While every pregnancy should be a joyful occasion, this is not yet the case. In many countries in the southern hemisphere, where 98% of the world’s maternal mortality occurs, family planning (FP) saves lives. Up to one-third of maternal deaths could be prevented if all women had access to FP, and child deaths would be 2.2 times fewer for couples who safely space births.

Guttmacher (2009) summarizes the global situation well:
 “While 71% of married women in Latin American and the Caribbean were using contraceptives in 2003, only 28% of married African women were doing so. Nearly one in four married women in Africa had an unmet need for contraception in 2002–2007, compared with 10–13% of their counterparts in Asia and in Latin America and the Caribbean. In 2008, about 40% of total pregnancies were unintended in lesser developed countries.”

To address these needs, we at MCHIP apply successful approaches to strategically integrate FP and build upon existing platforms across broad areas of maternal, newborn, and child health (MNCH). MCHIP/FP interventions promote the expansion of contraceptive choice, improvement in the quality of FP services, and increased access to these high-quality services, including innovative and underutilized technologies.

And integrating these services across a broad scope of critical interventions has the potential to provide FP information and services to more than 90% of women of reproductive age in many high fertility settings. To do this, MCHIP-FP tailors messages and services to correspond with and support other MNCH services, while proactively providing FP information and services. This includes:
 
• Systematically including postpartum FP (PPFP) services and counseling in the scope of work of staff in antenatal, labor units and postpartum wards;
• Reinvigorating postpartum IUDs as part of the method mix for postpartum women;
• Making the lactational amenorrhea method (LAM) easier for providers to counsel on and women to understand by  following UNICEF and WHO recommendations on exclusive breastfeeding;
• Using LAM as a ‘gateway’ to other FP methods; and
• Linking FP to infant and young child nutrition programs.

One perfect example of the power of PPFP is the story of Selina Begum, a 28-year old mother of two. Selina lives in a poor, rural village in northeast Bangladesh where cultural norms restrict her from moving freely outside her home, often preventing her from accessing facility-based health services. However, Selina and her husband wanted to avoid another pregnancy.
 
The Healthy Fertility Study began operating in Selina’s village while she was pregnant with her second child. Through a partnership between MCHIP, the Bangladesh Ministry of Health and Family Welfare, Shimantik, and the Center for Data Processing and Analysis, the project designed and tested an integrated model of PPFP, providing FP services as part of community-based maternal and newborn health programs.

As part of the study, Community Health Workers (CHWs) provide education on maternal and newborn health and PPFP to women and their family at the community level. After receiving PPFP counseling and information from such a CHW in her home, Selina elected to practice LAM for her first six months postpartum. She then transitioned to oral contraception through the assistance of a CHW, who again provided both counseling and FP commodities. More than a year after her last baby was born, Selinia is continuing to use a modern FP method, and is able to access related information and services in the privacy of her own home.

Selina is one of thousands of women whose lives have been improved through the services provided by the Healthy Fertility Study. In study intervention areas, use of any modern contraceptive at one year postpartum was 42%, while in the comparison areas, the use of any method (including traditional ones) was 25% at 12 months.  Additionally, women in the intervention arm had a 10% increase in exclusive breastfeeding rates throughout the initial six months of their babies lives. 

This is one of many examples of how MCHIP is working collaboratively with other aspects of MNCH to improve lives. And for Selina—and thousands of women like her—improved access to FP is making it possible for her to focus on her family while giving her the peace of mind that she will not have an unintended pregnancy.

Holly Blanchard
MCHIP Senior Reproductive Health/FP Advisor