This post by Sirina Keesara and Grace Lesser originally appeared on the Bill and Melinda Gates Foundation's Impatient Optimists blog. Keesara and Lesser are with Jacaranda Health in Kenya, which is "developing a replicable model to provide affordable, high-quality maternal health services to low-income women worldwide. Jacaranda Health is a stellar example of how the global community is working towards meeting the unmet need for family planning. Here, they share five lessons on integrating postpartum family planning services in their maternity services.
What lessons have you learned about integrating family planning into health services? Tell us in the comments.
Jacaranda Health is working to change the way that maternity care is provided in Africa. We are developing a replicable model to provide affordable, high-quality maternal health services to low-income women worldwide. Our goal is to become a global laboratory for some of the most exciting innovations in maternal and child health service delivery.
Family planning is one of the most cost-effective ways to reduce maternal mortality, and at Jacaranda we are committed to integrating high quality family planning services to the spectrum of our maternity services. We hope to contribute to the community by sharing what we are learning about providing postpartum family planning services in resource-constrained settings.
1. Integrate family planning into maternity services
Pregnant women have so much to think about during pregnancy – where to deliver, how to save for the costs, the baby clothes – that preventing the next child is often the last thing on their mind. But studies from around the world have shown that nearly 80 percent of women do not want a pregnancy in the two years following a delivery. Half of these women would like to start contraception within six weeks after delivery. In Kenya, 90 percent of women in the three months postpartum and 68 percent of women at one year postpartum still have an unmet need for family planning. Most health care facilities design maternity care and family planning as separate services; we believe the two should be married.
Integration of family planning into antenatal, postpartum, and child wellness services is proven to help women meet their contraceptive desires. At Jacaranda, we’ve integrated family planning cues into documentation so that providers do not have to struggle with multiple forms, and can respond to built-in prompts to initiate family planning dialogue throughout the continuum of care. We’ve also designed educational materials for our antenatal clients to take home, which plant the family planning seed early and equip clients with the knowledge they’ll need to make a decision after delivery. The postpartum period is often a missed opportunity for family planning, so we’re also considering helping our antenatal clients build a personal postpartum contraception plan, analogous to a “birth plan,” to encourage them to start planning early.
Evidence from Kenya and other countries suggests that once women have been fully counseled on family planning usage and side effects, satisfaction and uptake increases while unmet need drops.