• PPFP is a high-impact best practice because postpartum women are among those with the greatest unmet need for FP. According to an analysis of Demographic and Health Surveys (DHS) data from eight sub-Saharan countries, 95% of women who are 0–12 months postpartum want to avoid a pregnancy in the next 24 months. However, 70% are not using a contraceptive method and yet WHO MEC wheel of 2015 recommended immediate PPFP methods to include contraceptive Implants, POP pills, and both copper T and Levonorgestrel IUDs Link
  Yemane, T. T., Bogale, G. G., Egata, G., & Tefera, T. K. (2021). Postpartum Family Planning Use and Its Determinants among Women of the Reproductive Age Group in Low‐Income Countries of Sub‐Saharan Africa: A Systematic Review and Meta‐Analysis. International Journal of Reproductive Medicine, 2021(1), 5580490.
• Worldwide, more than 90% of women during the postpartum period want to either delay or avoid future pregnancies. However, in most cases, sexual activity is resumed without using any FP method
  WHO| Family planning/contraception: fact sheet No 351. 2015
• Women are more likely to engage with the healthcare system during antenatal care (ANC), delivery, postnatal care (PNC), and infant immunizations. Each of these encounters is an opportunity for health care workers to integrate FP into their existing counseling and services to better meet the needs of postpartum women
  Gaffield, M. E., Egan, S., & Temmerman, M. (2014). It’s about time: WHO and partners release programming strategies for postpartum family planning. Global Health: Science and Practice, 2(1), 4-9.
• Being counseled on the utilization of modern FP methods immediately after delivery increased the chance of utilizing modern PPFP methods by 2.16 times. It is in line with studies conducted in Ethiopia and India
  Tamrie, Y. E., Hanna, E. G., & Argaw, M. D. (2015). Determinants of long acting reversible contraception method use among mothers in extended postpartum period, Durame Town, Southern Ethiopia: a cross sectional community based survey. Health, 7(10), 1315-1326.

Structure of PPFP

• Service Provider Capacity to offer PPFP
  • Training: (Training of health care providers according to country specific training guidelines and curriculum)
  • Mentorship: Mentorship to be conducted by skilled mentors at the facility level using available guidance.  
  • Whole-site orientation: include the PPFP material in the FP whole site orientation package.
  • Provision of PPFP through by CBD – Orientation forums for CHWs or VHTs on PPFP for community referrals (to be done as part of CHP/CHV/VHT Orientation)
• Facility readiness to provide PPFP
  • Availability of equipment, commodities, job aids, skilled personnel, space and data reporting tools for PPFP at the service delivery points to ensure all data pieces in a given facility are captured.

Generating Demand for PPFP

• Community Health Promoters /workers/Village health teams
  • Information and counselling provision at the household level to pregnant women and breast-feeding mothers
  • Referrals of pregnant women and breast-feeding mothers, for PPFP
• Materials to promote PPFP
  • Community materials – leaflets, posters, brochures
  • Facility materials – job aids, management protocols, posters, WHO compendium

At the facility level

• Carry out a facility readiness assessment for provision of PPFP, focusing on skills, equipment, and space to offer family planning Ensure availability of commodities and proper documentation tools.
• Conduct whole-site orientation, including sessions on PPFP, for all staff within the facility to rally the needed support for service reorganization, appropriate mobilization, internal referrals of clients and documentation.
• Build the capacity of service providers from antenatal care (ANC), maternity, postnatal care (PNC), and post-abortion care (PAC) on clinical skills for PPFP.
• Update the commodity management system to capture commodities provided in all other service areas outside the family planning unit/room.
• Define the flow of FP commodities within the facility e.g., is it from the family planning unit/room or the central stores where the other departments will order their commodities?
• Ensure family planning commodities and equipment are available in the identified departments (maternity/postnatal ward (PNW) and Gynecological/female ward) for the implant and postpartum IUD insertion.
• Refer to the PPFP manual for the post-partum IUCD insertion and remember to print the job/ instructional aid for PPFP to remind providers about counseling and the provision of PPFP.
• Determine the departments (PNC, PAC, Maternity, CWC ) offering FP services and provide family planning register to document immediate and early (48 hrs,4-6 weeks) PPFP uptake data.
• Identify a facility PPFP champion whose responsibility is to ensure routine provision of immediate PPFP.
• Ensure and monitor quality of PPFP service provision as per the Ministry of Health standards and guidelines and quality improvements i.e., infection prevention measures adhered to, counselling and adverse side effects management.
• Conduct monthly facility review meetings on immediate PPFP to strengthen the quality of services by:
  • Reviewing FP service statistics data to evaluate performance
  • Addressing barriers to provision of  iPPFP services

Useful Tips

• Improve visibility and enhanced decision making through PPFP talking walls.
• Prioritize PPFP as a quality improvement project in the relevant department for continuous quality improvement

At Antenatal Care

 
• Antenatal contacts provide an opportunity for PPFP counseling and should include important options (e.g., LAM) and immediate postpartum methods for those delivering in facilities (e.g., postpartum IUDs, postpartum implants, or female sterilizations).
• Counsel women on their PPFP options at every ANC Avail the relevant IEC material to support counseling and method choice.
• Follow up with the client during each ANC visit.
• During the last trimester visit, review of the birth preparedness plan, prepare a PPFP plan, which includes the place of delivery, and indicate the method chosen in the MCH booklet/Antenatal card/use of the method stamp.
• Ideally, an ANC chart or card should have a mechanism for tracking PPFP counseling during ANC example use of PPFP stamp or a baby-mother booklet which should reflect the counselling and preferred PPFP choice.

 At Labor and Delivery/ Postnatal Care (PNC) Ward

Reorganize services to establish immediate PPFP service provision. Use the following steps as a guide:

 
• Use the available space and resources within the maternity/post-natal ward to provide immediate PPFP.
• Train/mentor service providers from labor and delivery/post-natal care on clinical skills for PPFP focusing on iPPFP.
• Avail the family planning commodities and update the commodity management system to capture commodities provided in the unit. Define the flow of FP commodities within the facility – g., Is it from the family planning unit/room or the central stores that the other departments will order their commodities from?
• Distribute family planning equipment to maternity/PNW and gynecological/female wards. This includes implant insertion and PPIUD insertion sets, Kelly forceps 32cms, sims speculum (1 large, 1 medium), sponge holding forceps, kidney dish and gallipot.
• Print the instructional aid for PPFP to remind providers about counseling and the provision of immediate PPFP.
• Provide a family planning register in all service delivery points g., Postnatal clinic, Post Abortion clinic, etc., and document Immediate PPFP uptake data.
• Link the client on discharge with a community health worker/promoter attached to her community.
• When a woman arrives in labor, confirm and prepare for her PPFP choice. Confirm again that the designated choice remains at the time of service provision.

Routine Postnatal Care

 
• Use the available space and resources within the post-natal ward to provide immediate PPFP.
• Ensure the availability of commodities and supplies at the service delivery point.
• Counsel women on PPFP options at every visit and provide the appropriate method.
• FP counseling should be part of the postpartum visit. Likewise, FP should be discussed in each subsequent visit, and decisions made and confirmed.
• For couples interested in limiting their families, the postpartum period aligns well with vasectomy. If a man has a vasectomy during the first 6 months of his partner’s pregnancy, it will be effective by the time she delivers her baby.
• Document in the family planning register

Gynecological/Female Ward

• Counsel clients on PPFP options at gynecological wards.
• Ensure the availability of commodities and supplies at the service delivery point.
• After they receive Post Abortion care, review the choice of method and counsel women and provide a method of choice.
• Document in the family planning and PAC register.

Community level

In conjunction with Community Health Promoters/Community Health Workers/ Volunteers/Villages Health Teams (CHP/CHW/VHT):

 
• Identify community champions to promote and create demand for PPFP
• Conduct orientation to the CHPs/CHWs/VHTs and champions on PPFP
• Provide them with job aids/IEC materials, and referral books.
• Conduct progress review meetings on PPFP to address any barriers to provision of PPFP services and
• Monitor the community referrals for PPFP.

Useful Tips

 
• Include PPFP material during orientation of CHPs/CHVs/VHTs.
• During ANC counseling, service providers should be encouraged to counsel clients on family planning options and documents.
• Provide IEC materials (leaflets), posters with PPFP/PAFP messages posted in maternity/PNW, Gynae ward and MCH department.
• Consider home visits if targeting PPFP adoption among first-time, young
• In case of any challenge with the availability of MoH FP and registers do not already capture Immediate PPFP data elements, provide alternative tools for data capture.

• Increased uptake of immediate and early (48 hrs and 4-6 weeks) PPFP at facility level
• Proportion of women delivering taking up of PPFP services
• Number and percentage of providers’ capacity built on PPFP
• Expanded PPFP method mix
• Proportion of community facility referrals for PPFP

• Monitor the provision of immediate post-pregnancy family planning methods including the hormonal IUCD through service statistics every month.
• Number of trained /mentored service providers on PPFP
• Routinely assess the quality of PPFP service provision against global/national standards and guidelines.
• Conduct quarterly data quality audits focusing on PPFP at all service delivery points and use of data for action
• Conduct supportive supervision to review PPFP services routinely
• Monitor quality improvement initiatives to improve PPFP according to the country’s guidance on change packages

 
• ALL women counseled on PPFP in ANC and select a method
• Increased proportion of women receiving PPFP, delivered and went home with an FP method
• Number of health care workers providing PPFP Expanded method mix for immediate PPFP to include implants, progestin-only pills, and IUDs (copper T and the LNGIUS) as per country MoH guidelines
• Number of referrals of pregnant women made by CHPs/CHWs/VHTs at the household level
• Number of women using immediate post-pregnancy contraceptive services following post-abortion care before discharge

• Training of Trainers of Trainers on PPFP
• Mentorship of health care workers at facilities implementing PPFP Incorporate demonstration and return demonstrations by participants as well as clinical practicums to ensure that providers acquire the skill
• Supportive supervision/follow up of health providers
• Data quality audit visits
• Printing and dissemination of PPFP guidelines, IEC management protocols tools and training materials (referrals, registers, summary tools at facility and community level)
• Secure and distribute PPFP equipment humanistic models for simulation

• Integrated concepts of PPFP within facility mentorship programs
• Incorporate /Prioritize PPFP in LG work plans for budgeting