JHPIEGO in partnership with Save the Children, Constella Futures, The Academy for Educational Development, The American College of Nurse-Midwives and IMA World Health All the best intentions: FP in the first year postpartum Catharine McKaig, Director ACCESS-FP New Mother in Albania (photo credit G. Stolarsky)

2 Session Objectives 1.Describe the components of postpartum family planning 2.Describe lessons learned from community-based newborn programs ands facility programs 3.Identify at least three areas for MNCH/FP integration LAM Ambassadors in Bangladesh (Credit: C. McKaig)

3 Mortality: Maternal and Child  Maternal Mortality  In 2000, promotion of FP had potential to avert 32% of maternal mortality:  90% of abortion related and  20% of obstetric related mortality and morbidity  Child Mortality  Conservatively “1 million of the 11 million deaths in children <5 could be averted by elimination of interbirth intervals of less than 2 years. Effective use of postpartum family planning is the most obvious way in which progress should be achieved.”  Cleland et al Lancet Series, Sexual and Reproductive Health,Volume 368, Number 9549, 18 November 2006

4 High levels of unmet need- potential for addressing maternal and child health Winfry and Borda Postpartum fertility and contraception: An analysis of findings from 17 countries. ACCESS-FP

55 India: Factors influencing return to fertility Source: ACCESS-FP Analysis of NFHS 2006

6 What is PPFP?  Through the first year postpartum  Return to fertility=pregnancy risk  Return to sexual activity  Breastfeeding  LAM and transition  Method considerations: timing and breastfeeding status  Healthy spacing of the next pregnancy  Integration—tailoring to fit with timing and service

Lessons learned- Community based  These are complex constructs with traditional practices- breastfeeding, return to sexual activity  Family members- mothers, mothers in law, husbands play important roles  Women’s perceptions about patterns of fertility return and pregnancy risk  The impact of simple messages is limited; movement towards normative change 7

Lessons learned- Facility based  Generally, FP is not being provided to amenorrheic women  Providers have misconceptions about fertility return and often make assumptions about sexual activity- limits service access  Challenges for counseling-based methods- LAM takes time  Contact with women limited; providers are busy; Need to provide additional staff for FP when integrated in larger, busy clinics 8

Best Practices from Global Experience  Offering FP information and services immediately postpartum and at multiple points during maternal care.  Initiating LAM-very effective method for up to six months; LAM users transition to other methods.  Providing a variety of contraceptive options including short and long acting methods.  Attention to postpartum long-acting and permanent methods.  Integrating PPFP into mother and child care—such as immunizations. Women waiting outside for services Photo credit: Barbara Deller

Ready for Scale up  Revitalize Postpartum TL  Revitalize Postpartum IUCD  Systematic Minimal Package:  LAM- clear, integrated  Pre-discharge for women delivering in facilities  Follow-up postpartum FP counseling  Expansion of method choice 10 New Mother in Postnatal Ward Photo credit: C. Ruparelia

Innovation needed!  FP and IYCN  Immunization and FP  Long acting methods- lower levels 11 Women waiting outside a PHC for services in Jhansi. Photo credit: Ricky Lu

Thank you! 12 New mothers with their newborns outside the postpartum ward. Photo credit: B. Deller