Postpartum Family Planning Services Research Articles

Unmet need for postpartum family planning and influencing factors in China

To explore the rate and influencing factors of unmet need for postpartum family planning (PPFP) in China. We conducted a retrospective cohort study at 60 hospitals in 15 provinces that were in eastern, central, and western regions of China. Participants were women who delivered a live birth at the study sites with an interval of 13 to 24 months between delivery and interviews. We selected participants using cluster randomization approach, and the first 300 postpartum women who gave a birth at each study hospital after the initial month that had been selected were interviewed. Information on the women’s background characteristics, pregnancy history, time when menstruation and sexual activity resumed after childbirth, the adoption of contraceptive method, breastfeeding, and any pregnancy or pregnancy outcome after delivery were collected. We performed life-table analysis to estimate the rate of unmet need for PPFP and a 2-level logistic regression model to explore factors that influence unmet need for PPFP within the first 24 months postpartum. A total, 19,939 postpartum women were screened in this study, of which, 17,466 (87.6%) were eligible for this analysis. The rates of unmet needs for any FP methods were 23.9% (95% confidence interval [CI] 23.3–24.6%), 11.8% (95%CI 11.3–12.3%); 10.6% (95%CI 10.1–11.1%) at 6, 12, and 24 months postpartum; these rates for modern FP methods were 35.5% (95%CI 34.7–36.2%), 25.6% (95%CI 24.9–26.2%), and 24.6% (95%CI 23.9–25.2%), respectively. Results of 2-level logistic regression analysis showed that less-educated young women, those who had only one child or delivered by vaginal delivery at secondary hospitals, were associated with increased risk of unmet need for PPFP. Approximately 31% of women who had unmet need for PPFP reported a pregnancy during the first 24 months postpartum, which was significantly higher than the level for their counterparts (10.0%). The level of unmet need for PPFP in China was high, resulting in a high pregnancy rate within 24 months after delivery. Women’s age, education level, prior pregnancy and abortion histories, and delivery method were significantly associated with the risk of unmet need for PPFP. National PPFP guidelines that integrate PPFP services into prenatal and postnatal care are urgently needed and should be implemented throughout the country as soon as possible. PPFP services should promote the use of modern contraceptive methods.

Effect of Package of Interventions on the Use and Quality of Postpartum Family Planning Services at Yekatit 12 Hospital Medical College (Y12HMC), Addis Ababa, Ethiopia.

Postpartum Family Planning (PPFP), which aims to prevent high risk unintended and closely spaced pregnancies during the first year following childbirth, is one of the highest impact interventions to avoid increased risk of premature birth, low birth weight, fetal and neonatal death, and adverse maternal health outcomes. This study aimed to assess the combined effect of a package of interventions on the use and quality of PPFP services at Y12HMC, Addis Ababa Ethiopia. Cross-sectional study design was conducted to evaluate the effect of the package of chosen interventions: creating a private counseling space near the postpartum ward and providing training for health care providers on the WHO decision tool kit and Long Acting Contraceptive Methods (LACM). Interviews were conducted with 470 women (235 before and 235 after the intervention). Frequency tables and graphs were used to describe the study variables and statistical significance between pre and post intervention indicators was declared at P value <.05. From 470 participants, 421 respondents participated which makes response rate of 90%. The majority of the participants were in the age category 20 to 29 years, married/lived together, completed at least primary education and had more than one child both at baseline and post intervention. The proportion of women who chose PPFP increased from 55.8% at baseline to 69% after the intervention. The most preferred contraceptive method was implant. The overall service satisfaction level of the study participants was 95.4% post intervention, significantly higher than at baseline (78%, P < .05). Providers indicated that clients are satisfied with the service and that the institutional structure is appropriate for delivering integrated services following the intervention. This study demonstrated that quality improvement interventions like creating a private counseling space and providing training using WHO decision tool kit can achieve significant improvement on satisfaction of clients and PPFP uptake.

Gaps and opportunities for the integrated delivery of mother-child care, postpartum family planning and nutrition services in Burkina Faso, Côte d’Ivoire and Niger

Background Maternal and infant deaths can be prevented through integrated service delivery during pregnancy, postpartum, and early childhood. Our study analyses the gaps and opportunities associated with integrating maternal, newborn, and child health (MNCH) services with postpartum family planning (PPFP) and nutrition services at different points of contact in health facilities in a preintervention context in west Africa. Methods We conducted a qualitative study from June to July 2018 in Burkina Faso, Côte d’Ivoire and Niger. The points of contact studied at the health facility level were the prenatal care, postpartum care and immunisation/growth monitoring services. Individual in-depth interviews were used to collect data from key informants (providers, community health workers and mother-child health programme managers). To measure the degree of service integration, we used the dimensions and indicators included in the Integra Initiative framework concerning four aspects of integration: physical (the availability of multiple services in the health facility), temporal (the availability of care more than one day per week), provider level, and functional (the receipt of integrated services by the client). Results The findings of this study show that the integrated delivery of MNCH, PPFP, and nutrition services is configured in similar ways in Burkina Faso, Côte d’Ivoire and Niger and is insufficient at all points of contact. Physical integration is high. However, the study found important gaps in temporal, functional and provider-level integration. The main barriers to integrated service delivery are the shortage of providers, the lack of training in integrated service delivery, and insufficient service organisation. However, the availability of multiple services throughout the week, the multiple points of contact between the mother-child pair and the health system, and the multiple skills of providers represent opportunities for functional integration through the establishment of a formal referral system between the different care units with follow-up and feedback among service providers. Conclusions The provision of training and the development of a well-organised referral system in different health facilities, taking into account the specific characteristics of each health facility (urban/rural, primary health facility/district hospital), can improve the delivery of integrated MNCH, PPFP, and nutrition care to the mother-child pair.

Gaps and evidences on programming postpartum family planning services in Nepal

Background: Postpartum family planning (PPFP) is one of the strategic efforts mentioned in the National Family Planning Strategy 2011/12 and National FP Costed implementation plan 2015-2020 of Nepal. Postpartum women are recognized as one of the groups that need attention to strengthen FP services in the country. Methods: We conducted a situational analysis in Nepal from December 2019 to May 2020, to identify the needs, gaps and provide evidence for strengthening future programming in this area using a combination of three methods: (i) non-systematic literature review using Google Scholar, Pubmed, and grey literature, (ii) secondary analysis using the dataset from Nepal Demographic and Health Survey (NDHS) 2016 that was based on a two-stage, stratified, nationally representative sample of households, and (iii) virtual assessment in purposively selected eight health facilities using a standard checklist related to PPFP. Results: Results show a lower modern contraceptive uptake (22.6%) and higher unmet need (31.5%) among postpartum women compared to all currently married women (43% and 24% respectively). Three most commonly used modern contraceptive methods among postpartum women in Nepal are injectables (8%), male condoms (7%), and oral contraceptive pills (3%). The PPFP services are available only in limited health facilities and were not integrated in Antenatal care (ANC), Postnatal care (PNC), childbirth and immunization services. Provision of family planning counseling during the ANC period is not recorded in the ANC card. Male partners do not participate in family planning counseling. Similarly, the uptake of family planning services at immunization, child health, and postnatal clinics is not recorded. Conclusion: This analysis provided evidence of the current status of PPFP in the country. There are gaps and challenges especially in strategy and guidelines, training, regular supply of commodities, awareness of PPFP, recording and reporting of PPFP. These gaps should be addressed with appropriate strategies.

Implementation and evaluation of a large-scale postpartum family planning program in Rwanda: study protocol for a clinic-randomized controlled trial

BackgroundThough the Rwandan Ministry of Health (MOH) prioritizes the scale-up of postpartum family planning (PPFP) programs, uptake and sustainability of PPFP services in Rwanda are low. Furthermore, highly effective long-acting reversible contraceptive method use (LARC), key in effective PPFP programs, is specifically low in Rwanda. We previously pilot tested a supply-demand intervention which significantly increased the use of postpartum LARC (PPLARC) in Rwandan government clinics. In this protocol, we use an implementation science framework to test whether our intervention is adaptable to large-scale implementation, cost-effective, and sustainable.MethodsIn a type 2 effectiveness-implementation hybrid study, we will evaluate the impact of our PPFP intervention on postpartum LARC (PPLARC) uptake in a clinic-randomized trial in 12 high-volume health facilities in Kigali, Rwanda. We will evaluate this hybrid study using the RE-AIM framework. The independent effectiveness of each PPFP demand creation strategy on PPLARC uptake among antenatal clinic attendees who later deliver in a study facility will be estimated. To assess sustainability, we will assess the intervention adoption, implementation, and maintenance. Finally, we will evaluate intervention cost-effectiveness and develop a national costed implementation plan.DiscussionAdaptability and sustainability within government facilities are critical aspects of our proposal, and the MOH and other local stakeholders will be engaged from the outset. We expect to deliver PPFP counseling to over 21,000 women/couples during the project period. We hypothesize that the intervention will significantly increase the number of stakeholders engaged, PPFP providers and promoters trained, couples/clients receiving information about PPFP, and PPLARC uptake comparing intervention versus standard of care. We expect PPFP client satisfaction will be high. Finally, we also hypothesize that the intervention will be cost-saving relative to the standard of care. This intervention could dramatically reduce unintended pregnancy and abortion, as well as improve maternal and newborn health. Our PPFP implementation model is designed to be replicable and expandable to other countries in the region which similarly have a high unmet need for PPFP.Trial registrationClinicalTrials.gov NCT05056545. Registered on 31 March 2022.

The Role of the Midwife in Postpartum Family Planning Services : A Case Study on Three Different Health Facilities in South Central Java

Postpartum family planning coverage in Central Java is below the national standard, or it only reached 26.8%. Postpartum mothers are at risk of getting pregnant if they do not use contraception. Modern contraceptives prevent 3.2 million of 5.6 million under-five deaths and 109,000 of 155,000 (70%) maternal deaths. Continuity of Midwifery Care during the extended postpartum period encourages mothers to use modern contraception to manage the pregnancy gap. This study aimed to explore midwifery services for Family Planning Postpartum from the perspective of providers and clients in three health facilities: hospitals (RS), Public Health Centers, and Independent Midwifery Practice (PMB). The research was implemented through a qualitative descriptive, a case study approach design in 2021. informants were ten postpartum mothers, nine midwives, two heads of Puskesmas, head division of Family Planning, Women and Children Empowerment (KBPPA) conducted an in-depth interview. The interviews were digitally recorded, transcribed, and analyzed using the Miles and Huberman method. Providers and clients identified several benefits of Postpartum Family Planning (KBPP). Midwives stated several obstacles in providing services, such as limited counseling time during labor and lack of support from hospital management. The competence of midwives constrained KBPP services at the Puskesmas. There were still few midwives at the Puskesmas certified to provide Long Term Contraception Method services. Midwives were also overloaded with work during the pandemic. Obstacles in the Independent Midwifery Practice were the lack of IMP with clinical networks and the limited authority of the midwife. Meanwhile, postpartum mothers' barriers included lack of knowledge about fertility and KBPP, worry about side effects, and the husband's lack of support. Therefore, optimizing the referral mechanism for long-term contraception in advanced health facilities is necessary. Continuity of care midwives and integration of services will increase coverage of postpartum contraception.

Family planning utilization and associated factors among postpartum women in Addis Ababa, Ethiopia, 2018

BackgroundPregnancies that occur in the first year after birth can result in adverse outcomes for the mothers and their babies. Postpartum family planning (PPFP) can save lives of many mothers and children. Only few data are available about the magnitude of PPFP use and its determinants in Addis Ababa, Ethiopia.ObjectiveTo assess PPFP utilization and associated factors in Addis Ababa, Ethiopia.MethodA facility-based cross-sectional study was conducted from April to June 2018. A total of 625 women were enrolled in the study. Statistical Package for the Social Sciences (SPSS) software was used to analyze the data. Binary logistic regression model with adjusted odd ratio (AOR) and 95% confidence interval (CI) was used to identify the factors associated with PPFP use. A p-value less than 0.05 was considered as significant.ResultThe magnitude of PPFP utilization in Addis Ababa was 71.8%. Previous family planning (FP) information (AOR = 13.2; 95% CI: (1.96, 88.07)), FP information from health facility visit (AOR = 2.23; 95% CI: (1.45, 3.43)), antenatal care (AOR = 4.96; 95% CI: (1.58, 15.64)), counseling on FP at postnatal care (AOR = 1.97; 95% CI: (1.27, 3.05)), menses resumption after birth (AOR = 1.75; 95% CI: (1.11, 2.76)), and commencing sexual activity after birth (AOR = 9.34; 95% CI: (5.39, 16.17)) were the factors associated with PPFP use.Conclusion and recommendationThough the magnitude of PPFP use is encouraging, still three out of the ten postpartum women did not use PPFP. The determinants of PPFP use were having FP information, having FP information from health facility visit, antenatal care, counseling about FP during postnatal care, menses resumption after birth, and commencing sexual activity after birth. The health system in the City and the healthcare providers should strive to reach every woman who is not accessing the PPFP services and antenatal care services, and improve counseling services on PPFP during delivery and postnatal care services.

Knowledge, Utilization and Associated Factors of Postpartum Family Planning Among Women Who Had Delivered a Baby in the Past Year in Oromia Regional State, Ethiopia.

BackgroundGlobally, 95% of women wants to avoid pregnancy for at least two years after giving birth, but 70% of them are not using contraception; majority of them were from developing countries. Postpartum family planning (PPFP) enables families to avoid unplanned pregnancies following 12 months after childbirth. Different studies in Ethiopia showed that the majority of postpartum women do not use PPFP. Moreover, the level of PPFP knowledge and utilization in West Shewa, Oromia region of Ethiopia is unclear.PurposeThis study aimed to assess the knowledge, utilization and associated factors of postpartum family planning (PPFP) Oromia regional state, Ethiopia.MethodsA community-based cross-sectional study was conducted in Ambo town, West Shewa Zone of Oromia regional state from April 01 to July 30, 2019. A sample of 367 postnatal women participated in the study. An interview administered questionnaire was used to collect the data and the collected data were entered into Epi Info version 7.1 and analyzed with SPSS version 23. Study participants’ characteristics were described using frequency and percentage. Bivariate and multivariate logistic regression was carried out to identify the associated factors with the outcome variables.ResultsA total of 354 women were participated in the study making a response rate of 96.4%. About 249 (70.3%) of the respondents had good knowledge about PPFP and 144 (40.7%) had utilized PPFP services. Higher education level [AOR= 3.4, 95% CI: 1.3–6.9], history of family planning utilization [AOR= 2.8, 95% CI: 2.1–4.4] and having ANC follow-up [AOR=2.1, 95% CI: 1.1–4.0] had showed a positive association with knowledge of PPFP. Meanwhile, knowledge of PPFP [AOR=2.1, 95% CI: 1.6–3.1], a grand multi-para women [AOR=1.7, 95% CI (1.3–3.6)] and received routine PNC service [AOR=2.5, 95% CI: 1.3–5.9] were associated with the utilization of PPFP.Conclusion and RecommendationAlthough the majority of the women knew about PPFP, more than half of them did not utilize PPFP. Due emphasis should be given to improve the utilization of PPFP.

The Effect of Improved Access to Family Planning on Postpartum Women: Protocol for a Randomized Controlled Trial.

BackgroundThe World Health Organization recommends that a woman waits at least 24 months after a live birth before getting pregnant again; however, an estimated 25% of birth intervals in low-income countries do not meet this recommendation for adequate birth spacing, and the unmet need for postpartum family planning (PPFP) services is high. Few randomized controlled trials have assessed the causal impact of access to PPFP services, and even fewer evaluations have investigated how such interventions may affect postpartum contraceptive use, birth spacing, and measures of health and well-being.ObjectiveThis protocol paper aims to describe a randomized controlled trial that is being conducted to identify the causal impact of an intervention to improve access to PPFP services on contraceptive use, pregnancy, and birth spacing in urban Malawi. The causal effect of the intervention will be determined by comparing outcomes for respondents who are randomly assigned to an intervention arm against outcomes for respondents who are randomly assigned to a control arm.MethodsMarried women aged 18-35 years who were either pregnant or had recently given birth were randomly assigned to either the intervention arm or control arm. Women assigned to the intervention arm received a package of services over a 2-year intervention period. Services included a brochure and up to 6 home visits from trained family planning counselors; free transportation to a high-quality family planning clinic; and financial reimbursement for family planning services, consultations, and referrals for services. Two follow-up surveys were conducted 1 and 2 years after the baseline survey.ResultsA total of 2143 women were randomly assigned to either the intervention arm (n=1026) or the control arm (n=1117). Data collection for the first follow-up survey began in August 2017 and was completed in February 2018. A total of 1773 women, or 82.73% of women who were eligible for follow-up, were successfully contacted and reinterviewed at the first follow-up. Data collection for the second follow-up survey began in August 2018 and was completed in February 2019. A total of 1669 women, or 77.88% of women who were eligible for follow-up, were successfully contacted and reinterviewed at the second follow-up. The analysis of the primary outcomes is ongoing and is expected to be completed in 2021.ConclusionsThe results of this trial seek to fill the current knowledge gaps in the effectiveness of family planning interventions on improving fertility and health outcomes. The findings also show that the benefits of improving access to family planning are likely to extend beyond the fertility and health domain by improving other measures of women’s well-being.Trial RegistrationAmerican Economics Association Registry Trial Number AEARCTR-0000697; https://www.socialscienceregistry.org/trials/697 Registry for International Development Impact Evaluations (RIDIE) Trial Number RIDIE-STUDY-ID-556784ed86956; https://ridie.3ieimpact.org/index.php?r=search/detailView&id=320International Registered Report Identifier (IRRID)DERR1-10.2196/16697

Effect of integrating postpartum family planning into the health extension program in Ethiopia on postpartum adoption of modern contraception

Background Ethiopia has large unmet need for contraception among postpartum women. Community-level services may improve postpartum contraceptive use in Ethiopia and other contexts where home childbirth is common. This study estimated the additional effect of systematically integrating messages on postpartum family planning (PPFP) into community contacts with pregnant and postpartum women, on top of integrated facility contacts. Methods The quasi-experimental study was conducted in two districts in Oromia Regional State and used a controlled trial design with random assignment of primary health care units—a health center and surrounding health posts—to intervention and comparison arms. We used the log-rank test and fitted a multivariate Cox proportional hazards regression model to estimate the adjusted hazard ratio (adjHR) and 95% confidence interval (95% CI) for differences in contraceptive uptake by arm. Time from delivery to uptake of modern contraception was the outcome variable. We separately analyzed subsets of women by place of delivery, as this variable interacts with the study arm. Results A total of 772 pregnant women were enrolled February–March 2017 and re-interviewed 15 months later (May 2018). Loss to follow-up was 10% in intervention, 7% in comparison areas. Among women who delivered at home, there was higher PPFP adoption by one year postpartum in the intervention arm (35.2%, 95% CI: 28.8–42.4%) versus comparison arm (27.8%, 95% CI: 22.2–34.4%). In the adjusted Cox regression model, women who delivered at home in the intervention arm were 45% more likely to adopt contraception (adjHR1.45, CI: 1.01–2.07). There was no difference by arm for women who delivered in a facility. Conclusions Integrating PPFP into community-level services for pregnant and postpartum women and infants may have additional benefit on top of PPFP services at facilities. The intervention benefited women who delivered at home, an important target population in countries like Ethiopia, where many women do not deliver in a facility. This study, implemented under real world conditions, informs the PPFP body of evidence and fills a gap in research on the contribution of community-based PPFP in contexts where services are integrated within maternal, newborn, and child health care in facilities.

Improving post-partum family planning services provided by female community health volunteers in Nepal: a mixed methods study

BackgroundFamily planning services in the post-partum period, termed post-partum family planning (PPFP) is critical to cover the unmet need for contraception, especially when institutional delivery rates have increased. However, the intention to choose PPFP methods such as post-partum intrauterine devices (PPIUD) remains low in countries such as Nepal. Community health workers such as Female Community Health Volunteers (FCHVs) could play an important role in improving the service coverage of PPFP in Nepal. However, their knowledge of PPFP and community-based services related to PPFP remain unclear. This study aims to assess the effect on community-based PPFP services by improving FCHV’s knowledge through orientation on PPFP.MethodsWe conducted this mixed-methods study in Morang District in Nepal. The intervention involved orientation of FCHVs on PPFP methods. We collected quantitative data from three sources; via a survey of FCHVs that assessed their knowledge before and after the intervention, from their monthly reporting forms on counseling coverage of women at different stages of pregnancy from the communities, and by interviewing mothers in their immediate post-partum period in two selected hospitals. We also conducted six focus group discussions with the FCHVs to understand their perception of PPFP and the intervention. We performed descriptive and multivariable analyses for quantitative results and thematic analysis for qualitative data.ResultsIn total, 230 FCHVs participated in the intervention and their knowledge of PPFP improved significantly after it. The intervention was the only factor significantly associated with their improved knowledge (adjusted odds ratio = 24, P < 0.001) in the multivariable analysis. FCHVs were able to counsel 83.3% of 1872 mothers at different stages of pregnancy in the communities. In the two hospitals, the proportion of mothers in their immediate post-partum period whom reported they were counseled by FCHVs during their pregnancy increased. It improved from 7% before the intervention to 18.1% (P < 0.001) after the intervention. The qualitative findings suggested that the intervention improved their knowledge in providing PPFP counseling.ConclusionThe orientation improved the FCHV’s knowledge of PPFP and their community-based counseling. Follow-up studies are needed to assess the longer term effect of the FCHV’s role in improving community-based PPFP services.

Characteristics of successful integrated family planning and maternal and child health services: Findings from a mixed-method, descriptive evaluation.

Background: Most postpartum women in low- and middle-income countries want to delay or avoid future pregnancies but are not using modern contraception. One promising strategy for increasing the use of postpartum family planning (PPFP) is integration with maternal, newborn and child health (MNCH) services. However, there is limited evidence on effective service integration strategies. We examine facilitators of and barriers to effective PPFP integration in MNCH services in Kenya and India. Methods: We conducted a cross-sectional, mixed-method study in two counties in Kenya and two states in India. Data collection included surveying 215 MNCH clients and surveying or interviewing 82 health care providers and managers in 15 health facilities across the four sites. We analyzed data from each country separately. First, we analyzed quantitative data to assess the extent to which PPFP was integrated within MNCH services at each facility. Then we analyzed qualitative data and synthesized findings from both data sources to identify characteristics of well and poorly integrated facilities. Results: PPFP integration success varied by service delivery area, health facility, and country. Issues influencing the extent of integration included availability of physical space for PPFP services, health workforce composition and capacity, family planning commodities availability, duration and nature of support provided. Conclusions: Although integration level varied between health facilities, factors enabling and hindering PPFP integration were similar in India and Kenya. Better measures are needed to verify whether services are integrated as prescribed by national policies.

Characteristics of successful integrated family planning and maternal and child health services: Findings from a mixed-method, descriptive evaluation

Background: Most postpartum women in low- and middle-income countries want to delay or avoid future pregnancies but are not using modern contraception. One promising strategy for increasing the use of postpartum family planning (PPFP) is integration with maternal, newborn and child health (MNCH) services. However, there is limited evidence on effective service integration strategies. We examine facilitators of and barriers to effective PPFP integration in MNCH services in Kenya and India. Methods: We conducted a cross-sectional, mixed-method study in two counties in Kenya and two states in India. Data collection included surveying 215 MNCH clients and surveying or interviewing 82 health care providers and managers in 15 health facilities across the four sites. We analyzed data from each country separately. First, we analyzed quantitative data to assess the extent to which PPFP was integrated within MNCH services at each facility. Then we analyzed qualitative data and synthesized findings from both data sources to identify characteristics of well and poorly integrated facilities. Results: PPFP integration success varied by service delivery area, health facility, and country. Issues influencing the extent of integration included availability of physical space for PPFP services, health workforce composition and capacity, family planning commodities availability, duration and nature of support provided. Conclusions: Although integration level varied between health facilities, factors enabling and hindering PPFP integration were similar in India and Kenya. Better measures are needed to verify whether services are integrated as prescribed by national policies.

Prevalence of Postpartum Family Planning Service Coverage in Selected Referral Facilities of Nepal

Nepal Society of Obstetricians and Gynecologists jointly with the Nepalese government and with the support from the International Federation of Obstetrics and Gynecology has implemented an initiative to institutionalize postpartum family planning services in selected major referral facilities of Nepal to address the gap of low uptake of postpartum family planning in Nepal. The aim of the study is to find the prevalence of the service coverage of postpartum contraception in the selected facilities. A descriptive cross-sectional study was conducted in seven major referral facilities across Nepal. Data were collected from the hospital records of all women who delivered in these facilities between October 2018 and March 2019. Ethical approval for this study was obtained from Nepal Health Research Council. Data analysis was done with SPSS version 23. Among the 29,072 deliveries from all the facilities, postpartum family planning counseling coverage was 27,301 (93.9%). The prevalence of uptake of Postpartum Intrauterine Device is 1581 (5.4%) and female sterilization is 1830 (6.3%). In total 11387 mothers (52.2%) had the intention to choose a postpartum family planning method. However, 36% of mothers neither used nor had the intention to choose a postpartum family planning method. The coverage of Postpartum Intrauterine Device counseling service coverage in Nepal is higher in 2018 as compared to 2016-2017 and in other countries implementing Postpartum Intrauterine Device initiatives. However, the prevalence of service coverage of immediate Postpartum Family Planning methods, mainly Postpartum Intrauterine Device in 2018 is lower in Nepal as compared to 2016-2017, and other countries implementing Postpartum Intrauterine Device initiative. More efforts are needed to encourage mothers delivering in the facilities to use the postpartum family planning method.

Characteristics of successful integrated family planning and maternal and child health services: Findings from a mixed-method, descriptive evaluation

Background: Most postpartum women in low- and middle-income countries want to delay or avoid future pregnancies but are not using modern contraception. One promising strategy for increasing the use of postpartum family planning (PPFP) is integration with maternal, newborn and child health (MNCH) services. However, there is limited evidence on effective service integration strategies. We examine facilitators of and barriers to effective PPFP integration in MNCH services in Kenya and India. Methods: We conducted a cross-sectional, mixed-method study in two counties in Kenya and two states in India. Data collection included surveying 215 MNCH clients and surveying or interviewing 82 health care providers and managers in 15 health facilities across the four sites. We analyzed data from each country separately. First, we analyzed quantitative data to assess the extent to which PPFP was integrated within MNCH services at each facility. Then we analyzed qualitative data and synthesized findings from both data sources to identify characteristics of well and poorly integrated facilities. Results: PPFP integration success varied by service delivery area, health facility, and country. Issues influencing the extent of integration included availability of physical space for PPFP services, health workforce composition and capacity, family planning commodities availability, duration and nature of support provided. Conclusions: Although integration level varied between health facilities, factors enabling and hindering PPFP integration were similar in India and Kenya. Better measures are needed to verify whether services are integrated as prescribed by national policies.

Delivering postpartum family planning services in Nepal: are providers supportive?

BackgroundHealth service providers play a key role in addressing women’s need for pregnancy prevention, especially during the postpartum period. Yet, in Nepal, little is known about their views on providing postpartum family planning (PPFP) services and postpartum contraceptive methods such as immediate postpartum intra-uterine devices (PPIUD). This paper explores the perspectives of different types of providers on PPFP including PPIUD, their confidence in providing PPFP services, and their willingness to share their knowledge and skills with colleagues after receiving PPFP and PPIUD training.MethodsIn-depth interviews were conducted with 14 obstetricians/gynecologists and nurses from six tertiary level public hospitals in Nepal after they received PPFP and PPIUD training as part of an intervention aimed at integrating PPFP counseling and insertion into routine maternity care services. The interviews were audio recorded, transcribed, and analyzed using a thematic approach.ResultsProviders identified several advantages of PPFP, supported the provision of such services, and were willing to transfer their newly acquired skills to colleagues in other facilities who had not received PPFP and PPIUD training. However, many providers identified several supply-side and training-related barriers to providing high quality PPFP services, such as, (i) lack of adequate human resources, particularly a FP counselor; (ii) work overload; (iii) lack of private space for counseling; (iv) lack of IUDs and information, education and counseling materials; and (v) lack of support from hospital management.ConclusionsProviders appeared to be motivated to deliver quality PPFP services and transfer their knowledge to colleagues but identified several barriers which prevented them from doing so. Future efforts to improve provision of quality PPFP services should address the barriers identified by providers.

Increasing Use of Postpartum Family Planning and the Postpartum IUD: Early Experiences in West and Central Africa.

A global resurgence of interest in the intrauterine device (IUD) as an effective long-acting reversible contraceptive and in improving access to a wide range of contraceptive methods, as well as an emphasis on encouraging women to give birth in health care facilities, has led programs to introduce postpartum IUD (PPIUD) services into postpartum family planning (PPFP) programs. We describe strategic, organizational, and technical elements that contributed to early successes of a regional initiative in West and Central Africa to train antenatal, maternity, and postnatal care providers in PPFP counseling for the full range of available methods and in PPIUD service delivery. In November 2013, the initiative provided competency-based training in Guinea for providers from the main public teaching hospital in 5 selected countries (Benin, Chad, Côte d'Ivoire, Niger, and Senegal) with no prior PPFP counseling or PPIUD capacity. The training was followed by a transfer-of-learning visit and monitoring to support the trained providers. One additional country, Togo, replicated the initiative's model in 2014. Although nascent, this initiative has introduced high-quality PPFP and PPIUD services to the region, where less than 1% of married women of reproductive age use the IUD. In total, 21 providers were trained in PPFP counseling, 18 of whom were also trained in PPIUD insertion. From 2014 to 2015, more than 15,000 women were counseled about PPFP, and 2,269 women chose and received the PPIUD in Benin, Côte d'Ivoire, Niger, Senegal, and Togo. (Introduction of PPIUD services in Chad has been delayed.) South-South collaboration has been central to the initiative's accomplishments: Guinea's clinical centers of excellence and qualified trainers provided a culturally resonant example of a PPFP/PPIUD program, and trainings are creating a network of regional trainers to facilitate expansion. Two of the selected countries (Benin and Niger) have expanded their PPFP/PPUID training programs to additional sites. Inspired after learning about the initiative at a regional meeting, Togo has outperformed the original countries involved in the initiative by training more providers than the other countries. Challenges to scale-up include a lack of formal channels for reporting PPFP and PPIUD service delivery outcomes, inconsistent coordination of services across the reproductive health continuum of care, and slow uptake in some countries. Continued success will rely on careful recordkeeping, regular monitoring and feedback, and strategic data use to advocate scale-up.

Integrating family planning into postpartum care through modern quality improvement: experience from Afghanistan.

To address low contraceptive use in Afghanistan, we supported 2 large public maternity hospitals and 3 private hospitals in Kabul to use modern quality improvement (QI) methods to integrate family planning into postpartum care. In 2012, QI teams comprising hospital staff applied root cause analysis to identify barriers to integrated postpartum family planning (PPFP) services and to develop solutions for how to integrate services. Changes made to service provision to address identified barriers included creating a private counseling space near the postpartum ward, providing PPFP counseling training and job aids to staff, and involving husbands and mothers-in-law in counseling in person or via mobile phones. After 10 months, the proportion of postpartum women who received family planning counseling before discharge in the 5 hospitals increased from 36% to 55%, and the proportion of women who received family planning counseling with their husbands rose from 18% to 90%. In addition, the proportion of postpartum women who agreed to use family planning and left the hospital with their preferred method increased from 12% to 95%. Follow-up telephone surveys with a random sample of women who had received PPFP services in the 2 public hospitals and a control group of postpartum women who had received routine hospital services found significant differences in the proportion of women with self-reported pregnancies: 3% vs. 15%, respectively, 6 months after discharge; 6% vs. 22% at 12 months; and 14% vs. 35% at 18 months (P < .001). Applying QI methods helped providers recognize and overcome barriers to integration of family planning and postpartum services by testing changes they deemed feasible.

Utilization of Postpartum Family Planning Services between Six and Twelve Months of Delivery at Ntchisi District Hospital, Malawi

This study examined factors that determine utilization of postpartum family planning services at Ntchisi District Hospital in Malawi. The study design was descriptive and utilized quantitative methods of data collection and analysis. A random sample of 383 postpartum women was interviewed using a structured questionnaire. Data were analysed using SPSS version 16.0. Chi-square tests were used to establish relationships between utilization of Post Partum Family Planning services and demographic variables. Knowledge about family planning services was almost universal at 94.3% among the women. About 75% of the women were using the contraceptives within the first year after delivery however they started taking the contraceptives after they had already resumed sex. There was a significant association (P < 0.05) between utilization of post partum family planning services and the following: clarity of family planning information given, level of education, period for resuming sex, husband’s approval of family planning method, counselling on fertility intention, duration of lactation amenorrhoea, maternal age and parity. There is therefore a need to promote these factors to increase uptake of postpartum services.