal and postnatal counselling groups . The ‘ Antenatal group ’ received one-to-one antenatal contraceptive counselling on several occasions while the ‘ Postnatal group ’ received a single one-to-one contraceptive counselling session at the sixth week postnatal check , as is routinely practised . All participants were contacted six months postpartum by telephone or personal visit , and question ed about their contraceptive use , if any . Results More women who had multiple antenatal contraceptive counselling sessions  used modern contraceptive methods than those who had a single postnatal counselling session ( 57 % vs. 35 % ; p = 0.002 ) . There was also a significantly more frequent use of contraception among previously undecided patients in the Antenatal group ( p = 0.014 ) . Conclusion Multiple antenatal contraceptive counselling sessions improve the use of modern postpartum contraception Objective To determine the level of Unmet need for Contraception among women in the first year post-delivery in Ile-Ife , Nigeria . Methods A prospect i ve study of 256 women attending antenatal clinic of the OAUTHC , Ile-Ife , Nigeria was carried out 9–10 months post-delivery . Using a semi-structured question naire , the respondents were interviewed for socio-demographic characteristics ; obstetric , sexual , and contraception history were also taken . The data were analyzed using descriptive and inferential statistical methods . Results There was a high level of unmet need ( 59.4 % ) in the sample of Nigerian women despite a high level of awareness of common methods of contraception . Education and parity had no significant effect on usage of contraception ( p > 0.05 ) . No reason was given for non-usage in the largest proportion ( 30.3 % ) of the non-users . Only one-third of the respondents could correctly report the ‘ at-risk ’ period for getting pregnant in the post-partum period . Conclusion There is a need to study in more detail the social and cultural factors that determine contraceptive utilization before success can be achieved in closing the gap of unmet need , as it has become evident that increasing the awareness and knowledge of contraception is not enough to achieve the objectives of family-planning programs The objectives of this study were to describe the most recent pregnancy intentions and family planning preferences of HIV-infected and HIV-uninfected postpartum Malawian women , and to assess whether HIV status is associated with fertility desire and knowledge of intrauterine contraception ( IUC ) and the subdermal contraceptive implant . We conducted a cross-sectional analysis of the baseline characteristics of Malawian women enrolled in a prospect i ve cohort study assessing postpartum contraceptive uptake and continuation . Women at a government hospital completed a baseline survey assessing reproductive history , family planning preferences , and knowledge of IUC and the implant . We used Pearson 's chi-square tests to compare these parameters between HIV-infected and HIV-uninfected women . Modified Poisson regression was performed to assess the association between HIV status and fertility desire and knowledge about IUC and the implant . Of 634 postpartum women surveyed , HIV-infected women were more likely to report their most recent pregnancy was unintended ( 49 % vs. 37 % , p = 0.004 ) . Nearly all women ( 97 % ) did not want a child in the next 2 years , but HIV-infected women were more likely to desire no more children ( adjusted prevalence ratio [ PR ] : 1.59 ; 95 % confidence interval [ CI ] : 1.33 , 1.89 ) . HIV-infected women were also less likely to know that  IUC  ( adjusted PR : 0.72 ; 95 % CI : 0.61 , 0.84 ) and the implant ( adjusted PR : 0.83 ; 95 % CI : 0.75 , 0.92 ) are safe during breast-feeding . Postpartum women strongly desire family spacing and many HIV-infected postpartum women desire no more children , suggesting an important role for these long-acting methods . Education about the efficacy and safety of IUC and the implant  particularly during breast-feeding may facilitate postpartum use 
    Output:
    
Perceptions of low pregnancy risk due to breastfeeding and postpartum amenorrhea were commonly associated with lack of contraceptive use and use of male condoms , withdrawal , and abstinence .
Women who were not using contraception were also less likely to utilize maternal and child health ( MCH ) services and reside in urban setting s , and be more likely to have a fear of method side effects and receive inadequate FP counseling .
In contrast , women who received FP counseling in antenatal and /or postnatal care were more likely to use PPFP .
Conclusions PPFP use is low and unmet need for contraception following pregnancy in LMIC is high .
Tailored counseling approaches may help overcome misconceptions and meet heterogeneous needs for PPFP