Number/percent of women who delivered in a facility and initiated or left with a modern contraceptive method prior to discharge

 

Definition:

“Initiated" refers to women who start using a contraceptive method (i.e., intrauterine device [IUD], implant, tubal ligation or the lactational amenorrhea method [LAM]) prior to discharge. ”Left with” includes women who leave the facility with a contraceptive method (i.e., progestin-only pill or condom) that is appropriate for postpartum women according to WHO’s Medical Eligibility Criteria (WHO 2015).  “Facility” refers to any public or private health facility offering both maternal health and family planning (FP) services. “Modern contraceptive  methods” appropriate for use during the early postpartum period include hormonal methods (progestogen-only pill, implant, hormonal IUD), non-hormonal IUD, condoms, tubal ligation and LAM (WHO, 2018).

The coverage indicator is calculated as:

(# of women who delivered in a facility who initiated or left with a modern FP method prior to discharge/ total # of women who delivered in a facility) x 100

Data Requirements:

Number of women who delivered in a facility who initiated or left with a modern contraceptive method. Also: type of contraceptive method (for disaggregation). Evaluators may also 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 contraceptive method. In some cases, an FP register may be used if it has space to record  what contraceptive method given to a woman during pre-discharge care.

This indicator can also be collected via surveys and client interviews (McCarthy 2018).

Purpose:

This indicator measures the uptake of FP in the immediate post-delivery period and can serve as a proxy for the integration and quality of FP with maternal health care services. It assesses the initial interactions between women post-delivery and service providers at the facility where they deliver. It attempts to measure the uptake of FP methods that the woman can start using prior to discharge, often with provider assistance (IUD, implant, tubal ligation, and LAM) as well as methods women can leave the facility with (pills or condoms).

Issue(s):

This indicator is only measuring one aspect of postpartum FP, namely the post-delivery period when the woman is still at the facility. Other measures are necessary to account for the entirety of the postpartum period.

This indicator is limited to facility-based births, but contraceptive methods can be initiated in the community. Additional indicators may be required to capture community-based births and community-based FP distribution.

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.

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

World Health Organization. 2015. Medical eligibility criteria for contraceptive use: Fifth edition. Available at: https://www.who.int/reproductivehealth/publications/family_planning/Ex-Summ-MEC-5/en/