Number or percent of women who delivered in a facility and received counseling on family planning prior to discharge

 

Definition:

The number of percent of women who gave birth in a health facility and received family planning (FP) counseling prior to being discharged from the facility. The recommended topics for FP counseling include information on reproductive intentions, pregnancy spacing for women who want another child, fertility desires for spacing and limiting, return to fertility after birth, return to sexual activity, safe modern contraceptive options for postpartum women including those breastfeeding (based on WHO’s medical eligibility criteria for contraceptive use), lactational amenorrhea (LAM), and transition from LAM to a modern method if the woman chooses to practice LAM (WHO 2013). For women who choose to adopt an FP method, counseling should also include procedures, side effects, and instructions on how to use desired method. “Facility” refers to any public or private health facility offering both maternal health and FP services.

The coverage indicator is calculated as:

(# of women who delivered in a facility counseled on FP prior to discharge/ total # of women who delivered in a facility) x 100

For closely related indicators in this database, see the Number/percent of women who delivered in a facility and initiated a modern contraceptive method prior to discharge under Family Planning and Maternal and Child Health; Number/percent of maternal and child health services clients who received counseling on LAM under Breastfeeding; Percent women receiving postpartum/postabortion family planning counseling (as a percent of women seen) under Safe Motherhood; and the Number/percent of women who received family planning information for pregnancy spacing during a postpartum/postabortion visit, by type of visit under Healthy Timing and Spacing of Pregnancy.

Data Requirements:

Number of women who deliver in a facility who receive counseling on FP prior to discharge. Evaluators may want to disaggregate data by age group (e.g. <20 & 20+).

Data Sources:

Facility-based records capturing care given immediately after birth and/or FP services. This would be a delivery register or postnatal care register for pre-discharge care, with a column to capture counseling. In some cases, an FP register may be used if it has space to record counseling given to a woman during pre-discharge care.

This indicator can also be collected via surveys and client interviews, and has shown to be information that women are capable of reporting (McCarthy 2018).

Purpose:

This indicator measures the level of postpartum FP counseling provided at health care facilities and can serve as a proxy for the integration and quality of FP with maternal health care services. Based on recommendations from the WHO technical consultation on birth spacing, women should wait at least 24 months after a live birth before attempting the next pregnancy and at least six months after a spontaneous or induced abortion.  Practicing healthy timing and spacing of pregnancy helps achieve the healthiest outcomes for women, newborns, infants, and children (WHO 2005).

Receiving timely information about FP is a critical step in ensuring optimal birth spacing. Delivery in a facility is an important opportunity to provide information on postpartum FP, especially since coverage of postnatal care is often low (WHO 2013, Pfitzer 2015). 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).

Issue(s):

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. This indicator does not capture the outcome of counseling services. Therefore, it is not recommended to use this indicator in isolation. This indicator should be used with the indicator: Number/percent of women who delivered in a facility and initiated or left with a modern contraceptive method prior to discharge. Using these two indicators together can indicate when quality of counseling may be problematic, though additional data is necessary to identify the gaps in the quality of counseling and reasons behind poor quality counseling.

This indicator is only measuring counseling when the woman is still at the facility after birth. Other measures are necessary to counseling during pregnancy and the entirety of the postpartum period. Furthermore, women who deliver at home and/or do not receive postpartum care will not be included in the calculation of this indicator.

Where the indicator is primarily based on self-report, clients may not remember or know for certain whether they received counseling, especially if there is a long time lag between receiving services and the interview.

References:

McCarthy KJ, Blanc AK, Warren CE, Mdawida B. 2018. Women’s recall of maternal and newborn interventions received in the postnatal period: a validity study in Kenya and Swaziland. J Glob Health, 8:010605. doi: 10.7189/jogh.08.010605.

Pfitzer A, Mackenzie D, Blanchard H, Hyjazi Y, Kumar S, Lisanework Kassa Set al. 2015. A facility birth can be the time to start family planning: postpartum intrauterine device experiences from six countries. Int J Gynaecol Obstet, 130(Suppl 2):S54–61.

USAID. 2008. Community Based Family Planning: Technical Update, No. 5. FP during the First Year Postpartum. Washington DC: USAID. Available at: https://www.k4health.org/sites/default/files/community%20based%20family%20planning%20tech%20update%205.pdf

World Health Organization. 2018. Family planning/Contraception Fact Sheet. Available at: http://www.who.int/mediacentre/factsheets/fs351/en/

World Health Organization. 2013. Programming strategies for postpartum family planning. Available at: https://apps.who.int/iris/bitstream/handle/10665/93680/9789241506496_eng.pdf;jsessionid=BB8543BB0D53C3ED888E847165A3F91E?sequence=1

World Health Organization. 2005. Report of a WHO Technical Consultation on Birth Spacing.  Available at: https://apps.who.int/iris/bitstream/handle/10665/69855/WHO_RHR_07.1_eng.pdf?sequence=1&ua=1