MCHIP and PSI Promote Postpartum IUD to Expand Access to Family Planning for More Women

Guest post by Holly Blanchard, Senior Reproductive Health/Family Planning Advisor, Maternal and Child Health Integrated Program (MCHIP)

Access to a wide range of safe and effective contraceptive options is every woman’s human right, including those who have just given birth. Access to family planning (FP) not only enables a woman to achieve her and her partner’s desired family size, but also contributes to improved health outcomes for both women and children. However, in many low resource settings, postpartum women are offered a limited range of FP methods, if they are counseled on postpartum FP (PPFP) at all. With increasing numbers of women delivering in health facilities, the opportunity to offer the option of immediate postpartum intrauterine device (PPIUD) services should be maximized.

Participants gather for a demonstration of PPIUD insertion using anatomic models at a West Africa regional postpartum family planning workshop in Ouagadougou, Burkina Faso this past February. Photo credit: Jhpiego

Participants at the PPIUD meeting in Ouagadougou, Burkina Faso gather for a demonstration of method insertion using anatomic models. Photo credit: Anne Pfitzer

A woman who has voluntarily chosen a PPIUD can leave the maternity ward with a reversible, highly effective method of contraception. She will not be at risk of becoming pregnant too soon and can breastfeed her baby up to the second year of life and beyond as is recommended by both the World Health Organization (WHO) and UNICEF. Many women experience unplanned pregnancies within the first 24 months after giving birth because they rely solely on breastfeeding. When lactational amenorrhea method (LAM), (exclusive breastfeeding and no return to menses), is used, it is highly effective, but temporary—for up to six months postpartum. To meet the nutritional needs of infants, they must start eating other foods at six months.

Studies have also shown that FP reduces child and maternal mortality. “By preventing high-risk pregnancies, especially in women of high parities[ more than four children] and those that would have ended in unsafe abortion, increased contraceptive use has reduced the maternal mortality ratio—the risk of maternal death per 100,000 live births—by about 26% in little more than a decade. A further 30% of maternal deaths could be avoided by fulfillment of unmet need for contraception.”[1]

The U.S. Agency for International Development’s (USAID) flagship Maternal and Child Health Integrated Program (MCHIP) and Population Services International (PSI) have initiated PPIUD services through integration into maternity services around the world, collectively reaching more than 160,000 postpartum women globally. Despite these efforts, PPIUDs still represent a small proportion of contraceptive service delivery in Sub‑Saharan Africa, and more must be done to make this option widely available to all women who deliver in a facility.

With this in mind, MCHIP and PSI’s Support for International Family Planning Organizations (SIFPO) project—with funding from USAID—are increasing awareness of the PPIUD and its role in expanding contraceptive method choice through regional meetings in Africa. The one in West Africa was held in Ouagadougou, Burkina Faso last February and attended by 48 participants representing 11 low-resource countries, including representatives of the Burkina Faso Ministry of Health (MOH) and international partner organizations.[2]

The three-day workshop allowed for south-to-south learning among experts, health providers, programmers, and policy makers to establish and scale up PPIUD services. Expanding the contraceptive method mix in West African countries to include the highly effective PPIUD depends on support from global and regional actors—including the WHO, West African Health Organization (WAHO), USAID, and United Nations Population Fund (UNFPA), as well as national decision makers including MOH staff.

The engagement of MOH officials is especially critical for fostering successful south-to-south learning. One of the most effective ways to encourage governments to incorporate the PPIUD into its basket of available contraceptive methods is through learning from neighboring countries about their experiences in PPIUD services. In his closing remarks, Guy Ahialegbedzi of UNFPA/Togo reflected on the importance of and participant enthusiasm regarding regional knowledge sharing with respect to the PPIUD: “The sharing of experiences has been very rich, with many practical lessons learned. The best testimonial we can make for this workshop will be our mobilization for a rapid implementation of our action plan.”

Update: Read the full meeting report now available (in English and French) on the K4H website, which details country experiences and learning shared during the meeting.

[1] Cleland, J., Conde-Agudelo, A., Peterson, H, and Ross, J. 2012. Contraception and Health. Lancet Volume 380, Issue 9837: 149–156.

[2] Burkina Faso, Cameroon, Cote d’Ivoire, Democratic Republic of Congo, Guinea, Haiti, Madagascar, Mali, Mauritania, Niger, and Togo.

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