Community Involvement

As with other health interventions, community engagement is critical to affect lasting social and behavior change in postpartum family planning (PPFP). Consistent with the MCHIP Program as a whole, FP efforts abide by the notion of a household-to-hospital continuum of care, and the notion that many services can be delivered most effectively at the doorstep of women and couples. Where community health workers (CHWs) already exist and make home visits to women around the time of birth, integrating PPFP messages and services is a logical intervention. Likewise, community sensitization and mobilization around healthy timing and spacing of pregnancies and options for contraception—including long-acting methods—is a common strategy.

MCHIP Community Involvement Key Activities

  • Barrier analysis was employed in Uganda, Guinea, and Bangladesh under ACCESS-FP to identify barriers to the transition from LAM to other modern FP methods.  Findings helped to inform the design of MCHIP community-based messages and materials.1,2
  • In Kenya, MCHIP is supporting the Ministry to pilot an approach to integrate maternal, infant, and young child nutrition (MIYCN) and FP services within communities and facilities. While at facility for antenatal, intrapartum and postnatal care, as well as FP and well child services, women receive MIYCN and FP messages and are offered referrals according to need. In addition, the program has a strong focus on community activities: CHWs share integrated counseling messages during home visits using MIYCN-FP counseling cards.  Messages focus on the importance of exclusive breastfeeding for the first six months, the Lactational Amenorrhea Method (LAM) and timely transition to another modern FP method, return to fertility, and postpartum contraceptive options.
  • In Bangladesh, through the Healthy Fertility Study, PPFP is integrated within a successful maternal and newborn health community program, which includes home visits, community mobilization sessions and engagement of “LAM Ambassadors,” as well as counseling and distribution of FP methods.
  • In Liberia and Guinea, MCHIP has tested innovative approaches such as working with beauty salons to promote FP, distribute condoms, and make referrals for other modern methods. Furthermore, in Liberia, MCHIP has started a Contraceptives for Market Project in Grand Bassa and Margibi counties in nine markets. This approach provides FP health education and services at selected markets in an effort to bring services closer to women through trained peer volunteers. MCHIP has also developed a sermon guide and engaged Liberian religious leaders in promoting FP.
  • In India, MCHIP has worked to integrate stronger FP counseling and services into Village Health and Nutrition Days at the community level, and has tested the use of a postpartum systematic screening tool to identify postpartum women in need of services.

Key Results

  • Interim findings of the Bangladesh Health Fertility study show that at 12 and 18 months post-delivery, women in the intervention arm showed significantly higher contraceptive prevalence compared with the control group (42% versus 27% at 12 months, and 47% versus 34% at 18 months post-delivery, respectively).3
  • In Mali, integrating PPFP into the work of a new cadre of CHWs, called Agents de Santé Communautaire, along with skills strengthening of community health center staff, led to a doubling of FP uptake in MCHIP-supported districts from 2011 to 2012.

———————-

1 Kouyate R and Mwebesa W.  2011. LAM and the Transition Barrier Analysis: Uganda and Guinea.  ACCESS-FP.

2 Kouyate R.  2010. LAM and the Transition Barrier Analysis: Sylhet, Bangladesh.  ACCESS-FP.

3 Ahmed S, Kabir N, Mungia J. et al. Integrating Family Planning within a Community-Based Maternal and Neonatal Health Program in Sylhet, Bangladesh. Asia Regional Meeting on Interventions for Impact in Essential Obstetric and Newborn Care. Dhaka, Bangladesh 2012.