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A life saving intervention within our grasp: Postpartum Family Planning

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. PPFP context.

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A life saving intervention within our grasp: Postpartum Family Planning

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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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