Counseling and Improved Family Planning Uptake during the Extended Postpartum Period – Pakistan

Experience

Dr Zonobia & Dr Fauzia 13th November 2013

International Conference for Family Planning, Ethiopia

Family Planning Needs in Postpartum Period

Slow progress towards achieving MDGs 4 &5

Limited information on pregnancy risk and contraceptive choices during postpartum period

Evidence shows 64% unmet need among women in the first year postpartum

Inefficient dissemination of LAM information

Low utilization rate of IUCD in postpartum period

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Source: PDHS 2006–07

Unmet nee

d64%

Us-ing FP22%

Desire

birth

<2yrs12%

Infecund2%

Unmet need of FP in Pakistan

Post Partum Family Planning (PPFP)

PPFP is a subset of FP for the prevention of unintended pregnancies through the first year postpartum.

Key Elements:

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Health Timing of Pregnancies

Providing access to FP Counseling and Services in MNCH Services

Expanding choice for modern contraceptives

Strengthening Postpartum Family Planning in Pakistan

PAKISTAN

Punjab

PPFP Introduction at MBD supported by the MOH/MOPW and Packard (Sep 2011 - Dec 2013)

Integrated PPFP and MNH Service Delivery Model at birthing facilities

Expand access to LARC- Involving community health workers

of PPFP Services at health facilities

Expanding choice of contraceptives

Involving community health workers

Mandi Bahauddin

Population: 1.3 MillionArea: 7623Sq.Kms 4

What was studied / analyzed?

Improving effectiveness of counseling by incorporating key messages on healthy timing and spacing, return to fertility and benefits of PPFP.

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Secondary data analysis of monthly Facility Reports (Sep 2012 – Aug 2013)

Information collected about Antenatal & Postnatal clients up to 1 year Postpartum

Information collected about Antenatal & Post natal clients up to 1 year Postpartum

Structured Performa / questionnaire

At District Level – Mandi Bahauddin

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Baseline Assessment

Physical resources for provision of PPFP services were inadequate.

Inappropriate knowledge about PPFP Services

IUCD insertion skills needs improvement

Infection Prevention is poor

FP R

esou

rces

Couns

elin

g & H

TSP

PPIUCD

CoCs

Inje

ctabl

es

Inte

rval

IUCDs

Infe

ction

Pre

vent

ion

Impl

ants

0

5

10

15

20

25

30

35

40

45

5045

18

0

7

27

1714

0

Baseline Assessment for Modern Contraceptive Methods

% Scores achieved

7

Interventions

Stakeholder

Involvement

Capacity building

Supportive

Supervision

Advocacy

Maximizing Opportunities !!!

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Integrating FP services at

health

Developing Referral Linkages

Recording + Reporting of PPF

Services

Establishing FP Counters at ANC

Clinics

Stamping ANC Cards

Training of PPFP Counselors

Involving Vaccinators

Provision of FP supplies at Delivery

Room/ Postnatal ward

Family Planning at Pediatric

OPDs

PPIUCD Services available

Postnatal Counseling

Distribution of information

material through LHWs

Results Sept12 - Feb13Increased Rate of Counseling at FP

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Gradual increase in clients counseled for PPFP.

Antenatal counseling rates increased from 21%—91%

Postnatal counseling increased from 24%—86%

Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 Apr-13 May-13 Jun-13 Jul-13 Aug-130

10

20

30

40

50

60

70

80

90

100

25

32

42

51

6669

81

94

87

76

65

90

% clients counselled on PPFP

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PPFP method AcceptanceSept 12 - Aug 13

PPFP method acceptance has increased from 18-55% in the postpartum period

Increased PPFP acceptance with increased client counseling

Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 Apr-13 May-13 Jun-13 Jul-13 Aug-13

0

10

20

30

40

50

60

70

80

18

25

35

4643 44

47

66

79

70

49

55

% women accepting PPFP (PN Women)

Clients Contraceptive Methods Choice

9.9% of MWRA accepted PPFP IUCDs 20 – 23% PPIUCD 0 – 2%

(acceptance as a new intervention)

COC’s 17.7 – 21.7% PIC’s 18.7 – 19.5% Implants 0.1% Permanent methods

5.0 – 4.2% (gradual decrease)

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Pills18%

Injec-tions18%

Condoms20%

LAM17%

IUD20%

PPIUCD2%

Permanent Method5%

Implants0%

PPFP Method Type

Conclusion

Effective counseling in the extended postpartum period of mothers is a major factor influencing their acceptance to use postpartum contraception;

Knowledge on extended postpartum contraceptives is very important to enable mothers make informed choices

Remarkable effect on FP methods uptake due to improved PPFP counseling by vaccinators, general physician (male) and Lady Health Workers at community level.

Need for family planning programs and policies to focus on the use PPFP as a measure to increase usage of modern contraceptive methods.

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Glimpses from the Field

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Glimpses from the Field

Jhpiego Pakistan

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