Transcript Slide 1

All the best intentions:
FP in the first year
postpartum
Catharine McKaig, Director
ACCESS-FP
New Mother in Albania (photo credit G. Stolarsky)
JHPIEGO in partnership with Save the Children, Constella Futures, The Academy for Educational Development,
The American College of Nurse-Midwives and IMA World Health
Session Objectives
1. Describe the components
of postpartum family
planning
2. Describe lessons learned
from community-based
newborn programs ands
facility programs
3. Identify at least three
areas for MNCH/FP
integration
LAM Ambassadors in Bangladesh (Credit: C. McKaig)
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Mortality: Maternal and Child
 Maternal Mortality

In 2000, promotion of FP had potential to avert 32% of
maternal mortality:
 90% of abortion related and
 20% of obstetric related mortality and morbidity
 Child Mortality

Conservatively “1 million of the 11 million deaths in children
<5 could be averted by elimination of interbirth intervals of
less than 2 years. Effective use of postpartum family planning
is the most obvious way in which progress should be
achieved.”
 Cleland et al. 2006 Lancet Series, Sexual and Reproductive Health,Volume 368,
Number 9549, 18 November 2006
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High levels of unmet need- potential for
addressing maternal and child health
Ethiopia 2005
Rw anda 2005
Ghana 2003
Uganda 2006
Madagascar 2003-2004
Tanzania 2004-2005
Kenya 2003
Pakistan 2006-2007
India 2005-2006
Nigeria 2003
Zam bia 2007
Bangladesh 2007
0
20
40
60
80
100
Percent unmet need
Winfry and Borda. 2010. Postpartum fertility and
contraception: An analysis of findings from 17 countries.
ACCESS-FP
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India: Factors influencing return to
fertility
100%
Sexually active
Return to menses
Exclusively breastfdg
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
0-3
4-6
7-9
10-12
Source: ACCESS-FP Analysis of NFHS 2006
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What is PPFP?
 Through the first year postpartum
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Return to fertility=pregnancy risk
Return to sexual activity
Breastfeeding
LAM and transition
Method considerations: timing and breastfeeding
status
 Healthy spacing of the next pregnancy
 Integration—tailoring to fit with timing and service
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Lessons learned- Community based
 These are complex constructs with
traditional practices- breastfeeding, return
to sexual activity
 Family members- mothers, mothers in law,
husbands play important roles
 Women’s perceptions about patterns of
fertility return and pregnancy risk
 The impact of simple messages is limited;
movement towards normative change
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Lessons learned- Facility based
 Generally, FP is not being provided to
amenorrheic women
 Providers have misconceptions about fertility
return and often make assumptions about
sexual activity- limits service access
 Challenges for counseling-based methodsLAM takes time
 Contact with women limited; providers are
busy; Need to provide additional staff for FP
when integrated in larger, busy clinics
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Best Practices from Global Experience
1. Offering FP information and services
immediately postpartum and at
multiple points during maternal care.
2. Initiating LAM-very effective method
for up to six months; LAM users
transition to other methods.
3. Providing a variety of contraceptive
options including short and long
acting methods.
4. Attention to postpartum long-acting
and permanent methods.
5. Integrating PPFP into mother and
child care—such as immunizations.
Women waiting outside for services
Photo credit: Barbara Deller
Ready for Scale up
 Revitalize Postpartum TL
 Revitalize Postpartum
IUCD
 Systematic Minimal
Package:
New Mother in Postnatal Ward
Photo credit: C. Ruparelia
 LAM- clear, integrated
 Pre-discharge for women
delivering in facilities
 Follow-up postpartum FP
counseling
 Expansion of method choice
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Innovation needed!
 FP and IYCN
 Immunization and
FP
 Long acting
methods- lower
levels
Women waiting outside a PHC for services in Jhansi.
Photo credit: Ricky Lu
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Thank you!
New mothers with their newborns outside the postpartum ward.
Photo credit: B. Deller
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