Midwife Miriam Mathose conducts an ultrasound on a pregnant woman.
When Kenyan Eunice Achieng, 24, found out that she was pregnant for the fourth time in six years she could not stop crying. Her other pregnancies had been hard on her young body and her first two babies were always in the hospital. Weak, sick and feeling alone, Eunice knew that she did not want to get pregnant again.
Nearly 1 in 3 women in poorer countries have an unintended and completely avoidable pregnancy within 2 years of a birth. According to a 2001 paper published in the journal International Family Planning Perspectives, even though over 90% of postpartum women want to delay their next pregnancy, nearly 65% are not using any form of contraception. This situation shows that new mothers do not have what they need to plan their families and their lives.
Contraceptive methods after birth
Postpartum family planning — when a woman starts using a modern contraceptive method within two years of giving birth — is critical to empower women to make choices about whether to delay their next pregnancy and avoid unintended pregnancies and abortions.
Recent policy changes in Kenya, which have made postpartum family planning available at all health facilities, helped Eunice to take control of her reproductive health. During a visit to a government health facility, she met with a family planning counselor and learned about various methods. After talking with her husband, the young mother chose a method that was right for the couple.
“When I am pregnant, I am sick and I am a burden to my husband. Together we decided that I should get a BTL [bilateral tubal ligation],” Achieng says in recalling the couple’s decision. She says choosing the right family planning method has benefited her and her family. “I became young and beautiful again! Just look at me! All my friends want to know my secret. I tell them, it’s finding a [family planning] method,” the young mother says. “Even sex is better now, because I’m not worried. My kids are growing healthy.”
Effective interventions
At the start of the first ever Global Maternal and Newborn Health Conference last October, philanthropist Melinda Gates said: “The single most effective intervention to improve maternal and newborn health is birth spacing and family planning.” When family planning is used in the first year after birth, it offers life-saving benefits for the mother and baby. A paper published in the Lancet in 2012 showed that when women use postpartum family planning, there is a potential to reduce 1 in 3 maternal deaths, while a 2006 paper, also published in the Lancet, showed that the promotion of family planning can avert 1 in 10 infant deaths and 1 in 5 child deaths.
With updated guidance from the World Health Organization, more postpartum contraceptive options are available than ever before. More women across the globe are starting to use contraception. More pregnant women and girls are delivering with skilled attendants. More countries are including postpartum family planning in their health strategies. Recognizing this opportune time, the great need and obvious benefits of postpartum family planning, global health leaders have galvanized a worldwide movement around greater access to postpartum family planning.
Updated global guidance
In June 2015, delegations from 16 countries came together in Chiang Mai, Thailand for the Accelerating Access to Postpartum Family Planning Global Meeting, hosted by Family Planning 2020 in partnership with Jhpiego, to learn about updated global guidance, share experience, and commit to taking action. Each of the 16 countries left with plans to ensure that every woman be offered a means to prevent an unintended pregnancy in the two years after a birth.
Since then, five east and southern African nations have made incredible progress to ensure women have access to safe, effective, and long-term family planning methods after birth. For example, Ethiopia equipped their large army of health extension workers with new materials to counsel women in rural areas on their postpartum family choices. Tanzania has trained health care workers to provide IUDs immediately after birth, expanding access to this long-acting method. Uganda has made sure all future health workers are able to provide postpartum family planning by including it in their teaching curriculum for nursing and midwifery students. Zambia is updating their health records system so health officials can better track postpartum family planning efforts. Kenya has included postpartum family planning in their national insurance plan to be provided for free at all public and private facilities.
Meaningful opportunities
These efforts are more than just policy changes; they are meaningful opportunities for women. Over the next year, more than 130 million births will take place in low and middle income countries including over 7 million births in the five previously mentioned east and southern African nations. Each of these births is an opportunity to provide women with postpartum family planning. These countries have dedicated themselves to not miss any opportunity to meet the overwhelming desire of women and adolescent girls for family planning at a time when their need is often underestimated — following the birth of a child.
Dr Isaac Malonza is Jhpiego’s regional director for East and Northern Africa, based in Kenya. Lindsay Breithaupt is senior programme co-ordinator for Jhpiego’s technical leadership office of family planning and reproductive health.