It's about time: WHO and partners release programming strategies for postpartum family planning

Mary Eluned Gaffield; Shannon Egan; Marleen Temmerman

doi:10.9745/GHSP-D-13-00156

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FIGURE.
Use of Contraceptive Methods in the Postpartum Period, According to WHO's Medical Eligibility Criteria

Source: World Health Organization³

Illustrative Assessment Findings	Potential PPFP Program Interventions
• High unmet need for limiting future pregnancies • High percentage of births in facilities • Health system with district-level infrastructure for IUD and female sterilization services	Facility-Based Intrapartum Services: • Expand counseling and method mix to include long-acting reversible contraceptives (LARCs) and permanent methods (PMs), access, affordability, and choice. • Integrate immediate postpartum IUD insertion, postpartum tubal occlusion, and exclusive breastfeeding (EBF) within labor and delivery units and in postpartum maternity wards at facilities at the district or sub-district level, if appropriate.

• Low modern contraceptive prevalence • High use of traditional methods • Short birth intervals • High percentage of home births	Community: • Train community health workers to integrate community education and individual counseling about healthy timing and spacing of pregnancy (HTSP), EBF, and the Lactational Amenorrhea Method (LAM) with referral for other contraceptive methods as a routine part of care. • Promote early PNC visits for home births to provide essential newborn care and EBF/LAM. • Focus on LAM as a gateway method to using other modern contraceptives. • Discuss women's reproductive intentions for spacing or limiting, and provide information on contraceptive methods and where to get them. • Use community-based integrated maternal, newborn, child health, and family planning (MNCH/FP) services.

• Existence of insurance or other finance mechanisms, such as vouchers, for basic maternity services and PNC	Financing: • Bundle PPFP with the birthing package to ensure that all contraceptive methods are covered during the extended postpartum period.

• High breastfeeding rates • Successful routine immunization sessions at health centers	PNC and Infant Care: • Introduce LAM and transition to other contraceptive methods. • Add a dedicated family planning provider to existing routine immunization programs or link/refer women to the family planning unit at the clinic.

• High rates of staff rotation within and among facilities • Lack of skills and knowledge about PPFP among facility staff, including the provision of LARCs/PMs • Facilities lack available and trained staff to provide MNCH/FP services	Strengthening Human Resources Capacity: • Strengthen policies and practices to address staff development and retention to ensure that providers with family planning skills are available within ANC, labor and delivery, and PNC. • Introduce or strengthen a comprehensive reproductive health education curriculum that addresses safe motherhood, family planning, and neonatal and child health training issues. • Integrate concepts of PPFP within preservice education and ensure that PPFP and HTSP are well-covered in teaching curricula, practical training, and examinations. • Dispatch mobile outreach teams to facilities in the short term in order to provide services while building capacity of staff for the long term. • Focus on community-based PPFP interventions, including EBF, LAM, pills, injectables, and condoms, while addressing health worker and capacity needs at the facility level.

• High HIV prevalence and existence of PMTCT services	Meeting the Needs of People Living With HIV/AIDS: • Integrate PPFP with PMTCT services and promote use of EBF and LAM, as well as appropriate complementary feeding at 6 months, with transition to another effective contraceptive method.

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GHSP-D-13-00156 Supplementary Material

Programming Strategies for Postpartum Family Planning -- a resource for policy makers and program managers when designing interventions to integrate postpartum family planning (PPFP) into national and subnational strategies. Published by the World Health Organization, with support from the U.S. Agency for International Development and the Maternal and Child Health Integrated Program (MCHIP), and with contributions from a large community of PPFP technical experts.

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Supplementary Material