Measuring Postpartum Pregnancy Risk to Improve Healthy Birth Intervals

Although the World Health Organization recommends using postpartum family planning (PPFP) to promote healthy birth spacing to improve maternal and newborn outcomes, approximately 60% of postpartum women in low- and middle- income countries (LMICs) do not use contraception. Understanding demographic and temporal variation in the biological and behavioral determinants of postpartum pregnancy risk can help identify or strengthen family planning interventions during a critical reproductive window, yet research on this topic has been limited by data and methodological constraints. The goal of this research is to identify when women are at risk of short birth intervals during the postpartum period and the dynamic behaviors that increase or reduce such risk in Ethiopia. The proposed project will use two cohorts of longitudinal, population-based survey data following pregnant and postpartum women for 12 months after birth, with a total sample of approximately 5,209 Ethiopian women to achieve two specific aims. First, we aim to establish common postpartum pregnancy risk trajectories of women in a setting with low PPFP use and high risk for adverse maternal and newborn outcomes associated with short birth intervals. Using monthly data in the 12-month postpartum period on contraceptive use dynamics, sexual activity, and return of menses, we will use sequence and cluster analyses to identify and understand risk profiles for short birth intervals. Second, we will identify individual, interpersonal, and health system factors that predict postpartum pregnancy risk trajectories. We will use multivariable logistic regression to determine if and how individual (e.g., sociodemographic); interpersonal (e.g., intimate partner violence); and health system (e.g., PPFP counseling over the continuum of care) factors are related to postpartum pregnancy risk trajectories. By identifying risk profiles of women as they relate to short birth intervals, particularly women at sustained high risk for unintended pregnancies, the findings will inform and better tailor ongoing efforts and interventions in Ethiopia by revealing potentially modifiable risk factors. Results can also inform future research in similar LMIC contexts, as both a proof of concept for the methodology’s applicability to the postpartum period, as well as related to the specific findings. Project Number: 1R03HD115941-01A1 | Fiscal Year: 2025 | NIH Institute/Center: Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) | Principal Investigator: Dana Sarnak | Institution: JOHNS HOPKINS UNIVERSITY, BALTIMORE, MD | Award Amount: $155,000 | Activity Code: R03 | Study Section: Population Sciences Study Section[CHHD-W] View on NIH RePORTER: https://reporter.nih.gov/project-details/1R03HD11594101A1