Evidence that preservice and/or inservice curricula includes postpartum care and pregnancy spacing/limiting components as part of postpartum family planning
Documented evidence exists that training curricula used for preservice or inservice training of maternal and child health (MCH) care providers, as well as postabortion care (PAC) providers, includes components on postpartum care and pregnancy spacing and limiting.
Preservice and inservice training can take place through hospitals, clinics, professional schools and certification programs, in addition to inservice training at public, private, non-governmental and community-based health facilities in which MCH services are offered. MCH services include antenatal care, labor and delivery, postpartum and/or infant and child care.
Recommended components of postpartum care include (USAID/ ACCESS-FP/ Frontiers, 2008):
- Prevention, early detection, and treatment of complications and diseases of mother and infant (including sexually transmitted infections and mother-to-child transmission of HIV)
- Referral of mother and infant for specialist care when necessary
- Counseling on essential newborn care
- Counseling and support for breastfeeding
- Counseling and service provision for return to fertility, birth spacing and limiting, the resumption
of sexual activity, and contraception (particularly methods compatible with breastfeeding, such as the lactational amenorrhea method)
- Immunization of the infant
- Nutrition care for mother and infant
Reviews of curricula used in a country or designated area by programs and facilities for preservice and inservice training of MCH and PAC service providers
Copies of training curricula for MCH and PAC service providers, including any curricula recommended by the respective ministry of health
This indicator measures whether training programs for MCH and PAC service providers contain the recommended components on postpartum family planning (FP) and can serve as a proxy for the level of integration of postpartum FP into MCH and PAC training and services. Training of service providers in relevant postpartum FP counseling and delivery of methods should be part of basic MCH and postabortion care. Providers who have been trained in and are knowledgeable about postpartum FP options report being more confident in the care they give women and their clients are more likely to start FP methods earlier and at increased rates (USAID/ACCESS-FP/Frontiers, 2008). FP use during the first year postpartum has the potential to significantly reduce the number of unplanned pregnancies leading to fewer closely pregnancy intervals, and decreases in maternal and child morbidity and mortality. The integration of training on counseling and provision of methods for postpartum women with MCH and PAC programs and services provides opportunities to streamline and improve care at the most favorable and critical times for maximizing women’s reproductive health and the health of their children. Multiple contacts with MCH services during the antenatal and the postpartum periods have been shown to increase women’s use of FP methods by six months postpartum and decrease unmet need for FP (USAID/ACCESS-FP/ Frontiers, 2008). The benefits associated with combining FP and MCH and PAC services are directly related to achieving Millennium Development Goals #4 reduce child mortality and #5 improve maternal health.
The inclusion of postpartum FP components in preservice and inservice training curricula for MCH and PAC does not provide information about the quality of the training or the quality of services provided by those who have been trained. In order to assess mastery of knowledge and skills, evaluators should also measure whether providers are knowledgeable and effective in communicating this information and in providing postpartum FP services. An example of a complimentary indicator would be “Number or percent of service providers trained in postpartum FP who have mastered relevant knowledge”.
Also, evaluators or program managers may want to track preservice and inservice separately, as well as look into the inclusion of postpartum FP components in policies or guidelines, in which case suggested indicators would be:
Evidence that preservice curricula includes postpartum care and pregnancy spacing/limiting components as part of family planning
Evidence that inservice curricula includes postpartum care and pregnancy spacing/limiting components as part of family planning
Evidence that policies, standards of practice, or other national service delivery guidelines include postpartum care and pregnancy spacing/limiting components as part of family planning
training, health system strengthening (HSS), integration, safe motherhood (SM), family planning, healthy timing and spacing of pregnancies (HTSP), newborn (NB), postabortion care
Pathfinder International, 2001, Comprehensive Reproductive Health and Family Planning Training Curriculum, Module 13: Postpartum and postabortion contraception, Waterton, Ma: Pathfinder International. http://www.pathfinder.org/publications/module-13-postpartum-postabortion-contraception/
USAID/Core Group, 2004, Maternal and Newborn Standards and Indicators Compendium, Washington DC: USAID/CORE Group. https://www.mchip.net/sites/default/files/Maternal_and_Newborn_Standards_and_Indicators_Compendium_2004.pdf
USAID/ACCESS-FP, 2006, Postpartum contraception: Family planning methods and birth spacing after childbirth.
USAID/ ACCESS-FP/ Frontiers, 2008, Strengthening Postnatal Care Services Including Postpartum Family Planning in Kenya, New York: The Population Council. http://pdf.usaid.gov/pdf_docs/Pnadn570.pdf