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
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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