11 Programme Strategies for Postpartum Family Planning: A new resource for FP programmes Mary Lyn Gaffield, PhD November 2013 Scientist, Human Reproduction Team

22 Background  Since 2010, WHO has been approached by Member States, USAID, and other development partners to promote and strengthen family planning services for women during the postpartum period – Clinically defined period (6 weeks) – WHO guidelines address contraceptive safety and service delivery during 6 week period  Recognition that programmes need to consider an extended postpartum period – the first 12 months after childbirth

33 Identifying and addressing the need  Development of a plan of work and products through… – Brainstorming meetings at WHO and MCHIP (March & November 2010, April 2011) – Panel sessions at international conferences First Global Forum for Health Services Research (Montreux, Switzerland), nd International Conference on Family Planning (Dakar, Senegal), 2011  The products – Statement for Collective Action – Programme Strategies for Postpartum Family Planning: A new resource for FP programmes managers and policy makers to implement the Statement

44 Statement for collective action  Highlights importance that family planning programmes reach postpartum women  Defines the issue, offers broad strategies to address unmet family planning needs for these women  Numerous endorsements obtained  Available in French, Spanish translation underway

55 WHO’s commitment at the Family Planning Summit – July 2012  Facilitating the delivery of family planning to women during the year postpartum identified as one of the essential components of health care.

66 The goal of the resource  Tailored for users with different needs – For comprehensive programming or – To strengthen single or multiple elements within the health system  Recognizes programme interventions require holistic perspective and need to be evidence- informed

77 The method of work  The process – 'Map' existing guidance on the topic – Interview public health officials from selected countries for contextual input – Synthesize the published evidence – Develop the draft document Meeting of expert to review draft document in July 2012 (Washington.DC) WHO Technical consultation to finalize document in September 2012 (Geneva, Switzerland) Multiple reviews of drafts among experts to produce final document

88 Drawing upon existing guidelines

99 Keeping the needs of users in mind  Reminders of the unique needs of postpartum women  Understanding the landscape for programme design: – Question-driven process – Applying a health systems framework – Illustrative examples  Integration points within the system  Examples from country programmes

10 Developed for the needs of users – cont.  Users guided to assess their national health system based upon WHO framework for action to understand their setting: – health services – HMIS – health workforce – medicines/technology – leadership/governance – health financing

11 Linking assessment to potential interventions Illustrative findingsPotential programme interventions High rates of breastfeedingIntroduce LAM and counsel on transitioning to other effective contraceptive methods High rates of staff rotation within and among facilities Strengthen policies and practices to address staff development and retention to ensure that providers with FP skills are avialable within ANC, labour and delviery and postnatal care. Low modern contraceptive prevalenceTrain community health workers to integrate community education and individual counseling about LAM, healthy timing and spacing, and exclusive breastfeeding with referral for other FP methods as a routine part of care

12 Content areas to guide programming  Antenatal care  Labor and delivery/pre-discharge  Postnatal  Infant health and immunization services CONTINUUM OF POINTS OF CONTACT FOR PPFP STAGE PregnancyLabour and delivery, Pre-discharge (0–48 hours) Postnatal, including prevention of mother-to-child transmission of HIV (PMTCT) (48 hours–6 weeks) Infant care (4–6 weeks through 12 months)

13 Example of a strategy  Overall programme goals  Programme outcomes  Approaches to programme design – Illustrative programme strategies – illustrative programme activities – illustrative indicators

14 Additional resources  Monitoring and evaluation  Indicators, definitions, data source, frequency  Sample indicators address  policy/enabling environment  service delivery/capacity  client/community/FP demand  FP service coverage  Supporting evidence for program design

15 Stay tuned  Publication on WHO website: – fp_strategies/en/index.html fp_strategies/en/index.html  Publication on USAID website: –  Publication on MCHIP website:  Questions ? us at:  Translations into French and Spanish will be undertaken