Family Planning

1. Jhpiego in partnership with Save the Children, Constella Futures, The Academy for Educational Development,
The American College of Nurse-Midwives and IMA World Health
Catharine McKaig
31 August 2001
A life saving
intervention within our
grasp: Postpartum
Family Planning
CHW and Mother, Healthy Fertility Study ,Bangladesh
Photo Credit: Salahuddin Ahmed

2. PPFP context
 Progress in maternal health- increased
emphasis on FANC, facility deliveries,
immediate postpartum
 New efforts in newborn care-
community based with emphasis on
the first week
 FP was in policies linked to postpartum
(6 wk) and MNCH, but not being
implemented
 Some FP in FANC;
 Not much PNC or PPFP;
 LAM not known or trusted;
 PPIUCD provision limited.
2
Father and Infant at Well baby Visit, Albania
Photo Credit: Galina Stolarsky

3. Postpartum family planning
Through one year
postpartum
 Return to fertility=pregnancy
risk
 Return to sexual activity
 Immediate, exclusive and
continued breastfeeding
 LAM and transition
 Method considerations: timing
and breastfeeding status
 Healthy spacing of the next
pregnancy
 Integration—tailoring to fit
with timing and service
Factors influencing fertility return
in Bangladesh
3
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
0-3 4-6 7-9 10-12
Sexually active
Return to menses
Exclusively breastfdg
Winfrey and Borda. 2007: Addressing the Family Planning
Needs of Women in the First Year Postpartum: Bangladesh.
ACCESS-FP

4. 4
High levels of unmet need - potential for
addressing maternal and child health
0 20 40 60 80 100
Bangladesh 2007
Zambia 2007
Nigeria 2003
India 2005-2006
Pakistan 2006-2007
Kenya 2003
Tanzania 2004-2005
Madagascar 2003-2004
Uganda 2006
Ghana 2003
Rwanda 2005
Ethiopia 2005
Percent unmet need
Winfrey and Borda. 2010. Postpartum fertility and contraception:
An analysis of findings from 17 countries. ACCESS-FP

5. FP use in the first year postpartum
LAM use 3-6 months FP use 9-12 months
5
0 15 30
Bangladesh 2007
Congo, DRC 2007
India 2005-2006
Kenya 2003
Malawi 2004
Pakistan 2006-2007
Uganda 2006
Ethiopia 2005
Tanzania 2004-2005
Rwanda 2005
Ghana 2003
Mali 2006
Nigeria 2003
Guinea 2005
Haiti 2005-2006
Madagascar 2003-2004
Zambia 2007
0 15 30 45
Guinea 2005
Mali 2006
Ethiopia 2005
Rwanda 2005
Congo, DRC 2007
Uganda 2006
Madagascar 2003-2004
Nigeria 2003
Ghana 2003
Haiti 2005-2006
Tanzania 2004-2005
Pakistan 2006-2007
Kenya 2003
India 2005-2006
Malawi 2004
Zambia 2007
Bangladesh 2007
Winfrey and Borda. 2010. Postpartum fertility and contraception:
An analysis of findings from 17 countries. ACCESS-FP

6. LAM transition- barrier analysis
Compared 40 transitioners and 40
non-transitioners
 Higher education for transitioners
(5 yrs) than non (3 yrs)
 Transitioners
 More likely to have menses
return
 More likely to report believing
they could become pregnant
when any of the criteria
changed
 Report they had social support
6
CHW counseling woman 30 day visit, Sylhet Bangladesh
(Credit: C. McKaig)
R. Anthony-Kouyate et al. Barrier Analysis LAM and Transition in
Sylhet, Bangladesh, ACCESS-FP, Report Forthcoming

7. Revisiting the PPIUCD
 Very effective, reversible, long-term method
 Does not effect quantity/quality of breastmilk
 Convenient for women (don’t need to return) – in
Egypt: 71.2% chose PP insertion and 7.2% chose interval
insertion
 Skilled birth attendants as providers
 Less expensive than interval – in Peru $9 for PPIUCD
insertion and $24 for interval insertion
 Increased cramping/bleeding masked by normal PP
symptoms
Foreit et al. 1993. International FP Perspectives. 19(1),19-24,33.
Mohamed, Med Princ Pract 2003;12: 170-175

8. Postpartum systematic screening in Nigeria
Among women attending immunization and pediatric care
in two sites, (88%) wanted to wait before getting
pregnant again or did not want any more children but
were not using FP
Intervention effectively improved counseling referring
41% for services, but only 15% of women went for
referrals on the same day
8
E. Charurat et al. Postpartum Systematic Screening in Northern Nigeria: A
Practical Application of Family Planning and Maternal Newborn and Child Health
Integration, ACCESS-FP, Report Forthcoming

9. FAMILY PLANNING
ANC-FP messages-
Immediate Post Partum Family
Planning
0-48 hours
Postpartum FP
6 wk visit
Extended postpartum FP
6 weeks to 12 months
Birth Preparedness
ANC
Delivery care
3-6 days
6 weeks
POSTPARTUM
Immunization EBF 6 wks
Immunization EBF 10 wks
Immunization EBF 14 wks
Complementary Feeding
6 mo
Immunization-Measles
9 mo
TT Immunization
Neonatal care 6-12 hrs
Later postnatal
3-6 days
Immediate postpartum
6-12 hrs
MATERNAL HEALTH NEONATAL & CHILD
HEALTH
P
M
T
C
T
P
E
D
C
A
R
E
PROGRAMMATIC FRAMEWORK: PPFP IN
AN INTEGRATED CONTEXT
HIV
Opportunities?

10. Integrated services to prevent
unintended pregnancies
 Early community level contacts- LAM and
effective transition through provision of
other modern methods
 Increased skilled birth assistance-
provision of PPIUCD
 More effective integration in postnatal and
infant care- multiple contacts including
provision of services
10

11. Make every pregnancy- an intended
pregnancy
11
New mothers with their newborns outside the
postpartum ward. Photo credit: B. Deller
Satisfied PPIUCD Users, Embu, Kenya Photo credit E. Charurat
PPFP e-learning course at http://www.globalhealthlearning.org/
PPFP tool kit at http://www.k4health.org/toolkits/ppfp