This study aimed to determine the level of unmet need for postpartum family planning (PPFP) and associated factors. The study found a rate of 20.5% of unmet need for PPFP among women in Riyadh city. Although our findings were a little bit lower than what was found at the national level, it is important to emphasize that this study focused on PPFP and not unmet need in general. Other two studies conducted in the Southern Region of the Saudi Arabia in general and in Abha and Asser in particular, showed levels of unmet need for family planning of 34% and 32.6%, respectively (3, 12). However, these two studies examined the contraceptive behavior of women up to 5 years prior to the time of their study. When comparing our findings to similar studies in the Arab world, the level of unmet need for PPFP in Saudi Arabia is higher than Egypt (20.5% versus 16.3%) in 2017 (5). However, the estimated rate of unmet need in the Arab countries was found as 12%, according to the last UN report (2017) on contraceptive prevalence (7).
Worldwide, the rates of unmet need for postpartum family planning vary significantly. Our findings are comparable to other studies conducted across the globe. For instance, a group of researchers carried out a study on family planning among six-week postpartum women in five low-income countries (2015): India, Zambia, Pakistan Guatemala and Kenya, found the rate of unmet need for family planning ranged between 25.5% in Zambia to 96.6% in Pakistan (13). Controversial findings were found between different studies conducted in the region. For example, in Pakistan, Iraq, and Ethiopia a higher rate of unmet need for family planning was found than what we report in our study (32 %, 28.1%, 44%, respectively) (14-16).
As to the prevalence of contraceptive use, this study has shown that 62% of women use modern contraceptive methods and 14 % use traditional methods. It is noted here, that this level is higher than the national prevalence of unmet need which is 30% according to the UN report on contraceptive prevalence (7). This level could vary from rural to semi-urban to urban regions. All the participants in the study were from the urban area. The educational level and the occupation of the participants explain the high prevalence of contraceptive use. When compared to other studies, the level of prevalence of contraceptive in this study is lower than prevalence from Al Madinah (88.0%), (10) and Taif (67.7 %) in Saudi Arabia, as well as in Egypt (80.7 %) (5, 17). However, it was higher than the prevalence reported in Abha and Asser, the southern part of the country (54.7%) (3).
Post-Partum family planning seeks to prevent closely spaced and unintended pregnancies in the first 12 months postpartum. Studies have revealed that 30% of maternal deaths and 10 % of under-five child mortality can be prevented with the 2-year inter-birth interval (18). The prevention of closely spaced and unintended pregnancies should target not only those women who reported no use of family planning (perceived unmet need) but also who don’t consider themselves susceptible to pregnancy immediately (perceived no need) and those who use traditional FP methods (perceived met need). In this study, 14 % of the total need for FP was met with traditional methods, and 2.8 % do not see themselves at risk of falling pregnant.
Studies on unmet need for family planning usually distinguish four types of reasons: fear of side effects of the contraceptive methods, infrequent sex, opposition from partners and family members, and cultural and religious barriers (9, 15, 19, 20). The WHO is intensifying its efforts to increase the prevalence of contraceptive use globally, with a focus on the least developed regions. The Family planning initiative of 2020 seeks to promote family planning as a way of empowering women in the developing countries. This study has investigated the reasons for unmet need among the participants. The findings of the study reveal that breastfeeding and infrequent sex were the most reported reasons for unmet need, whereas family and Health issues were the less reported reasons. The findings of the study in relation to health issues are in contrast with many studies. In Egypt, fear of side effects was reported in 25% of the participants (21) in 2018 and 19.2% in the case of postpartum women in 2017 (5). Family issues were highly reported in this study, with 30.5%. Family issues in the research included husband’s opposition and opposition from relatives. Much of the literature focuses on the role of the spouse in unmet need. Husband opposition appeared in 15.9% of the cases in rural Egypt in 2018 (21), in 16.4 % in Iraq(14).
Limitations of the study
As this study was conducted in only one City of Saudi Arabia (Riyadh), thus, the findings could not be generalized for the whole country and considered among the limitation of the study, among others. Thus, a nation-wide study is needed to determine the real level of unmet need. The questionnaire used in the study addressed some key areas of unmet need, such as demographic characteristics, fertility preferences and contraceptive behavior. However, there are a few variables that could have been included, such as the ideal number of children and the role of the spouse in the choosing the family planning. These variables could have affected the level of unmet need. However, the current global trend is also using to measure unmet need by studying on men, as it usually investigates the attitudes and the collaboration of the husband in family planning. This study was exclusively investigated females. Therefore, a future study should be a male-based study to yield more results regarding the husband opposition/permission to contraceptives.
Although there are some limitations of this study, it is considered among the few studies conducted in Saudi Arabia and it is the first one done among attendees of the primary health care centers in the kingdom. Moreover, it is also the first study that investigates women at the postpartum state.