Number or percent of service delivery points that offer postpartum family planning integrated with other services, by type of service

 

Definition:

 

The number or percent of maternal and child health (MCH service delivery points (SDPs) in a designated area that offer postpartum family planning (FP) integrated with other services subset by the type of service.  Postpartum FP includes counseling and, if applicable, provision of method and/or referral.

SDPs include all public, private, non-governmental and community-based health facilities and outlets in which MCH services are offered, including antenatal care, labor and delivery, postpartum visits, and/or infant and child health/immunization visits.

The recommended contraceptive options for postpartum women include the lactational amenorrhea method (LAM) for the first six months and methods that do not interfere with breastfeeding and are safe to use any time after birth including: condoms; IUD (non-hormonal);diaphragm; vasectomy; and tubal ligation. The full range of postpartum contraceptive options are presented below.

ACCESS-FP, 2007

The Family Planning Global Handbook for Providers (WHO/JHU-CCP, 2011) notes that breastfeeding women can also take progestin-only pills (as soon as six weeks postpartum) and combined oral contraceptives. If the woman is partially breastfeeding, she can start combined oral contraceptives as soon as six weeks postpartum. If she is fully or nearly fully breastfeeding, she can start the pills six months postpartum or when breast milk is no longer the baby’s main food, whichever comes first. For more background on the full range of postpartum contraceptive options, see USAID/ACCESS-FP (2007).

This indicator is calculated as:

(Number of SDPs that offer postpartum FP integrated with other services / Total number of SDPs in a designated area) x 100

Data Requirements:

Data on integration of provision of postpartum FP services with MCH services by the types of service. A comprehensive facility survey instrument called the Service Provision Assessment (SPA) has been developed by USAID and Macro International Inc. to be used with nationally representative samples of health facilities to provide information on the characteristics of health services, including availability of FP methods as part of labor and delivery, postpartum, and/or child health care (MEASURE DHS, 2011). The data can be further disaggregated by the type of facility or program (public, private, non-governmental, community-based, etc.), by the specific types of methods available, and by other relevant factors such as districts, urban/rural location, and target populations.

Data Sources:

Facility registers on services provided; surveys, such as SPA; WHO's Service Availability and Readiness Assessment (SARA); and information management systems.

Purpose:

This indicator can be used to compare and track trends in the level of integration of FP with MCH services and can serve as a proxy for women’s access to postpartum FP services.  When subset by type of service, the indicator can help policy and program planners identify where scaling up of integrated FP and MCH services is taking place and where there are gaps. Optimally, MCH programs and services can provide a range of methods to meet the needs of postpartum woman for limiting and spacing pregnancies. FP use during the first year postpartum has the potential to significantly reduce the number of unplanned pregnancies leading to fewer closely spaced pregnancy intervals and decreases in maternal and child morbidity and mortality. The integration of the range of contraceptive methods for postpartum women with MCH programs and services provides opportunities to streamline and improve care at the most favorable and critical times for maximizing women’s reproductive health and the health of their children. Multiple contacts with MCH services during the antenatal and the postpartum periods have been shown to increase women’s use of FP methods by six months postpartum and decrease unmet need for FP (USAID/ACCESS-FP/ Frontiers, 2008). The benefits associated with combining FP and MCH services are directly related to achieving Millennium Development Goals #4 reduce child mortality and #5 improve maternal health.

Issue(s):

This indicator measures integration of and increased access to postpartum FP through MCH services, but the overall access to, distribution of, and quality of services can best be measured using a range of indicators that provide data on method procurement, storage, affordability, travel time to facilities, staffing, delivery of method services and follow-up, and client utilization and satisfaction (WHO, 2010).

References:

 

MEASURE DHS. 2011, Service Provision Assessments (SPA) Survey Overview, DHS Website. http://www.measuredhs.com/What-We-Do/Survey-Types/SPA.cfm

USAID, 2011, Family Planning for Postpartum Women: Seizing a Missed Opportunity, Washington, DC: USAID. https://www.k4health.org/toolkits/info-publications/family-planning-postpartum-women-seizing-missed-opportunity

USAID/ACCESS-FP, 2007, Postpartum contraceptive Options, Washington, DC: USAID. http://www.accesstohealth.org/toolres/pdfs/ACCESSFP_ContOptionsGraphEN.pdf

USAID/ ACCESS-FP/ Frontiers, 2008, Strengthening Postnatal Care Services Including Postpartum Family Planning in Kenya, New York: The Population Council. http://pdf.usaid.gov/pdf_docs/Pnadn570.pdf 

WHO and Johns Hopkins Bloomberg School of Public Health/Center for Communication Programs (JHU-CCP), 2011, Family Planning: A Global Handbook for Providers, Baltimore, MD: Johns Hopkins University.  http://www.globalhandbook.org/

WHO, 2010, Monitoring the building blocks of health systems: a handbook of indicators and their measurement strategies, Geneva: WHO. http://www.who.int/healthinfo/systems/WHO_MBHSS_2010_full_web.pdf