• Research has demonstrated that more than 90% of women during their first year postpartum want to either delay the next pregnancy for at least two years or avoid future pregnancies all together.
• Women are much more likely to take up postpartum family planning if they have made a decision before going into labor.
• Pregnancies in the postpartum period pose the greatest risk for women and their infants and have increased risks of adverse health outcomes (WHO 2018).

At facility level

• Carry out a facility readiness assessment for provision of PPFP, focusing on skills, equipment, and space to offer family planning service. Ensure availability of commodities and proper documentation.
• Conduct whole-site orientation, including lessons on PPFP, for all staff within facility to rally the needed support for service reorganization, appropriate mobilization of clients and documentation.
• Train/mentor service providers from antenatal care (ANC), maternity, postnatal care (PNC), and post-abortion care (PAC) on clinical skills.
• Update the commodity management system to capture commodities provided in all other service areas outside 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?
• Distribute family planning equipment to maternity/postnatal ward (PNW) and Gynae ward for implant and postpartum IUD insertion:
  • Kelly forceps 32 centimeters
  • Sims speculum: 1 large and 1 medium
  • Sponge
  • Holding forceps
  • Kidney dish
  • Gallipot
• Print the instructional aid for PPFP to remind providers about counseling and provision of PPFP.
• Document Immediate PPFP uptake data. Provide a family planning register in all service delivery points (PNC, PAC, etc.).
• Identify a facility PPFP champion whose responsibility is to ensure routine provision of immediate PPFP.
• Conduct monthly facility review meetings on immediate PPFP to strengthen the quality of services through:
  • Review of FP service statistics data to evaluate performance, and
  • Address barriers to provision of immediate PPFP services.

At Antenatal Care

• Counsel women on their PPFP options at every ANC visit.
• During the last trimester visit, review the birth preparedness plan and prepare a PPFP plan, which includes the place of delivery and the method chosen.

At Maternity / Postnatal Ward

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

• Allocate a room or space in maternity/PNW to provide immediate 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 commodity within the facility – e.g., Is it from family planning unit/room or the central stores that the other departments will order their commodities from?
• Distribute family planning equipment to maternity/PNW, Gynae ward. 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 provision of immediate PPFP.
• Document Immediate PPFP uptake data. Provide a family planning register in all service delivery points e.g., PNC, PAC, etc.

At Routine Postnatal Care

• Counsel women on PPFP options at every visit.

At Gynae ward

• After they receive care, counsel women who have come for non-FP services and procedures on PPFP and provide service.
• Distribute FP equipment and commodities.

At Community level

In conjunction with Community Health Extension Workers/Community Health Volunteers/Villages Health Teams (CHEW/CHV/VHT):

• Conduct orientation on PPFP.
• Provide VHTs/CHVs/CHEWs with job aids/IEC materials, myths and misconception booklets.
• Conduct progress review meetings on PPFP to address any barriers to provision of PPFP services and other support needed.

Useful Tips

• During ANC counseling, service providers should be encouraged to counsel clients on family planning options and document this counseling.
• Provide IEC materials, such as posters with PPFP messages, posted in maternity/PNW, Gynae ward and MCH.
• Consider home visits if targeting PPFP adoption among first time, young parents.
• If MOH registers do not already capture Immediate PPFP data elements, provide alternative tools for data capture.

• Increased uptake of family planning and contraception services at facility level
• Enhanced opportunities for provider-initiated family planning

• Monitor provision of immediate post-pregnancy FP through service statistics on a monthly basis.
• Routinely assess the quality of PPFP service provision against global/national guidelines.
• At least monthly, provide supportive supervision to review PPFP services and data.

• Number of women who select a method during ANC and are eligible who receive desired method prior to discharge
• Increased number of women who deliver and go home with a FP method
• Increased number of women counseled on a FP method
• Increase in competent health care workers providing PPFP services
• Expanded method mix for immediate PPFP to include implants, progestin only pills and IUDs
• All pregnant women within households reached with PPFP information by CHVs/CHEWs/VHTs

• Facility readiness assessment
• Training of health care workers at facilities implementing PPFP
• Training of CHWs/CHEWs/VHTs to implement PPFP at community level
• Printing of PPFP tools (referrals, registers, summary tools at facility and community level)
• Supportive supervision of PPFP activities
• Cascade whole site orientation to other facilities; mentor/train providers
• PPFP guidelines dissemination
• PPFP IEC printing
• Follow-up visits/home visits
• PPFP landscaping and desk review by data clerk in consultation with Reproductive Health Coordinator
• PPFP equipment purchase

• Integrate concepts of PPFP within facility mentorship programs and ensure that PPFP and healthy timing and spacing of pregnancy (HTSP) are well-covered in practical training
• Integration of FP services within Maternal Newborn and Child services