International FP Conference 2013 Lynn Bakamjian, Consultant P OSTPARTUM F AMILY P LANNING : Lynn Bakamjian, MPH Consultant O PPORTUNITIES FOR I NTEGRATION Presentation, International FP Conference 2013 Addis Ababa, Ethiopia

A CKNOWLEDGEMENTS PPFP Programming Strategies document team Synthesis of PPFP Program literature, Barbara Deller, Jhpiego, 2012 (unpublished) The many stakeholders at consultations held from 2010 to 2012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 1 st 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 ENERAL P RINCIPLES OF PPFP

… 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 ENERAL P RINCIPLES OF PPFP U NDERSTANDING THE PPFP “C ONTINUUM OF C ARE ”

PPFP C ONTINUUM OF CARE C ONTACT P OINTS Pregnancy 0-48 hours48 hours – 6 weeks4-6 weeks – 12 months

PPFP C ONTINUUM OF CARE S ERVICE D ELIVERY AT C ONTACT P OINTS 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 home, w/in 24 hours facility, prior to discharge Day 3 (48-72 hours) Between 7 and 14 days 6 weeks Pregnancy 0-48 hours48 hours – 6 weeks4-6 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 NIQUE P ROGRAM C ONSIDERATIONS FOR PPFP

N ON -B REAST F EEDING W OMEN B REAST F EEDING W OMEN A LL W OMEN T IMING OF METHOD AND B REASTFEEDING C ONSIDERATIONS IUD F EMALE S TERILIZATION M ALE S TERILIZATION C ONDOMS /S PERMICIDES E MERGENCY C ONTRACEPTION D IAPHRAGM /C ERVICAL C AP 48 hours3 weeks4 weeks6 weeks6 months12 months + L ACTACTIONAL A MENORRHEA M ETHOD P ROGESTIN O NLY C OMB. E STROGEN /P ROGESTIN P ROGESTIN -O NLY M ETHODS C OMBINED E STROGEN -P ROGESTIN P OSTPARTUM C ONTRACEPTIVE O PTIONS

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 PPFP P ROGRAMMING S TRATEGIES Pregnancy (Antenatal Care) 0-48 hours48 hours – 6 weeks4-6 weeks – 12 months

PPFP P ROGRAMMING S TRATEGIES 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 W OMEN DISCUSS REPRODUCTIVE INTENTIONS AND CHOOSE A METHOD DURING ANC S TRENGTHEN AWARENESS OF AND DEMAND FOR PPFP DURING ANC

PPFP P ROGRAMMING S TRATEGIES GOAL STRATEGY W OMEN 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

PPFP P ROGRAMMING S TRATEGIES GOAL STRATEGY P OSTPARTUM WOMEN WHO ARE NOT EXCLUSIVELY BREASTFEEDING AND WHO WISH TO AVOID A CLOSELY SPACED PREGNANCY CHOOSE A FP METHOD H OME - 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

PPFP P ROGRAMMING S TRATEGIES GOAL STRATEGY P OSTPARTUM WOMEN WHO PRACTICE EBF AND LAM UNTIL INFANT IS 6 MONTHS, TRANSITION TO ANOTHER MODERN METHOD I NTEGRATE 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 ESSONS FROM THE P ROGRAM E VIDENCE

F INAL W ORDS S TART WHEREVER YOU CAN ALONG THE PPFP CONTINUUM OF CARE – YOU CAN MAKE A DIFFERENCE !