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Programme Strategies for Postpartum Family Planning: A new resource for FP programmes

Mary Lyn Gaffield, PhD

November 2013

Scientist, Human Reproduction Team

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Background

Since 2010, WHO has been approached by Member States, USAID, and other development partners to promote and strengthen family planning services for women during the postpartum period – Clinically defined period (6 weeks) – WHO guidelines address contraceptive safety and service delivery

during 6 week period

Recognition that programmes need to consider an extended postpartum period – the first 12 months after childbirth

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Identifying and addressing the need Development of a plan of work and products through…

– Brainstorming meetings at WHO and MCHIP (March & November 2010, April 2011)

– Panel sessions at international conferences• First Global Forum for Health Services Research (Montreux, Switzerland), 2010

• 2nd International Conference on Family Planning (Dakar, Senegal), 2011

The products – Statement for Collective Action

– Programme Strategies for Postpartum Family Planning: A new resource for FP programmes managers and policy makers to implement the Statement

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Statement for collective action

Highlights importance that family planning programmes reach postpartum women

Defines the issue, offers broad strategies to address unmet family planning needs for these women

Numerous endorsements obtained

Available in French, Spanish translation underway

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WHO’s commitment at the Family Planning Summit – July 2012

Facilitating the delivery of family planning to women during the year postpartum identified as one of the essential components of health care.

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The goal of the resource

Tailored for users with different needs

– For comprehensive programmingor

– To strengthen single or multiple elements within the health system

Recognizes programme interventions require holistic perspective and need to be evidence-informed

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The method of work

The process– 'Map' existing guidance on the topic– Interview public health officials from selected countries

for contextual input– Synthesize the published evidence– Develop the draft document

• Meeting of expert to review draft document in July 2012 (Washington .DC)

• WHO Technical consultation to finalize document in September 2012 (Geneva, Switzerland)

• Multiple reviews of drafts among experts to produce final document

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Drawing upon existing guidelines

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Keeping the needs of users in mind

Reminders of the unique needs of postpartum women

Understanding the landscape for programme design: – Question-driven process – Applying a health systems framework– Illustrative examples

Integration points within the system Examples from country programmes

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Developed for the needs of users – cont.

Users guided to assess their national health system based upon WHO framework for action to understand their setting:– health services– HMIS– health workforce– medicines/technology– leadership/governance– health financing

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Linking assessment to potential interventions

Illustrative findings Potential programme interventions

High rates of breastfeeding Introduce LAM and counsel on transitioning to other effective contraceptive methods

High rates of staff rotation within and among facilities

Strengthen policies and practices to address staff development and retention to ensure that providers with FP skills are avialable within ANC, labour and delviery and postnatal care.

Low modern contraceptive prevalence Train community health workers to integrate community education and individual counseling about LAM, healthy timing and spacing, and exclusive breastfeeding with referral for other FP methods as a routine part of care

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Content areas to guide programming

Antenatal care Labor and delivery/pre-discharge Postnatal Infant health and immunization services

CONTINUUM OF POINTS OF CONTACT FOR PPFP STAGE

Pregnancy

Labour and delivery, Pre-discharge (0–48 hours)

Postnatal, including prevention of mother-to-child transmission of HIV (PMTCT)

(48 hours–6 weeks)

Infant care (4–6 weeks through 12 months)

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Example of a strategy

Overall programme goals

Programme outcomes

Approaches to programme design– Illustrative programme strategies– illustrative programme activities– illustrative indicators

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Additional resources

Monitoring and evaluation Indicators, definitions, data source, frequency Sample indicators address

policy/enabling environment service delivery/capacity client/community/FP demand FP service coverage

Supporting evidence for program design

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Stay tuned Publication on WHO website:

– http://www.who.int/reproductivehealth/publications/family_planning/ppfp_strategies/en/index.html

Publication on USAID website:– http://www.usaid.gov/

Publication on MCHIP website: http://www.mchip.net/addisppfp

Questions ? Email us at: reproductivehealth@who.int

Translations into French and Spanish will be undertaken