Nigeria: Service Delivery
Postpartum Family Planning
Postpartum family planning (PPFP) entails the provision of family planning (FP) information, counseling and services to women within the postpartum period. This can be done in the immediate postpartum period (within 6 weeks of delivery) and in the extended postpartum period (up to 1 year post delivery). PPFP has been identified as a high impact practice targeted at increasing access to contraception for women of reproductive age following childbirth, thereby reducing unintended pregnancies and associated maternal, child and infant morbidity and mortality.
According to WHO Medical Eligibility Criteria for Contraceptive Use (2015), women can safely use the contraceptive implants alongside most of the other contraceptive options in the immediate postpartum period. This is further broken down for breastfeeding and non-breastfeeding women.
- FP options for breastfeeding women: intrauterine device (IUD), Implants, progestogen-only pills, lactational amenorrhea method (LAM), condoms, male sterilization and female sterilization.
- FP options for non-breastfeeding women: IUD, implants, injectables, condoms, emergency contraception, combined oral contraceptives (commence 21 days after delivery), male sterilization and female sterilization.
What are the benefits of PPFP?
- Adequate spacing and limiting of pregnancies with prevention of unintended pregnancies and its associated complications
- Seamless access to contraceptive services immediately after delivery pre-discharge and in the extended postpartum period during routine childhood immunization visits
- Improved quality of life for women, adolescent girls, children and the family
How to implement:
Step 1: Identify facilities with high client load for antenatal care (ANC) services
Facilities with high ANC volume present viable opportunities for PPFP integration and, as such, will be a good starting point for PPFP services, with plans for scale up to other facilities with moderate ANC volume over time. High-volume facilities can be identified using ANC attendance numbers on the DHIS2 platform. Facility-based PPFP services start from the point of ANC when pregnant women begin to receive information and counseling on FP including its benefits, method options information and availability of FP services within the health facility. This gives the women adequate time to make an informed decision about whether or not to take up a method and informed choice on a particular method.
Step 2: Conduct a training needs assessment of health providers within selected facilities
Selected facilities may already offer FP services including provision of FP services for women in the postpartum period. In other words, there may already be trained FP providers within the facilities. PPFP entails that FP services are offered to women at the maternity unit following delivery in the immediate postpartum period or at designated FP units in the extended postpartum period. The training needs assessment will enable the team to categorize relevant providers based on whether or not they have received FP training and are providing FP services. The assessment will focus particularly on Nurses and CHEWs in the RMNCH unit. Areas of optimization of the PPFP approach within selected facilities will also be assessed with emphasis on PPFP integration across relevant service delivery points (SDP) within the facility, inter-facility referrals from identified SDPs, and documentation of the PPFP services provided. The capacity building approach will be responsive to address gaps identified in these areas to effectively optimize PPFP services.
Step 3: Capacity building of health providers on PPFP
Based on the outcome of the training needs assessment, the team will categorize health providers into two major groups including trained FP providers currently providing FP services, including long-acting reversible contraceptives (LARC), and MCH unit providers without FP training. A comprehensive PPFP training will be organized for untrained providers in the maternity/FP units to prepare them for PPFP implementation. A 1-2-day PPFP orientation will be conducted for providers already trained on provision of FP services including LARC. The PPFP trainings and orientation will cover key areas of FP method options, documentation and reporting, and referral strengthening from relevant service points.
These trainings are based off of the Family Planning Training for Physicians and Nurses/Midwives: National Training Manual. Participants are certified as family planning providers following post training supportive supervision. Other useful training tools can be found here.
The whole site orientation (WSO) approach should also be adopted to provide relevant PPFP information and benefits to the entire facility staff including staff from relevant integration points to improve their understanding of PPFP and engender their support for seamless PPFP service provision. Some of the relevant integration points include ANC, children clinics, immunization units and MNCH weeks.
Step 4: Integrate PPFP messages into routine RMNCH social mobilization activities
Work with existing pool of social mobilizers within focus communities to include relevant PPFP messages into social and behavior change and communication (SBCC) activities for RMNCH programs. Review existing information, education and communication (IEC) materials to reflect PPFP information and circulate widely within the communities. Engage community leaders including religious and traditional leaders who are already FP champions to advocate for PPFP services within their congregations and at other relevant community events. Discuss PPFP information and services as part of routine FP outreaches and during MNCH weeks and refer interested postpartum women to nearby health facilities for PPFP services.
Step 5: Family planning commodity management and security
Strengthen FP commodity logistics management systems (CLMS) across selected facilities. Facilities already offering FP services are likely to have a moderately functional or strong logistics systems in place compared to newly identified facilities for PPFP services. It is advisable for states to kick-start implementation of the PPFP approach in FP-experienced facilities with focus on strategies to close existing gaps in the facility supply chain management systems. For PPFP-naïve facilities, states will need to develop an activation plan which includes instituting FP CLMS within the facilities, training of providers on FP, inclusion of the facilities on the list of FP facilities for requisition and supply, and on the DHIS for reporting etc. To fully operationalize the PPFP approach, there may be need to set up the maternity unit to be able to provide FP services directly without having to refer to the FP units, this will require proper planning and organization of the unit, with seamless commodity supply from the FP unit. The facility team will receive coaching and technical assistance on the use of FP requisition, issue and report forms (RIRF) to enable them to request for adequate commodities based on utilization. The maternity team will work closely with the team at the FP unit to ensure synergy in requisition and reporting.
Step 6: Streamline existing reporting tools
Provide technical assistance to states to review the current FP tools to capture relevant PPFP data as much as possible. The current register already captures required information around FP service provision. Providers should be guided to use applicable section of the register to indicate PPFP when FP services are provided in the immediate or extended postpartum periods. Where possible, work with state government to design a monthly summary form to help in reporting the indicators listed below to provide evidence for scaling the approach and necessary review for improvement.
Indicators to measure progress
Number of pregnant women counselled on FP during ANC
Number of women receiving PPFP Counselling after delivery
Number of providers trained to provide PPFP services
TCI Project records
Number of providers that received orientation on PPFP
Number of WSO conducted bordering on PPFP
Number of women referred for PPFP services through Social mobilization activities
Number of women who completed referrals and took up FP services
Number of women who took up FP method in the immediate postpartum period (within 6 weeks of delivery) disaggregated by method and age (< 20 years, > 20 years)
Number of women who took up FP method in the extended postpartum period (between 6 weeks and 1 year of delivery) disaggregated by method and age (< 20 years, > 20 years
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Question 1 of 3
Postpartum family planning cannot be provided more than 6 months after delivery.CorrectIncorrect
Question 2 of 3
Which of the following is NOT a benefit of postpartum family planning?CorrectIncorrect
Question 3 of 3
Facilities with high antenatal care volume present viable opportunities for PPFP integration.CorrectIncorrect
Services Delivery Approaches
- Integrate PPFP counseling into routine ANC health talks across facilities
- Invite clients in the postpartum period who have taken up FP methods to talk to pregnant women during ANC clinics
- Ensure adequate commodities and consumables in the facilities to avoid missed opportunities pre-discharge
- Ensure seamless integration of PPFP counseling and information into immunization and child welfare clinics
- Place PPFP information, education and communication (IEC) materials at strategic points especially integration points within the facilities
- Use existing systems and structures for reporting as much as possible
- Most of the health facilities that currently deliver FP services provide PPFP by extension but do not optimize the approach across the continuum of pregnancy and antenatal care, delivery, postnatal and child care and immunization
- FP commodity requisition, distribution and alignment between then maternity and FP units may present an issue if not adequately organized and documented
- PPFP reporting has always been an issue and as such, facility management teams need to be deliberate and intentional in reporting PPFP services
- Initial costs for training of health workers and set up of PPFP points at the maternity units