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

International Conference for Family Planning, Ethiopia Dr Zonobia & Dr Fauzia 13th November 2013

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
Source: PDHS 200607

Unmet need of FP in Pakistan

Desire birth <2yrs 12%

Infecund 2%

Using FP 22%

Unmet need 64%

Post Partum Family Planning (PPFP)

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

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 LARCInvolving community health workers
PAKISTAN

Mandi Bahauddin

Population: 1.3 Million Area: 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.
Secondary data analysis of monthly Facility Reports (Sep 2012 Aug 2013)

At District Level Mandi Bahauddin

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

Baseline Assessment
Physical resources for 50 provision of PPFP 45 services were 40 inadequate. Inappropriate knowledge35 about PPFP Services 30 25 IUCD insertion skills 20 needs improvement 15 Infection Prevention is 10 poor 5
0
FP Counseling PPIUCD Resources & HTSP CoCs Injectables Interval IUCDs Infection Implants Prevention

Baseline Assessment for Modern Contraceptive Methods

45

27

18

17 14

% Scores achieved

Interventions

Stakeholder Involvement

Advocacy

Capacity building

Supportive Supervision 7

Maximizing Opportunities !!!

Distribution of information material through LHWs Developing Referral Linkages Recording + Reporting of PPF Services

Postnatal Counseling

Establishing FP Counters at ANC Clinics

PPIUCD Services available

Integrating FP services at health

Stamping ANC Cards

Family Planning at Pediatric OPDs

Training of PPFP Counselors Provision of FP supplies at Delivery Room/ Postnatal ward Involving Vaccinators

Results Sept12 - Feb13 Increased Rate of Counseling at FP

% clients counselled on PPFP

Gradual increase in clients counseled for PPFP. Antenatal counseling rates increased from 21%91% Postnatal counseling increased from 24%86%

100 90 81 80 70 60 51 50 42 40 32 30 20 10 0
Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13

94 87 90

76 66 69 65

25

Apr-13

May-13

Jun-13

Jul-13

Aug-13

PPFP method Acceptance Sept 12 - Aug 13

% women accepting PPFP (PN Women)

PPFP method acceptance has increased from 18-55% in the postpartum period Increased PPFP acceptance with increased client counseling

79 80 70 70 60 66

55 46 43 47 44 49

50
40 30 20 10 0
Sep-12 Oct-12 Nov-12

35 25 18

Dec-12

Jan-13

Feb-13

Mar-13

Apr-13

May-13

Jun-13

Jul-13

Aug-13

10

Clients Contraceptive Methods Choice

9.9% of MWRA accepted PPFP IUCDs 20 23% PPIUCD 0 2% (acceptance as a new IUD 20% intervention) COCs 17.7 21.7% PICs 18.7 19.5% Implants 0.1% Permanent methods 5.0 4.2% (gradual decrease)
PPFP Method Type
Permanent Method Implants 0% 5% PPIUCD Pills 2% 18%

LAM 17%

Injections 18% Condoms 20% 11

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

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Jhpiego Pakistan

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