CONTEXT: In many low-income countries, postpartum women typically start contraception after the resumption of sexual intercourse or menstruation. Postpartum breast-feeding and abstinence delay these events. Information isneeded on women's motivations to rely on these traditional birthspacing practices and their difficulties in startinga contraceptive method after a birth in urban West Africa.METHODS: In 2012, provider-client interactions and service delivery were observed for a week in seven health facilities in Ouagadougou, Burkina Faso, and semistructured interviews were conducted with 33 women and 12 menwith infants younger than 24 months. Existing postpartum family planning services and women's transition from traditional practices to a family planning method are described.RESULTS: Family planning is scheduled to be delivered at the six-week postpartum checkup, which women rarely attend. No women viewed amenorrhea as protective against pregnancy, and all had started or planned to start amethod just before or when they resumed sexual activity. Half of the women abstained for six or more months, and some then either adopted a method they used incorrectly or did not adopt one at all. The main difficulties includedproviders' requirements for amenorrheic women seeking contraceptives and husbands' refusal to refrain from unprotected sex.CONCLUSION: The initial postpartum family planning visit should occur right after delivery. Integration of family planning into immunization programs would provide opportunities to reach women who did not adopt a methodearly in the postpartum period. Provider barriers for amenorrheic women should be ended. Men should be involved in the postpartum family planning consultation.