Jhpiego in partnership with Save the Children, Constella Futures, The Academy for Educational Development, The American College of Nurse-Midwives and IMA World Health Catharine McKaig 31 August 2001 A life saving intervention within our grasp: Postpartum Family Planning CHW and Mother, Healthy Fertility Study,Bangladesh Photo Credit: Salahuddin Ahmed

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. 2 Father and Infant at Well baby Visit, Albania Photo Credit: Galina Stolarsky

Postpartum family planning Through one year postpartum  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 Factors influencing fertility return in Bangladesh 3 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 Postpartum fertility and contraception: An analysis of findings from 17 countries. ACCESS-FP

FP use in the first year postpartum LAM use 3-6 monthsFP use 9-12 months 5 Winfrey and Borda Postpartum fertility and contraception: An analysis of findings from 17 countries. ACCESS-FP

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 6 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

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 Foreit et al International FP Perspectives. 19(1),19-24,33. Mohamed, Med Princ Pract 2003;12:

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 8 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

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

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 10

Make every pregnancy- an intended pregnancy 11 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 PPFP tool kit at