Program Approach :
Postpartum Family Planning
Postpartum Family Planning
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
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.
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.
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.