Postpartum Family Planning: Bridging barriers and motivating change Chelsea Cooper Holly Blanchard Mini University March 7, 2014

Session Overview  Discussion on PPFP and its importance  7 principle PPFP behaviors  Case studies: Application in small groups  MCHIP Kenya & Liberia Experiences  SBCC for PPFP Resources 2

What is Postpartum Family Planning (PPFP)? PPFP is the initiation and use of family planning methods during the first year after delivery Through the first year postpartum consider :  Healthy timing & spacing of pregnancy  Return to sexual activity  Breastfeeding status  LAM and transition to another FP  Continue breastfeeding  Return to fertility=pregnancy risk  Integration—tailoring to fit with timing and service

4 Kenya: Factors Influencing Return to Fertility Across Postpartum Periods Among All PP Women Postpartum Women: N=2,264 Sexually Active: N=1,724 Return to Menses: N= 1,286 Exclusive Breastfeeding: N= 180 Predominant Breastfeeding: N=277

5 Sources: Conde-Agudelo 2005 and DaVanzo et al 2007 Birth to Pregnancy Intervals and Relative Risk of Adverse Maternal, Perinatal and Pregnancy Outcomes—Basis for HTSP

PPFP: High Unmet Need, Low Use 6 Source: Ross and Winfrey “Contraceptive use, Intention to use, and unmet need during the extended postpartum period, Intl FP Perspectives, Want to space or limit, 95% Using a FP method, 38% Not using a FP method, 62% 0-12 Months Postpartum Women Other, 5%

The 7 Principle PPFP Behaviors 7 Key PPFP Behaviors Women who use LAM breastfeed exclusively for up to 6 months as long as menstruation has not returned, and then transition to another modern method once their child reaches six months or sooner if they introduce other foods/liquids Couples discuss FP together, including ideal family size and whether to have another child Women/couples wait at least 2 years after a live birth or 6 months after an abortion or miscarriage before starting another pregnancy Women breastfeed immediately after delivery and exclusively for 6 months Women/couples discuss PPFP options suitable to breastfeeding status and timing postpartum with a health worker during ante- and postnatal health contacts Women/couples use an FP method before they are at risk of pregnancy Champions discuss the benefits of healthy spacing of pregnancy, PPFP, and LAM with others in the community Healthy Spacing Immediate & Exclusive Breastfeeding Seek PPFP during Health Contacts Know Risk, Initiate Use LAM + Transition PPFP Champions Couple Communication

8 Couples discuss FP together, including ideal family size and whether to have another child Couple Communication 1

9 Women/couples wait at least 2 years after a live birth or 6 months after an abortion or miscarriage before starting another pregnancy Healthy Spacing 2

10 Women breastfeed immediately after delivery and exclusively for 6 months Immediate & Exclusive Breastfeeding 3

11 Women/couples discuss PPFP options suitable to breastfeeding status and timing postpartum with a health worker during ante- and postnatal health contacts Seek PPFP during Health Contacts 4

12 Women/couples select an FP method and initiate use before they are at risk of pregnancy Know Risk, Initiate Use 5

13 Women who use LAM breastfeed exclusively for up to 6 months as long as menstruation has not returned, and then transition to another modern method once their child reaches six months or sooner if they introduce other foods/liquids LAM + Transition 6

14 Champions discuss the benefits of healthy spacing of pregnancy, PPFP, and LAM with others in the community PPFP Champions 7

Social and Behavior Change Communication for PPFP  In order to improve PPFP outcomes, consider:  What are the current PPFP practices?  Which PPFP practices should be prioritized?  What are barriers and motivating factors for these behaviors?  What activities will be most effective in addressing these factors and improving the practice of these behaviors? 15

Case Example: Liberia (Bong & Lofa Counties) Formative assessment findings revealed:  Stigma around sexual activity and use of FP before baby walks  Fear that FP will harm the breastmilk and the baby’s health  Lack of provider knowledge of postpartum FP; little integration of FP across MNCH contacts  Partner opposition prevents many women from using FP  Clients and providers lack knowledge of LAM and cues to transition  Most women want to wait at least 2 years before the next pregnancy 16

Case Example: Kenya (Bondo District) Formative assessment findings revealed:  Low continuation of EBF through 6 months  Partner and family support strongly influence FP uptake and EBF  Perceptions that EBF affects woman’s libido and interferes with sex  Misconceptions around exclusive breastfeeding vis-à-vis HIV status.  Perceptions that FP can cause side effects for mother and baby.  Lack of clear understanding among providers and clients about LAM criteria and cues to transition  Lack of routine integration of FP with other MNCH services 17

Group Work Instructions:  Form small groups of 3-4 participants  Each group will be assigned one behavior  Based on the Kenya and Liberia formative assessment findings, discuss the questions raised on your handouts. 18

FP/Immunization Integration in Liberia 19

MIYCN-FP in Kenya 20

Forthcoming SBCC for PPFP Resources  A Guide for Planning and Implementing Social and Behavior Change Communication Activities for Postpartum Family Planning  Social and Behavior Change Communication for Postpartum Family Planning e-learning Course 21

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