Effect of Postpartum Family Planning Counseling on Adoption & Continuation of Modern Contraceptive Methods

April 2014

Authors
Bitar Nisreen, HSS II Project, Abt Associates, Jordan. (Principle Investigator)
Al-Faiz Layl, MOH, Jordan.

Al-Masri Anas, HSS II Project, Abt Associates, Jordan

Sulimat Abd-almane', MOH, Jordan. Wright Susan, HSS II Project, Jordan.
Abt Associates | pg 2

Background
Location: Middle East
Population: 6.5 M Literacy Rate: 93% Employment Rate: 88% Women employment: 17%

Public hospitals with Maternity: 30

Abt Associates | pg 3

Background
Modern CPR 42% (unchanged in 10 yrs) TFR 3.5 (2012)

Traditional methods use increased from 15% in 2002 & 2007 to 17% in 2009 and 19% in 2012.
In Jordan 99% of women deliver in hospitals.

In 2011, HSS II Project assisted the public sector to gradually integrate PP FP within hospitals PP services
By end of 2013, 23 public hospitals were providing PP FP services; 53% received counseling and 32% received modern FP methods
Abt Associates | pg 4

Study Methodology
Goal: To assess effectiveness of PP counseling on adoption and use of modern FP methods Study design: Prospective case control Location: Obstetric & Gynecological Ward - Al-Bashir Hospital, Amman Jordan Treatment group received a FP counseling session while control didnt Data Collection: 1600 PP Women recruited; 800 for each group; basic info collected from women while in hospital

Phone interviews (structured questionnaire) at 40 days, 3 and 6 months

Abt Associates | pg 5

Counseling Received
Interactive counseling session provided to PP woman within treatment group by a trained midwife Main topics discussed: Healthy birth spacing Exclusive breastfeeding & LAM

Womans medical history, FP experience & preferences.

Modern FP methods Womans concerns/questions

Dispense method
Referral if needed
Abt Associates | pg 6

Sample Characteristics
Received PP FP Didn't receive PP Counseling FP Counseling Mean Age 27 27

Mean Number of Alive Children

Mode of Delivery No education Education Primary Secondary

3 Vaginal: 64%; C/S: 36% 2%

41% 40% 11% 7% 6% 47%

3 Vaginal: 57%; C/S: 43% 2%

40% 39% 12% 8% 6% 43%
Abt Associates | pg 7

2-year collage
University/Masters Work Outside the House Used Modern FP Methods Previously

Use of Modern FP Methods at 40 Days, 3 & 6 Months

Received PP FP Counseling 61% 50% 50% Didn't receive PP FP Counseling 59%

53%

n = 533

n = 476

n = 607

28%

At 40 days

n = 628

At 3 months

n = 555

At 6 months
Abt Associates | pg 8

n = 479

Use of Modern Methods at 40 Days

Women received counseling
Implant Injection or COCs 2% 1%

Women didnt receive counseling

LAM IUD Condom 6% 4% 5% POPs 12%

IUD LAM 8% 10%

Implant injection 1%

POPs 19% Condom 10%

Not using 50%

Not using 72%

n = 607

n = 627
Abt Associates | pg 9

Top Reasons for Not Using Modern FP Method at 3 & 6 Months Top Reasons
Using traditional method Breastfeeding Waiting for menses Husband traveling/separated I am pregnant Want pregnancy Received counseling Didn't receive

3M
70 62 10 17 4 6

6 M
102 27 6 12 18 11

3M
103 78 11 9 4 9

6M
109 32 10 7 26 9

Abt Associates | pg 10

Conclusions
Results show significant effect of FP counseling provided to PP women before discharge from hospital on early adoption and use of modern FP methods, compared to women who did not receive counseling. (p value less than 0.05 at 40 days and 3 months)

Providing this service to all PP women before discharge from hospitals could significantly increase PP FP use and reduce the incidence of closely spaced births in Jordan.

Abt Associates | pg 11

Challenges
Ensuring that all PP women receive FP counseling before discharge from hospitals

Assisting women to cope with side effects and other difficulties in using her preferable method over time
Improving breastfeeding behavior and correct use of LAM Assure all hospital service providers providing quality PP FP services Reduce missed opportunities for FP counseling and services at PHC facilities
Abt Associates | pg 12

Lessons Learned
Commitment of policy makers and hospitals managers is very important for the success of PP FP programs Allocate specific midwives/nurses to provide PP FP services increased the percentage of reached women and improved the quality of services provided FP services should be offered to women at both health centers and hospitals (out-patient and inpatient clients)

Abt Associates | pg 13