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Postpartum Family Planning: A Life-Saving Intervention

Learn about the significance of postpartum family planning in preventing unintended pregnancies and promoting maternal and child health. Explore factors influencing fertility return in Bangladesh and effective contraceptive methods postpartum.

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Postpartum Family Planning: A Life-Saving Intervention

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  1. A life saving intervention within our grasp: Postpartum Family Planning Catharine McKaig 31 August 2001 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. Father and Infant at Well baby Visit, Albania Photo Credit: Galina Stolarsky

  3. Postpartum family planning Through one year postpartum Factors influencing fertility return in Bangladesh • 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 Winfrey and Borda. 2007: Addressing the Family Planning Needs of Women in the First Year Postpartum: Bangladesh. ACCESS-FP

  4. High levels of unmet need - potential for addressing maternal and child health 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 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 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 Mohamed, Med Princ Pract 2003;12: 170-175 Foreit et al. 1993. International FP Perspectives. 19(1),19-24,33.

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

  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

  11. Make every pregnancy- an intended pregnancy 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

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