The ABC’s of Postpartum Family Planning. Robin Anthony Kouyaté, BCC Advisor CORE Elluminate Session 14 October 2008. Photo by Emmanuel Otolurin. Objectives. At the end of the session, participants will be able to discuss: Overview of PPFP Barriers to PPFP services and method use
Robin Anthony Kouyaté, BCC Advisor
CORE Elluminate Session
14 October 2008
Photo by Emmanuel Otolurin
At the end of the session, participants will be able to discuss:
Photo by Angela Nash-Mercado
Kenya- 23% of births are less than 2 years apart.
Lack of awareness of health benefits of spacing
Shifts in traditions that protected from pregnancy – postpartum abstinence
Lack of knowledge about fertility return
Spousal permission/clandestine use
Lack of support from MILBarriers to PPFP service and method use
Access to services
Wait at least 24 months after a live birth before attempting the next pregnancy in order to reduce the risk of adverse maternal, perinatal and infant outcomes.
Wait at least 6 months after a miscarriage or induced abortionbefore attempting the next pregnancy in order to reduce risks of adverse maternal and perinatal outcomes.
Source: World Health Organization, 2006 Report of a WHO Technical Consultation on Birth Spacing
If you are
Your risk of pregnancy increases as breastfeeding decreases and as time passes
If you are
NOT breastfeedingA woman’s risk of pregnancy after childbirth
YOU CAN BECOME PREGNANT EVEN IF YOUR MENSES HAS NOT RETURNED!!
If you are
Three criteria for a PP women to practice LAM
Transition to another method should occur when ANY 1 of the 3 criteria changes
Draft LAM Client Brochure: Georgetown University/IRH
Message: There are many FP methods with no affect on breastfeeding.
Adapted from the MAQ Exchange: Contraceptive Technology Update
Message: “Couples, discuss a family planning method before your baby is 1 month old and obtain more information from your health provider. An understanding between couples early on, can help prevent unplanned pregnancies.”
NEONATAL & INFANT HEALTH
Immediate Neonatal care 6-12 hrs
Immediate Post Partum FamilyPlanning
6 wk visit
Immunization EBF 6wks
Immunization EBF 10 wks
Extended postpartum FP
6 weeks to 12 months
Immunization EBF 14 wks
Infant feeding 6 mo
3 pronged approach:
Modifications to ACCESS-Nigeria MNH HH counseling schedule to integrate PPFP
Photos by Angela Nash-Mercado
Photo by Berengere de Negri
Photo by Angela Nash-Mercado
CHW screening & referral system:
Photo by Robin Anthony Kouyate
Chance and choice for
Mothers’, infants’ and children’s health and survival!
Cleland, J., Bernstein, S., Ezeh, A., Faundes, A., Glasier, A., Innis, J. (2006.) Family planning: The unfinished agenda. The Lancet, 368(9549), 1810-1827.
Ross, J. A. and Winfrey, W. L. (2001.) Contraceptive use, intention to use and unmet needs during the extended postpartum period.International Family Planning Perspectives, 27, 20–27.
Ross, J Winfrey W (2002) Unmet Need for Contraception in the Developing World and the Former Soviet Union: An Updated Estimate International Family Planning Perspectives, 28(3):138–143
Healthy Timing and Spacing of Pregnancies :
Norton, M. (2005.) New evidence on birth spacing: Promising findings for improving newborn, infant, child, and maternal health. International Journal of Gynecology and Obstetrics, 89: 1-6.
Report of a WHO Technical Consultation on Birth Spacing Geneva, Switzerland, 13–15 June 2005.
Healthy Timing and Spacing of Pregnancies: A pocket guide for health practitioners, program managers, and community leaders. Extending Services Delivery Project. http://www.esdproj.org
Return to fertility:
Gray, R.H., Campbell, O.M., Apelo, R., Eslami, S.S., Zacur, H., Ramos, R.M., et al. (1990.) Risk of ovulation during lactation. The Lancet, 335(8680): 25-29.
Becker & Ahmed. (2001). Dynamics of Contraceptive Use and Breastfeeding during the Post-Partum Period in Peru and Indonesia. Population Studies, 55 (2), pp. 165-179.
Resumption of sexual activity:
Gebreselassie, T., Rutstein, S. and Mishra, V. (2008). Contraceptive use, BF, Amenorrhea and Abstinence during the Postpartum Period: An analysis of four countries. DHS Analytical Studies No.14. Calverton, MD: Macro International Inc.
Desgrees-du-Lou & Brou. (2005). Resumption of sexual relations following childbirth: Norms, practices and reproductive health issues in Abidjan Cote d’Ivoire. RHM. 13 (25):155-163.Selected resources
Hight-Laukaran, V., Labbok, M. H., Peterson, A. E., Fletcher, V., von Hertzen, H., and Van Look, P. F. (1997.) Multicenter study of the Lactational Amenorrhea Method (LAM): II. Acceptability, utility, and policy implications.Contraception, 55(6), 337–346.
Hardy, E., Santos, L. C., Osis, M. J., Carvalho, G., Cecatti, J. G., and Faundes, A. (1998.) Contraceptive use and pregnancy before and after introducing lactational amenorrhea (LAM) in a postpartum program.Advances in Contraception, 14(1), 59–68.
Lopez-Martinez, M.G., Romero-Gutierrez, G., Ponce-Ponce De Leon, A.L. (2006.) Acceptance of lactational amenorrhoea for family planning after postpartum counseling. The European Journal of Contraception and Reproductive Health Care, 11(4), 297-301.
Spousal agreement on birth spacing:
Gebreselassie, T., Rutstein, S. and Mishra, V. (2007). DHS Working Paper No. 35: Spousal Agreement on Waiting Time to Next Birth in Sub-Saharan Africa.
Polygamy and contraceptive use:
Audu et al. (2007). Polygamy and the use of contraceptives. International Journal of Gynecology and Obstetrics, 101, pp. 88-92.
BCC for FP:
Population reports: Communication for Better Health (Jan 2008). Series J, Number 56.
Please visit the PPFP publications page on the ACCESS website for more resources: http://www.accesstohealth.org/toolres/pubs.htm