Number or percent of providers at service delivery points who know the contraceptive options for postpartum women up to six months postpartum
The number and percent of providers at maternal and child health (MCH) service delivery points (SDPs) who know the range of contraceptive options that do not interfere with breastfeeding.
SDPs include all public, private, non-governmental and community-based health facilities and outlets in which MCH services are offered, including antenatal care, labor and delivery, postpartum and/or infant and child care.
The recommended contraceptive options for postpartum women include
the lactational amenorrhea method (LAM) for the first six months and methods that do not interfere with breastfeeding and are safe to use any time after birth including: condoms; IUD (non-hormonal); diaphragm; vasectomy; and tubal ligation. The full range of postpartum contraceptive options are presented below.
The Family Planning Global Handbook for Providers ( WHO/JHU-CCP, 2011) notes that breastfeeding women can also take progestin-only pills (as soon as six weeks postpartum) and combined oral contraceptives. If the woman is partially breastfeeding, she can start combined oral contraceptives as soon as six weeks postpartum. If she is fully or nearly fully breastfeeding, she can start the pills six months postpartum or when breast milk is no longer the baby’s main food, whichever comes first. For more background on the full range of postpartum contraceptive options, see USAID/ACCESS-FP (2007). The questionnaire used by USAID/ACCESS/Frontiers (2008) asks providers which methods they would normally offer to breastfeeding women within 48 hours, at two weeks, and at six weeks postpartum.
This indicator is calculated as:
(Number of providers at SDPs who know contraceptive options during breastfeeding / Total number of providers at SDPs in a designated area during a specified time period) x100
Data from surveys and interviews with facility staff about which contraceptive methods are recommended for use while women are breastfeeding. Questions need to be standardized in advance and used consistently over time in order to compare programs, locations, and trends. The data can be disaggregated by the type of provider, by the type of facility (public, private, non-governmental, community based) and by other relevant factors such as districts and urban/rural location.
Health worker interviews; specialized surveys
This indicator measures the knowledge of MCH service providers about contraceptive options for women who are breastfeeding and can serve as a proxy for the coverage and quality of service provider training in postpartum family planning (FP).
Additionally, the indicator can be used to compare and track the level of women’s access to this information through MCH services. Providers who have been trained in and are knowledgeable about contraceptive options for breastfeeding women report being more confident in the care they give postpartum women and their clients are more likely to start contraceptive methods earlier and at increased rates (USAID/ ACCESS/Frontiers, 2008). FP use during the first year postpartum has the potential to significantly reduce the number of unplanned pregnancies leading to fewer closely spaced pregnancy intervals and decreases in maternal and child morbidity and mortality. The integration of counseling and provision of methods for postpartum women with MCH 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/ Frontiers, 2008). The benefits associated with combining FP and MCH services are directly related to achieving Millennium Development Goals #4 reduce child mortality and #5 improve maternal health.
The providers’ knowledge of methods compatible with breastfeeding does not indicate that they are effective or consistent in communicating this information or in providing related contraceptive services or referrals.
breastfeeding (BF), quality, training, family planning, newborn (NB)
WHO and Johns Hopkins Bloomberg School of Public Health/Center for Communication Programs (JHU-CCP), 2011, Family Planning: A Global Handbook for Providers, Baltimore, MD: Johns Hopkins University. http://www.globalhandbook.org/
USAID, 2011, Family Planning for Postpartum Women: Seizing a Missed Opportunity, Washington, DC: USAID. https://www.globalhealthlearning.org/sites/default/files/reference-files/FP%20for%20PP_eng.pdf
USAID/ACCESS-FP, 2007, Postpartum contraceptive Options, Washington,
DC: USAID. http://www.accesstohealth.org/toolres/pdfs/ACCESSFP_ContOptionsGraphEN.pdf
USAID/ ACCESS-FP/ Frontiers, 2008, Strengthening Postnatal Care Services Including Postpartum Family Planning in Kenya, New York: The
Population Council. http://reprolineplus.org/system/files/resources/accessfp_kenyappfp.pdf