International FP Conference 2013 Lynn Bakamjian , Consultant

POSTPARTUM FAMILY PLANNING:

Lynn Bakamjian, MPHConsultant

OPPORTUNITIES FOR INTEGRATION

Presentation, International FP Conference 2013Addis Ababa, Ethiopia

ACKNOWLEDGEMENTS

• PPFP Programming Strategies document team • Synthesis of PPFP Program literature, Barbara

Deller, Jhpiego, 2012 (unpublished)• The many stakeholders at consultations held

from 2010 to 2012

• PPFP is the systematic provision of family planning to women during the 1st year postpartum – when unmet need is high

• Promote PPFP as a standard of care• Promote immediate and exclusive breastfeeding; and

LAM – a “win-win” for mothers and infants• Expand contraceptive choice and options to meet

women’s needs• No missed opportunities across continuum of care

G E N E R A L P R I N C I P L E S O F P P F P

… to assist policy makers and leaders to:• Identify opportunities for integrating PPFP

within Maternal and Child Health services• Support decisions about program design and

investment :– For introducing or strengthening existing services– For comprehensive or discrete programming

G E N E R A L P R I N C I P L E S O F P P F P

UNDERSTANDING THE PPFP “CONTINUUM OF CARE”

P P F P C O N T I N U U M O F C A R E

CONTACT POINTS

Postnatal (including PMTCT)

Pregnancy

Labor, Delivery,

Pre Discharge

Infant Care

0-48 hours 48 hours – 6 weeks 4-6 weeks – 12 months

P P F P C O N T I N U U M O F C A R E

SERVICE DEL IVERY AT CONTACT POINTS

• Facility-based antenatal care (ANC)

• Community-based pregnancy screening

• Facility-based or home-based with skilled birth attendant

• Facility, home, or community-based visits:• Immunizations (DPT or

Pentavalent 1, 2, 3; measles; rota-virus; boosters; etc.)

• Well child visits• Nutrition/growth monitoring,

event days (e.g., Vitamin A)• Illness visits (e.g.,

iCCM/IMNCI)• PMTCT/antiretroviral (ARV)

care and treatment

• Facility or household visits

Birth @ home, w/in 24 hoursBirth @ facility, prior to dischargeDay 3 (48-72 hours)Between 7 and 14 days6 weeks

Postnatal (including PMTCT)

Pregnancy

Labor, Delivery,

Pre Discharge

Infant Care

0-48 hours 48 hours – 6 weeks 4-6 weeks – 12 months

• Medical eligibility criteria: Initiation of method and timing of method are dependent on # of hours/days/weeks post-delivery, lactation status, and a woman’s choice.

• Other contextual issues:– Integration requires coordination among health

services– Socio-cultural norms and beliefs surrounding

childbirth, the newborn and lactating mother

U N I Q U E P R O G R A M C O N S I D E R AT I O N S F O R P P F P

NON-BREAST FEEDING WOMEN

BREAST FEEDING WOMEN

ALL WOMEN

T I M I N G O F M E T H O D A N D B R E A S T F E E D I N G C O N S I D E R AT I O N S

IUD

FEMALE STERILIZATION

MALE STERILIZATION

CONDOMS/SPERMICIDES

EMERGENCY CONTRACEPTION

DIAPHRAGM/CERVICAL CAP

48 hours 3 weeks 4 weeks 6 weeks 6 months 12 months +

LACTACTIONAL AMENORRHEA METHOD

PROGESTIN ONLY

COMB. ESTROGEN/PROGESTIN

PROGESTIN-ONLY METHODS

COMBINED ESTROGEN-PROGESTIN

P O S T PA R T U M C O N T R A C E P T I V E O P T I O N S

• Illustrative Goals, Strategies, Activities and Indicators for each contact point

• Menu of options – not intended as a “How-To” but to illustrate possibilities

……Due to time limitations, will provide one illustrative goal/strategy for each contact point

P P F P P R O G R A M M I N G S T R AT EG I E S

Pregnancy (Antenatal Care)

Labor, Delivery,

Pre Discharge

0-48 hours

Postnatal (including PMTCT)

Infant Care

48 hours – 6 weeks 4-6 weeks – 12 months

P P F P P R O G R A M M I N G S T R AT EG I E S

Pregnancy (Antenatal Care)

Integrate PPFP info and

counseling into ANC services

Assign health workers to

routinely provide group education

on PPFP

Make PPFP IEC materials

available at facilities or for

home visits

Promote inclusion of husbands and

other family members in ANC

education and counseling

GOAL

STRATEGY

WOMEN DISCUSS REPRODUCTIVE INTENTIONS AND CHOOSE A METHOD DURING ANCSTRENGTHEN AWARENESS OF AND DEMAND FOR PPFP DURING ANC

P P F P P R O G R A M M I N G S T R AT EG I E S

Labor, Delivery,

Pre Discharge

GOAL

STRATEGY

WOMEN WHO CHOSE A METHOD DURING ANC RECEIVE HIGH QUALITY SERVICE

PPFP INFO, COUNSELING, AND SERVICES ARE PROVIDED AT MATERNAL SERVICE DELIVERY POINTS

Conduct skills training (pre- and

in-service)

Establish protocols for

informed consent

Ensure exclusive breastfeeding and LAM are routine

components of pre-discharge

counseling

Support providers with supervision,

job aids

Postnatal Care

P P F P P R O G R A M M I N G S T R AT EG I E S

GOAL

STRATEGY

POSTPARTUM WOMEN WHO ARE NOT EXCLUSIVELY BREASTFEEDING AND WHO WISH TO AVOID A CLOSELY SPACED PREGNANCY CHOOSE A FP METHOD HOME-BASED MATERNAL AND NEWBORN CARE INCLUDES PPFP COUNSELING AND SERVICE REFERRAL

Health care provides provide PPFP messages

and referrals

CHWs are trained in counseling skills

and equipped with job aids,

commodities

CHWs conduct community education activities that engage

men, families and communities to

support PPFP

Community health workers provide

short-term methods

P P F P P R O G R A M M I N G S T R AT EG I E S

Infant Health and Immunization Services

GOAL

STRATEGY

POSTPARTUM WOMEN WHO PRACTICE EBF AND LAM UNTIL INFANT IS 6 MONTHS, TRANSITION TO ANOTHER MODERN METHODINTEGRATE PPFP WITH ROUTINE IMMUNIZATION SERVICES

Conduct group talks (HTSP, return to

fertility, FP) during routine

immunization sessions

Dedicated FP providers provide co-located, same-day FP counseling

and services

Community-based workers mobilize

mothers for immunization days

and assist with group FP sessions and

follow-up

Immunization providers screen women about FP

needs and provide vouchers or referrals

for services

• Program attention at any contact point to increase accurate information, upgrade skills and capacities of health care workers to provide quality counseling and services will generally result in increased FP use by postpartum women

• However, longer programs with multiple contact across the continuum of care may have more effect on PPFP utilization than short programs with few contacts.

L E S S O N S F R O M T H E P R O G R A M E V I D E N C E

F I N A L W O R D S

START WHEREVER YOU CAN ALONG THE PPFP CONTINUUM OF CARE – YOU CAN MAKE A

DIFFERENCE!