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We conduct a randomized controlled trial that provides pregnant and immediate postpartum women with improved access to family planning through counseling, free transportation to a clinic, and financial reimbursement for family planning services over two years. We study the effects of our intervention on child growth and development outcomes among 1,034 children born to participating women directly before the intervention rollout. We find that children born to mothers assigned to the family planning intervention arm were 0.28–0.34 standard deviations taller for their age and 10.7–12.0 percentage points less likely to be stunted within a year of exposure to the intervention. Children born to mothers assigned to the intervention arm also scored 0.17–0.20 standard deviations higher on a caregiver-reported measure of cognitive development after two years of intervention exposure. Although the nonmeasurement of children is a challenge in our study, our estimates are robust to multiple methods of correcting for potential attrition bias. Our results are consistent with models of fertility that link couples' fertility decisions to child health and human capital. Our results also suggest that improved access to family planning might have positive downstream effects on child health beyond contraceptive use and fertility outcomes. [ABSTRACT FROM AUTHOR]

Injectables are one of the most popular methods of contraception worldwide, particularly in sub‐Saharan Africa. An advantage of injectables over shorter‐acting methods is that they provide additional flexibility by not requiring re‐supply as frequently. However, there is a risk that injectable users may delay their next injection and may therefore have reduced or no protection from pregnancy. In surveys, women may report that they are using contraception in the form of injectables when the time since they had their last injection (more than four months) would imply that they have reduced protection against the risk of pregnancy. We carried out two field studies in urban Malawi, and we record reported injectable contraceptive use while also asking the number of months since women received their last injection. We observe that 13.8 percent of women who report using injectables also report that they received their last injection more than four months ago, and 11 percent report that they received their last injection more than six months ago. Our analysis highlights the need for additional follow‐up with women who report using injectables in surveys to confirm whether they are, in fact, using the method effectively. [ABSTRACT FROM AUTHOR]

Studies have suggested that improving access to family planning (FP) may improve contraceptive use and reduce fertility. However, high-quality evidence, particularly from randomized implementation trials, of the effect of FP programs and interventions on longer-term fertility and birth spacing is lacking. We conduct a nonblinded, randomized, controlled trial to assess the causal impact of improved access to FP on contraceptive use and pregnancy spacing in Lilongwe, Malawi. A total of 2,143 married women aged 18 to 35 who were either pregnant or had recently given birth were recruited through home visits between September 2016 and January 2017 and were randomly assigned to an intervention arm or a control arm. The intervention arm received four services over a 2-y period: 1) up to six FP counseling sessions; 2) free transportation to an FP clinic; 3) free FP services at the clinic or financial reimbursement for FP services obtained elsewhere; and 4) treatment for contraceptive-related side effects. Contraceptive use after 2 y of intervention exposure increased by 5.9 percentage points, mainly through an increased use of contraceptive implants. The intervention group's hazard of pregnancy was 43.5% lower 24 mo after the index birth. Our results highlight the positive impact of increased access to FP on a woman's contraceptive use. In addition, we show that exposure to the FP intervention led to a prolongation of birth intervals among intervention women relative to control women and increased her control over birth spacing and postpartum fertility, which, in turn, may contribute to her longer-term health and well-being. [ABSTRACT FROM AUTHOR]

Purpose: Study findings suggest association between anemia and postpartum depression, but available evidence is scant and inconsistent. We investigate whether anemia is related to postpartum depression among women who have recently given birth in Malawi, where anemia prevalence is high., Methods: We use cross-sectional data from 829 women who were 18-36 years old, married, lived in Lilongwe, Malawi, and gave birth between August 2017 and February 2019. The primary outcome is postpartum depression in the year after birth, defined by the Patient Health Questionnaire-9 (PHQ-9). Anemia status was assessed using hemoglobin levels that were measured at the time of the interview. Multivariate logistic regression analyses were used to investigate the relationship between postpartum depression and anemia status., Results: Our analysis sample consists of 565 women who completed the PHQ-9, tested for anemia, and had no missing values for covariates. Of these women, 37.5% had anemia (hemoglobin levels ≤ 110 g/L), and 2.7% were classified as showing symptoms of a major depressive disorder (MDD). After adjusting for potential confounders, anemia was significantly associated with increased risk of MDD (OR: 3.48, 95% CI: 1.15-10.57, p -value: 0.03). No significant associations were found between other covariates and postpartum depression., Conclusions: Our findings suggest a potential association between anemia and postpartum depression among women in Malawi. Policies that aim to improve nutrition and health outcomes for pregnant and postpartum women could generate a "double benefit" by both preventing anemia and reducing the risk of postpartum depression.