Integrating Family Planning and Maternal, Newborn, and Child Health Services
Why does integrating family planning and maternal, newborn, and child health services matter?
Pregnancies spaced too closely together pose serious health risks to both mothers and children, yet many postpartum women have an unmet need for family planning. Capitalizing on opportunities to provide family planning information, services, and referrals when mothers and children have contact with the health system to receive safe delivery, immunization, nutrition, or other health services can save time and money and reach more women with essential services.
Integration: The joining together of different types of health services in order to expand access to care and improve health outcomes
LAM: The lactational amenorrhea method of pregnancy prevention, which relies on the natural hormonal effect of breastfeeding on fertility, is more than 98% effective if the following three conditions are met: (1) the mother’s monthly bleeding has not yet returned, (2) the baby is exclusively breastfed, and (3) the baby is less than 6 months old. (IRH)
Low birth weight: Weight at birth less than 2,500 grams (5.5 pounds) (WHO)
Preterm birth: Babies born alive before 37 weeks of pregnancy are completed (WHO)
Small for gestational age: Birth weight below the 10th percentile (NLM)
Family planning can be integrated at several maternal, infant, and child health service delivery points, with positive and complementary effects on maternal and child health. Harmonizing counseling and services for maternal, newborn, and child health (MNCH) and family planning throughout the continuum–from delaying pregnancy among adolescents to healthy timing and spacing of pregnancies in adulthood–will help improve health outcomes across all stages of the life cycle. Supportive policies, evidence-based service delivery guidelines, capable service providers and managers, strong logistics to ensure availability of supplies, and broad acceptance by both communities and health workers are all essential to successful integration.
There are many opportunities to integrate family planning with maternal, newborn, and child health services throughout the life cycle:
- Antenatal care: During antenatal visits, providers can talk with mothers about their ideal number of children and their plans to space or limit subsequent pregnancies after the birth of this child. Integrating discussions about immunization and postpartum family planning, including the lactational amenorrhea method (LAM), into antenatal services will help ensure that mothers and fathers are aware of the benefits of adhering to the recommended vaccination schedule, breastfeeding, and healthy timing and spacing of pregnancies. When expectant couples have thought about their health and family planning needs and options before their child’s birth, they can make informed choices to achieve optimal nutrition and protection for mother and baby and avoid a too-closely-spaced subsequent pregnancy.
- Birth and postpartum care: Exclusive breastfeeding in the first six months after birth not only provides perfect nutrition for the infant, it also meets the mother’s contraceptive needs if she practices LAM. Providing support for exclusive breastfeeding and clear information about how to prevent pregnancy during the transition from exclusive breastfeeding to solid foods greatly benefits the whole family. Counseling breastfeeding mothers about their contraceptive options, including LAM, progestin-only pills and injectables, and the postpartum IUD, will help them care for themselves and plan for healthy families.
- Immunization, well-baby, and child health visits: Offering family planning information and services to postpartum women during their infants’ well-baby visits, immunization visits, and routine child health visits provides recurring opportunities to reach women who may have unmet need for family planning with information, counseling, referrals, or even direct services to ensure that women who wish to space or limit pregnancies are able to do so.
- Adolescent health: Adolescence is a crucial growing period for a young woman. Adolescent pregnancy poses health risks to young mothers, including anemia, obstetric fistula, unsafe abortion, and even mortality. Babies born to adolescent mothers are also at increased risk of preterm birth, low birth weight, undernutrition, and infant mortality. Ensuring that adolescents have access to youth-friendly contraceptive information, services, and counseling is crucial.