This document summarizes a project in Uganda aimed at improving maternal health through increased access to postpartum family planning services. The project trained over 600 health workers across 160 facilities in 15 districts, as well as 118 tutors and preceptors from 18 midwifery institutions. It equipped these facilities and institutions with tools to provide long-acting reversible contraceptives like IUDs. Additionally, 154 village health workers were trained to promote family planning options in communities. As a result of these efforts, over 80,000 couple years of protection were achieved and 694 postpartum IUDs were inserted. The document highlights the importance of expanding access to family planning, especially long-acting reversible methods, for empowering women

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Improving
Maternal Health
through
Postpartum
Family Planning
MINISTRY OF HEALTH

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MUBENDE
YUMBE
ARUA
OYAM
GULU
KATAKWI
KAABONG
MOROTO
NAKAPIRIPIRIT
ABIM
KOTIDO
KITGUM
AMUDAT
BUNDIBUGYO
KANUNGU
REPUBLIC OF SOUTH SUDAN
KENYA
TANZANIA
DEMOCRATIC
REPUBLIC OF CONGO
N
S
EW
Target Districts
UNFPA TARGET DISTRICTS

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FOREWORD
Uganda’s reproductive health and family planning
landscape has changed dramatically over the past
five years. We have seen impressive efforts geared
towards strengthening health systems to deliver
quality reproductive health services, increased
commitment to ensure reproductive health and
family planning (RH/FP) commodity security, and
additional efforts to train health workers to provide
a wide range of family planning methods to women
who wish to delay, space or limit their pregnancies.
Uganda still has a long way to go in ensuring that the
unmet need for family planning is greatly reduced.
The country has one of the world’s youngest
populations and faces unique challenges in meeting
these adolescents’ health needs, including their
sexual and reproductive health. We need to enable
our health providers and health care system to be
responsive to the needs of our young population.
Our partnership with Jhpiego on the “Capacity
Building for Family Planning Providers” project
has resulted in 439 health workers being equipped
with cutting-edge skills to deliver quality family
planning (FP) services and 160 health facilities
receiving the necessary equipment to provide
long-acting reversible contraceptives including the
postpartum intrauterine device in the 15 United
Nations Population Fund (UNFPA) target districts1
.
1 UNFPA target districts for this project included Mubende, Katakwi, Abim, Amudat,
Nakapiripirit, Moroto, Kotido, Kaabong, Oyam, Gulu, Kitgum, Bundibugyo, Kanungu,
Arua and Yumbe.

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Additionally, we worked with 18 midwifery insti-
tutions to revise their family planning curriculum
to include postpartum family planning so that new
midwives will be competent in this strategy upon
graduation. These activities have contributed toward
achieving 80,190 couple years of protection over 12
months.
This success story book highlights the investments
made through the work of Jhpiego, the Ugandan
MinistryofHealth,and15districtlocalgovernments.
These stories provide evidence to build upon and
scale up what this project has started. It is critical
that Uganda continues to tap into these resources
and build RH/FP competent communities that will
tackle reproductive health challenges, especially for
young people.
On behalf of the Ministry of Health, I would like
to express our appreciation to UNFPA for providing
financial resources that have made it possible for us
to extend these critical services to the women and
families of Uganda. We look forward to continued
partnership with Jhpiego and other development
partners as we work to increase access to family
planning services.
Prof. Anthony Mbonye
Director Clinic and Community Services
Ministry of Health - Uganda

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ThegovernmentofUgandaisdedicatedtoimproving
access to and utilization of family planning services.
The five-year National Development Plan (2010/11–
2014/15) acknowledges that limited access to family
planning (FP) services hinders overall development
of society in general and women in particular. One
of the goals outlined in the plan is to reduce unmet
need for family planning by ensuring access to FP
services, especially in rural areas.
FPservicesaretherangeofinformationalandmedical
interventionsthatallowwomentodecideif,when,and
how to grow their families. They include counseling,
administration of a family planning method, and
follow-up care. Postpartum family planning (PPFP)
is a service delivery strategy that expands access
to family planning through integration within the
existing continuum of maternal, newborn and child
health services. To effectively deliver PPFP services
health care providers must be trained to provide
tailored counseling and correct information on all
family planning methods, including long-acting
reversible contraceptives (LARCs), a category of
family planning methods which provide extended
protection from pregnancy (between 1 – 10 years
dependent upon the method) and can be removed
when a women wishes.
With support from the United Nations Population
Fund (UNFPA), over a one and a half year period,
Jhpiego worked with the Ugandan Ministry of Health
to strengthen the capacity of health care providers
in 15 target districts and future midwives from
18 institutions to deliver high-quality postpartum
OVERVIEW

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Our partnership with Jhpiego and UNFPA has been
fundamental in ensuring an increase of highly skilled
health workers offering family planning services. Our
hope at the ministry is that this capacity building program
is scaled up to all referral hospitals and health centers
country-wide, so that we have many more women accessing
postpartum family planning.”
- Dr. Mihayo Placid, Family Planning Focal Person, MOH

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family planning services with an emphasis on the
immediate postpartum period (0-48 hours after
delivery).
During the project implementation, Jhpiego used
three capacity building approaches:
1. Train providers from the Antenatal Care (ANC)
and labor/delivery units to deliver PPFPservices,
including the administration of LARCs with a
special focus on the PPIUD.
2. Train providers from the existing health center
and hospital FP units to deliver PPFP services,
including the administration of LARCs with a
special focus on the PPIUD.
3. Revise FP planning curriculum to include PPFP
service provision, including the administration
of LARCs with a special focus on the PPIUD,
and build the capacity of midwifery teachers,
tutors, preceptors and clinical training sites to
offer this pre-service training to current and
future midwifery students.
In addition to building health worker capacity,
Jhpiego delivered training and medical equipment to
the health centers, hospitals, and training institutions
so that health care providers and students can
continue to practice and perfect their skills after the
project.
Finally, recognizing the importance of demand
generation for PPFP services to their success as an
intervention,Jhpiegotrainedandprovidedsupportive
supervision for members of village health teams
(VHTs) from the 15 target districts. These VHTs

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are now empowered to promote PPFP
services at a community level and refer
women interested in receiving these
services to health care workers who
can provide additional counseling and
administer a FP method.
This comprehensive project, has
provided training and tools for
communities, health centers, hospitals,
and training institutions to increase
access to FP planning services,
especially PPFP services, for Ugandan
women. The stories captured in
this booklet highlight the different
strategies and interventions employed
in this project and provide evidence for
their future scale-up.
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80,190COUPLE YEARS OF PROTECTION
THOUSAND
160 Health
Facilities reached
15 districts

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114health care
providers
trained on
PPIUD.

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According to Uganda’s Demographic and Health
Survey (DHS), contraceptive prevalence for modern
contraceptives in Uganda moved from 14% in
2000–01 to 17.9% in 2006 and to 25.9% in 2011. As
women increasingly seek FP services it is important
that they have access to a wide-range of methods
that fit their varied desires and needs. Jhpiego, with
support from UNFPA, trained 631 current health
care providers at 160 health facilities in 15 districts
to provide PPFP services, including counseling on
and the administration of LARCs.
Jhpiego’s training reached beyond the classroom to
ensure that health care workers were empowered
provide services at the facilities where they work
and that they have a local resource for follow up
questions. First Jhpiego trained two “trainers of
trainers” from each district in FP service provision.
Then, with support from Jhpiego, these trainers led
training for other health workers from facilities
in their district. In these trainings the health care
workers developed their skills and knowledge
through classroom-based training and practice on
humanistic models. Finally, Jhpiego conducted
supportive supervision visits to the trainees’ health
facilities to continue training and identify barriers to
FP service provision.
Following these trainings, the 15 target districts
have reported 80,190 couple years protection have
been achieved and 694 PPIUDs have been inserted.
EMPOWERING HEALTH WORKERS TO
PROVIDE PPFP SERVICES, WITH AN
EMPHASIS ON LONG-ACTING METHODS

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My first encounter with Jhpiego’s clinical training on PPIUD
was last year and it has been very good for me and my
colleagues. We had been offering family planning services
like use of contraceptive pills, injectables and to a small extent IUDs.
We are currently pushing for the PPIUD method because we have
realized that many women are now able to space their children. We
have gone on to mentor other providers in health centers in Arua and
constantly supervise them to ensure they are providing these services
effectively. We hope that next time we can target VHTs in order to
reach more women in communities who are not able to come to the
health centers.””
- Jane Angucia, Nursing officer, Arua Regional Referral Hospital

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Training current health care workers to provide PPFP
alone will not address Uganda’s growing demand
for FP services. To provide for the future provision
of services both within the 15 target districts where
current health care workers were trained and also
throughout Uganda, Jhpiego, with support from
UNFPA, worked with the Ugandan Ministry of
Health and 18 midwifery institutions to revise the
FP curricula across the country to include PPFP
services, including the administration of LARCs.
Beyond revising the curricula, Jhpiego trained 118
tutors, clinical instructors and preceptors in maternal
and newborn health updates, PPFP, and effective
teaching and clinical skills training to improve the
quality of education that midwifery students receive
in PPFP. Additionally, Jhpiego provided humanistic
models and medical equipment to the midwifery
institutions which will enable their students to
practice the methods and skills they learn in the
classroom.
This support and investment in the education of
midwifery students supports graduates so that they
have the knowledge and skills to provide quality
PPFP services to Ugandan women.
SUPPORTING PRE-SERVICE TRAINING
FOR MIDWIFERY INSTITUTIONS
To date, 18midwifery schools have
participated in the
pre-service training.

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“Jhpiego Uganda has provided us with equipment and
models that enable us to give practical lessons to our
students.Initially,weonlytaughtabout familyplanningin
theory and our students only practiced what was taught
when they went to the field. We can now offer practical
lessons at schools and all midwifery students are required
to do a placement in health center IIIs and IVs before
graduation. This reinforces their training and confidence
to offering family planning services”
- Tumwesigye Richard, Tutor, Nyakibale School of
Nursing, Rukungiri.
“We ensure that the midwifery course is mandatory for
all students at the nursing school, so that there can be an
increase of health care providers equipped with knowledge
and skills in family planning. Theoretical study and clinical
experience cover all aspects of antenatal, labor, postnatal
and neonatal care. We are happy that Jhpiego Uganda
provided us with the PPIUD kits, ‘Mama U’ and ‘Mama
Natalie’ models. These tools enhance learner experience
especially when our students go for clinical training.”
- Ogarubo Mary, Tutor, Lira School of Comprehensive
Nursing, Lira

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In order to retain their newly acquired skills and
knowledge, health workers must have the tools and
resources to continue practicing after training. To
facilitate this continuing education, Jhpiego, with
supportfromUNFPA,purchasedthesamehumanistic
models used during training and distributed them to
districts and midwifery institutions so that providers
and students can continue to perfect their abilities.
Additionally, Jhpiego identified that health facilities
lacked the specialized forceps to insert the PPIUD.
To fill this gap, Jhpiego, with support from UNFPA,
purchased and distributed 755 PPIUD kits containing
thereusableforcepsandothermaterialsnecessaryfor
PPIUD administration to all of the health facilities
and midwifery institutions that it trained providers
at during this project. Without these tools providers
would have been unable to insert the PPIUD and
women would have continued to lack access to this
innovative family planning method.
EQUIPPING HEALTH CENTERS TO PROVIDE
FAMILY PLANNING SERVICES
“Jhpiego Uganda has been very instrumental in building
capacity of our health workers and moved a step further
to provide the necessary tools required to provide family
planning services effectively. Initially, family planning
services were only available at the regional referral and
district hospitals, health center IVs but now we have
scaled them up to health center IIIs with at least one
health care provider trained in long-acting and reversible
methods.”
- Dr. Sebudde Stephen, DHO Kanungu

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160 health facilities &
18midwifery schools were
equipped with PPIUD kits for
continuous practice as a means of
buiding on the competences and
health confidence of health providers.

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Training current and future health care workers is
critical to expanding access to FP services; however,
women must also be made aware of the different FP
services and methods available to them. To build
this knowledge within communities, Jhpiego trained
154 village health team members to inform women
of their FP service options, including PPFP and
LARCs, and where they can access them. So far 694
PPIUDs have been inserted, suggesting that women
are receiving information about its availability
and are following up with health care workers for
counseling and insertion.
MAKING THE CHOICE TO ADOPT A LONG-
ACTING FAMILY PLANNING METHOD

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Akwiya Consi, is a 30 year old mother of seven,
married to a polygamous husband. Over a year ago,
her husband who had been living with his second
wife came home unexpectedly, and she remembered
that she had no protection whatsoever. Knowing that
her husband was against family planning, she snuck
away from him and rushed to the health center to
talk to a nurse about available contraceptive options.
She did not know that her husband had followed
her to see why she had gone to see the nurse. He
was very upset and asked her to leave immediately-
threating to divorce her if she used any family
planning method. Distraught and feeling desperate,
she went back home and promised herself to return
to the health center a few days later. She didn’t. She
discovered she was pregnant a month later and had
her 7th baby in early 2015.
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694women provided
with PPIUD
services across the 15 target
districts.
“During my antenatal trips at Angaya health center
III in Gulu, the midwife advised me to try the PPIUD
family planning which would offer me protection
from unwanted pregnancies and my husband would
not know about it. She counseled me and as soon
as I delivered my baby, the PPIUD was inserted.
I am delighted to say that it has not given me any
problems and as a farmer, I am now able to work all
year round, tend to my crops and sell my produce. I
can now afford to take care of my children better,”
says Consi.

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“I am happiest when I get couples
coming for antenatal together, I give
themalltheinformationIcanonfamily
planning and encourage them to adopt
a family planning method. We always
encourage these men to talk to their
fellow men when they are in the bar
or church so they feel free to come to
the health center with their partners
and access family planning services.”
- Koriang Mariam, Midwife, Moroto
Regional Referral Hospital
158
VHTs trained in
PPFP advocacy
and linking to
service delivery
points.

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ACKNOWLEDGEMENTS
Jhpiego would like to thank all partners for their contributions which made this project a success. Special
thanks go to the health workers in the facilities and training institutions we worked with to achieve our
project goals. We appreciate the Government of Uganda through the Ministry of Health for their continued
guidance and the United Nations Population Fund for their financial support.
We greatly appreciate the individuals who agreed to share their personal stories and photographs for this
publication.
CONTACT: EMILY KATARIKAWE, COUNTRY DIRECTOR, JPHIEGO - UGANDA
PROGRAM IMPLEMENTATION: TONNY KAPSANDUI AND JOSEPHINE NABUKEERA
Jhpiego @jhpiego
uganda.countryoffice@jhpiego.org

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“I“am blessed to have been trained by Jhpiego on the
PPIUD. The best part for me is the use of practical
tools and kits that enhance our learning ability.”
- Amono Jennifer, Senor Nursing Officer-Midwifery, Gulu
Regional Referral Hospital

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Jhpiego—an affiliate of Johns Hopkins University
Plot 36, Lower Naguru, East road
Kampala, Uganda
Tel: 0393 202 937
www.jhpiego.org
www.facebook.com/Jhpiego