(P24-012-24) Family Planning and Nutritional Status Among Women of Reproductive Age: A Systematic Review and Meta-Analysis

Objectives: Use of contraceptives may be related to maternal nutritional status through changes to birth spacing, parity, age at first birth, menstruation, and income. We aim to synthesize evidence of relationships between the use of family planning methods and nutritional outcomes among women of reproductive age (15-49 years), and adolescent girls (10-19 years) in low- and middle- income countries.

Methods: Searches for randomized controlled trials, non-randomized trials, and cohort studies published from 2000 on were conducted using PubMed, Embase, Web of Science, and Cochrane Library. Exposures of interest included any contraception type, with no restrictions by comparator arms. Main outcomes of interest were maternal anthropometry and iron-status indicators. Random effects meta-analyses were conducted on comparisons for which there were at least 3 studies with matching interventions and outcomes, and similar study designs. Certainty of evidence and risk of bias were assessed.

Results: Of 20,097 publications identified, we included 99 publications in our synthesis. In total, 23 interventions and 29 outcomes were reported, and 6 meta-analyses were conducted. Meta analysis of RCTs showed that use of hormonal IUD was associated with significantly higher hemoglobin than use of oral contraceptives (four studies; mean difference=1.25 g/dL; 95% CI: 0.38, 2.12; certainty=very low). Use of any hormonal contraceptive was associated with slightly lower BMI compared to non-contraceptive controls (seven studies; mean difference = -0.28 kg/m2; 95% CI: -0.52, -0.04; certainty=low). Evidence for all remaining relationships explored was very uncertain and not statistically significant.

Conclusions: There is weak and uncertain evidence that users of hormonal IUD have higher hemoglobin than users of oral contraceptives and that use of any hormonal contraceptive is associated with lower BMI compared to non-use. Menstrual blood losses are likely limited by hormonal IUDs, leading to higher hemoglobin compared to oral contraceptive users. The mechanisms behind lower BMI after use of hormonal contraceptives is unclear. More robust evidence on links between family planning and nutrition will help guide policy efforts to improve nutrition.

Funding Sources: Bill and Melinda Gates Foundation (grant # INV-042771)