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Postpartum Family Planning

Kneeling woman checks newborn wrapped in cloth and lying on floor

Female community health volunteer (FCHV) examines newborn during home visit

ACCESS-FP is designed to complement the ACCESS Program through the promotion and scale up of postpartum family planning (PPFP) using community and clinic-based approaches suitable for low-resource settings.

The ACCESS Program works to expand coverage, access and use of key maternal and newborn health services across a continuum of care from the household to the hospital. ACCESS-FP promotes the integration of family planning throughout this continuum of care to ensure that information and services are provided in a coordinated, convenient manner. For instance, the most critical time for activities aimed at reducing maternal and newborn mortality is during birth and the first 3 days of life. This immediate postpartum period is also an ideal time to discuss the use of exclusive breastfeeding as a contraceptive method, future fertility and birth spacing or limiting intentions, and appropriate family planning methods.

In recognition of the need to ensure access to family planning beyond the traditional end of the six-week postpartum period, ACCESS-FP activities extend a full year post-birth to ensure that the reproductive health needs of the mother, as well as the health care needs of the infant, are fully met.

ACCESS-FP works to strengthen and expand the following priority areas:

  • National maternal and newborn policies and strategies to ensure the inclusion of family planning in the development of essential packages of care;
     
  • Curricula, standards and guidelines for preservice education, in-service training and service delivery to include postpartum information including return to fertility, birth spacing and the full range of family planning methods;
     
  • Behavior change communication strategies to educate and support birth spacing and family planning, including exclusive breastfeeding and LAM;
     
  • Facility and community approaches for integrating family planning messages and services with antenatal care, safe delivery, essential newborn care, postpartum care for the mother and newborn, and essential child care; and
     
  • Reaching underserved pregnant and postpartum women, including married adolescents, those in the poorest economic quintiles, and HIV+ women, with information and services on birth spacing and family planning.

Integration

There are multiple opportunities to provide birth spacing and family planning information and services in the context of maternal, infant and child health care services. These opportunities include antenatal care, early postpartum and extended postpartum visits, as well as immunization and well child care.

For HIV positive women—whether enrolled in a program aimed at the prevention of mother to child transmission of HIV/AIDS or not—there are special needs for counseling about exclusive breastfeeding and abrupt weaning that affect women’s return to fertility. Prevention programs have an additional need to provide ongoing care and support to the mother and infant during the postpartum period, both to support exclusive breastfeeding and for follow-up testing and treatment. ACCESS-FP, with its focus on the extended postpartum period, works with these programs to build or strengthen postpartum follow-up services for mother and infant.

No Missed Opportunities

ACCESS-FP is uniquely positioned to effectively work with facilities on a no-missed opportunity concept. This ensures that all women who attend antenatal care, deliver in a facility, are referred for emergency care services, or come for postnatal services (which traditionally focus on the infant) have the necessary information about birth spacing and family planning and services.

In light of the fact that most women in the developing world do not give birth in health facilities, ACCESS-FP builds on any initial point of contact—either facility or community-based—for linking follow-up PPFP services.

Learning about What Works

As with many programs that work toward integrated services, it is sometimes necessary to test and adapt approaches to ensure their viability. To accomplish this, ACCESS-FP collaborates with researchers to design and document both educational messages and service approaches to integrate PPFP into ongoing maternal, newborn, infant and child health services.

Scaling Up

ACCESS-FP promotes and scales up successful family planning practices through human resource management, standards-based management and performance quality improvement mechanisms, and collaboration and partnerships. These approaches empower communities to be active users of health care and active participants in planning services.

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