Percent women receiving postpartum/ postabortion family planning counseling (as a percent of women seen)
The percent of women who received postpartum or postabortion care in a health facility or community-based program during a specified time period, who also received family planning (FP) counseling. Ideally, health facilities and programs will include all public, private, non-governmental, and community-based services in a designated area.
The postpartum period is defined as up to 6 weeks and the immediate postpartum period as the first week following delivery. The recommended topics for FP messages and counseling during the postpartum period include: exclusive breastfeeding; reproductive intentions; pregnancy risk; pregnancy spacing for women who want another child; lactational amenorrhea or other methods as reproductive intentions indicate; and importance of postnatal care for mother and newborn (USAID, 2009).
The recommended best practices for postabortion FP counseling and services are to provide these before women are discharged from the facility. In countries where abortion is legal, programs may offer FP counseling when women make an appointment for their abortion, then provide women with FP services after completion of their abortion. In countries where abortion is illegal, emergency treatment and postabortion FP counseling and services should be provided as a single service (Curtis et al., 2008). However, although this is considered a best practice and FP counseling and provision is one of the key components of postabortion care, it is frequently not provided in many settings.
This indicator is calculated as:
(Number of women who received postpartum or postabortion FP counselling / Total number of women who received postpartum or postabortion care in a health facility or community-based program during a specified time period) x 100
Data can be used from facility records, health information systems (HIS), and specialized surveys. The data can be disaggregated by whether the women were postpartum or postabortion, age, the type of facility or program (public, private, non-governmental, community-based), and by other relevant factors such as districts and urban/rural location.
If targeting and/or linking to inequity, classify outlets where counseling is taking place by location (poor/not poor) and disaggregate by area served. Exit interviews can be conducted with clients to determine client’s poverty status.
Facility records; HIS; specialized surveys.
This indicator measures the level of postpartum and postabortion FP counseling provided by health care facilities and community-based programs, and can serve as a proxy for the integration and quality of FP with maternal health care services. Demographic and Health Surveys (DHS) show that very few women (3 to 8 percent) want another child within two years of giving birth, and 40 percent of women who intend to use FP are not doing so, thereby demonstrating a high unmet need for postpartum FP (USAID, 2009). There is strong evidence of health risks for both mothers and infants associated with short birth intervals, yet about one fourth of births in many low-income countries occur with intervals less than two years (USAID, 2008). Many women are unaware that they are at risk of pregnancy postpartum and may wait until the return of menses to seek FP. Accordingly, FP counseling in the early postpartum period is instrumental in avoiding a ‘missed opportunity’ to inform and prepare women for their return to fertility and to discuss available choices of postpartum FP methods and services. Systematically reaching women postpartum has the potential to provide FP information and services to over 90 percent of women of reproductive age in high fertility settings (USAID, 2008).
Likewise, the provision of postabortion FP counseling is a valuable opportunity to inform and provide women with effective FP. An estimated 35 million abortions occur in low-income countries each year, with 20 million of these considered unsafe, and the lives of 67,000 women lost due to complications (WHO, 2005). These abortion-related deaths represent 13 percent of all pregnancy-related mortality and, in some countries, as high as 25 percent of maternal deaths. If contraception were accessible and used consistently and correctly by women wanting to avoid pregnancy, maternal deaths could decline by an estimated 25 to 35 percent (Lule et al., 2007). Overall, FP is a cost-effective means to lower maternal mortality rates by: 1) reducing the absolute number of complications due to fewer pregnancies; 2) reducing the incidence of abortion by averting unwanted and unplanned pregnancies; and 3) averting pregnancies that occur too early, too late or too frequently during the woman’s reproductive cycle, and those that are inadequately spaced (UNFPA, 2004). Moreover, use of FP can reduce the number of cases of mother-to-child transmission of HIV. The provision of postpartum and postabortion FP counseling and services in health care facilities is directly related to achieving Millennium Development Goals #5. improve maternal health and #4. reduce child mortality.
This indicator does not measure the quality of the FP counseling services, and whether the facility has methods available, makes referrals, or follows up with women on the adoption, correct use, or continuation of FP methods. Women who deliver at home and/or do not receive postpartum care will not be included in the calculation of this indicator, nor will women who do not receive postabortion care, particularly in settings where abortion is illegal or having an abortion is highly stigmatized and women do not seek care for complications.
postabortion care, safe motherhood (SM), breastfeeding (BF), family planning, healthy timing and spacing of pregnancies (HTSP), quality
Curtis C, Huber D and Moss-Knight T., 2010, Postabortion Family Planning: Addressing the Cycle of Repeat Unintended Pregnancy and Abortion, International Perspectives on Sexual and Reproductive Health, Vol 36 (1) March. https://www.guttmacher.org/pubs/journals/3604410.html
Lule E, Singh S and Chowdhury SA, 2007, Fertility Regulation Behavior and Their Costs: Contraception and Unintended Pregnancies in Africa and Eastern Europe and Central Asia, Washington, DC: World Bank.
UNFPA, 2004, Program Manager’s Planning Monitoring and Evaluation Toolkit, Part II: Indicators for Reducing Maternal Mortality, New York: UNFPA. http://www.unfpa.org/monitoring/toolkit/Tool6_2.pdf
USAID, 2009, 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, 2008, ACCESS Programmatic Framework for Postpartum Family Planning in an Integrated Context, Washington, DC: USAID. http://www.accesstohealth.org/toolres/pdfs/ACCESSFP_pgmframework.pdf
USAID, 2008, ‘Community Based Family Planning,’ Technical Update, No. 5, FP during the First Year Postpartum, Washington DC: USAID.
WHO, UNFPA, 2008, National-level monitoring of the achievement of universal access to reproductive health: conceptual and practical considerations and related indicators, Geneva: WHO. http://whqlibdoc.who.int/publications/2008/9789241596831_eng.pdf
WHO, 2007, Maternal Mortality in 2005; Estimates Developed by WHO, UNICEF, UNFPA and the World Bank, Geneva:WHO. http://www.who.int/whosis/mme_2005.pdf
WHO, 2009, WHO Recommended Interventions for Improving Maternal and Newborn Health2009, Geneva: WHO. http://whqlibdoc.who.int/hq/2007/WHO_MPS_07.05_eng.pdf