Determinants of Early Postpartum Contraceptive Use in Africa: A Scoping Review of Barriers and Facilitators of Early Postpartum Contraceptive Use

Abstract

Background: Early postpartum is a high-impact window during which contraception should be initiated to prevent unintended pregnancy and maximise birth spacing. In Africa, postpartum contraceptive uptake during the initial postpartum period continues to be heterogeneous and depends on various factors. Objectives: To map and synthesise empirical evidence (2006–2025) on determinants (barriers and facilitators) of early postpartum contraceptive use in African settings, identify evidence gaps, and provide implications for policy, practice, and research. Methods: We conducted a scoping review following PRISMA-ScR guidance. PubMed, Scopus, CINAHL, Web of Science and key grey literature sources (WHO, UNFPA, national reports) were searched between 5 October and 1 November 2025 for studies published 2006–2025. Two reviewers screened records and charted data on study design, setting, postpartum timeframe, contraceptive outcomes, and determinants. A thematic narrative synthesis grouped determinants into individual, interpersonal, health system, and structural domains. Results: From 3,200 records identified and 200 full texts screened, 63 studies met the inclusion criteria. Studies clustered in East and West Africa (notably Ethiopia, Kenya, Nigeria), with fewer from Central and Francophone Africa. Early postpartum contraceptive uptake varied widely: e.g., immediate postpartum IUD uptake ~19.3% in West Wollega, Ethiopia (hospital-based) and PPFP utilisation up to ~71% in Bule Hora District (community-based) (Dinsa et al., 2024; Sirage et al., 2024). Consistent facilitators across contexts were: maternal education, knowledge/awareness, antenatal/postnatal counselling, facility delivery and linkage of services (e.g., immunisation → FP), male/partner support, and proximity/access to services. Frequent barriers included myths and misconceptions, fear of side effects, partner or family opposition, poor provider counselling/attitudes, commodity stockouts, transport/distance, and restrictive cultural or religious norms. Evidence gaps included inconsistent definitions of “early postpartum,” underrepresentation of some regions and subpopulations (adolescents, WLHIV), and limited longitudinal or intervention studies. Conclusions: Early postpartum contraceptive uptake in Africa is influenced by multi-level determinants. Interventions should emphasise integrated counselling across the maternal care continuum, male engagement, service accessibility and method availability, and culturally tailored demand-generation. Research should standardise timing definitions, expand geographic coverage, and evaluate implementation strategies using longitudinal and intervention designs