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Ccih 2014-fp-immunization-integration-anne-pfitzer


Anne Pfitzer, Family Planning Technical Team Leader, MCHIP, discusses post-partem family planning and the importance of integrating family planning services with immunization services.

Anne Pfitzer, Family Planning Technical Team Leader, MCHIP, discusses post-partem family planning and the importance of integrating family planning services with immunization services.

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  • 1. Family Planning Integration within Maternal, Newborn and Child Health and Nutrition CCIH conference; Integrating Family Planning into other health programs Anne Pfitzer, MCHIP Family Planning Team Leader Family Planning and Immunization Integration Rebecca Fields, MCHIP Sr. Immunization Advisor
  • 2. Why integrate?  Short birth intervals result in:  51% more LBW, 58% more preterm  If <18 months → 83% more infant deaths  If <24 months → 61% more newborn deaths → 48% deaths in children <5 Sources: Kozuki, Lee, et al, 2013, BMC Public Health, 13(Suppl 3) Kozuki & Walker, 2013, BMC Public Health, 13(Suppl 3) → Children 25% more stunted and 25% more underweight Source: Rutstein, 2008, DHS Working paper 41
  • 3. Short intervals are very common Source: Moore, Z et al, An Analysis of Birth-to-Pregnancy Intervals, Contraceptive Method Use, and Pregnancy Risk Among Postpartum Women in 21 Low- and Middle-Income Countries (forthcoming) Percentage of Postpartum Women with Short, Ideal and Long Birth-to-Pregnancy Intervals
  • 4. Pakistan Return to Fertility and Pregnancy Risk (DHS 2006-07) Factors influencing return to fertility among all women 0–24 months postpartum Risk of pregnancy among sexually active women 0–24 months postpartum Postpartum Women: N = 3,375 Return to Menses: N = 2,304 Sexually Active: N = 2,741 Exclusive Breastfeeding: N = 430 Predominant Breastfeeding: N = 755 Sexually Active: N = 2,741 Using Modern FP: N = 571 Predominant Breastfeeding: N = 456 Note: the women predominantly breastfeeding from 6-11.9 months have increasing risk of return to fertility, especially if their menses have returned
  • 5. PPFP: High Unmet Need, Low Use 5 Source: Ross and Winfrey “Contraceptive use, Intention to use, and unmet need during the extended postpartum period, Intl FP Perspectives, 2001. Want to space or limit, 95% Using a FP method, 38% Not using a FP method, 62% 0-12 Months Postpartum Women Other, 5%
  • 6. Family Planning; Every Woman, Every Time
  • 7. Lactational Amenorrhea Method (LAM)
  • 8. MIYCN-FP integration  Kenya model demonstration  Facility: Multiple integration points  ANC, L&D/PNC and child health  Community through CHVs  Home visits, breastfeeding support groups, community mobilization
  • 9. Postpartum IUDs  13 countries supported by MCHIP  Low complication rates:  Expulsion, infection, perforation  Acceptable  Cramping and bleeding masked
  • 10. Liberia: FP/Immunization Integration 10
  • 12. DTP3 stagnant and lower, at 73-75%, in poorest countries for past 5 years
  • 13. Integration: a guiding principle in the Global Vaccine Action Plan for the Decade of Vaccines, 2010-2020  On integration, GVAP says: “Strong immunization systems, as part of health systems and closely coordinated with other primary health care delivery programmes, are essential for achieving immunization goals.”  Higher priority on integration of health interventions to address a common condition, e.g., vaccines + case management to reduce pneumonia or diarrheal disease
  • 14. Possible effects on immunization of integrating services with family planning Positive: - Secure support for EPI by using it as platform to serve another program - By increasing convenience to caregivers through “one stop shopping” increase utilization of services and vaccination coverage Negative: - Deter mothers who accept EPI but not FP - Create confusion that EPI is really FP and a masked attempt to sterilize women or children
  • 15. Precedent: experiences with negative consequences  Cameroon (early 1990s) – death threats to vaccinators; halted immunization efforts for 2-3 years  Philippines (early 1990s) – halt in immunization services, lingering damage; efforts to engage Church did not succeed  Madagascar (2004/05) – MCH Weeks with FP and tetanus toxoid for women  confusion, distrust, ineffective campaign  Northern Nigeria (2004-2006) – allegations that polio vaccine is sterilizing agent  the failure of polio campaigns led to re- introduction of polio virus to countries as distant as Indonesia; massive, multi-country setback to Polio Eradication Initiative that lasted years  Pakistan (2012-present) – targeted murders of >75 vaccinators and escorts for polio campaigns due to allegations that campaigns sterilize children and are related to spying
  • 16. For engaging the immunization community 17 Reduce risks • Design approaches that minimize hazards. DO NOT INTEGRATE FP and EPI DURING IMMUNIZATION MASS CAMPAIGNS. • Design win/win approaches intended to benefit EPI and FP Show benefits • Actively measure effects on EPI using MOH EPI data • Share data that demonstrate gains, if documented Share experience • Engage country level immunization staff in both designing and sharing FP/Imm experiences • Disseminate the how-to approach so it can be replicated
  • 17. Useful resources:  Toolkits on K4Health  PPFP  MIYCN-FP  FP-Immunization  Join Communities of practice  Endorse Statement for Collective Action! 18
  • 18. THANK YOU! 19