analysis of the integration of family planning services in postpartum, postabortion and prevention of mother to child transmission programs in Nicaragua," FRONTIERS Final Report. Washington, DC: Population Council. This Report is brought to you for free and open access by the Population Council.

A diagnostic study of the provision and use of contraception in postpartum, postabortion, and prevention of mother-to-child transmission (PMTCT) programs in the Dominican Republic was conducted with funding from USAID's Latin American and the Caribbean Bureau. The objectives of the study were to assess the contraceptive knowledge, attitudes, and behaviors of providers and clients, the degree to which information, counseling, and delivery are implemented in postpartum, postabortion, and PMTCT services, the quality of these services, and the readiness of postpartum, postabortion and PMTCT services to offer contraceptive services. Researchers visited and carried out service inventories at 59 hospitals and health centers of the Ministry of Health (MOH), the Dominican Social Security Institute, and Profamilia (the IPPFaffiliate). Interviews were held with 522 health providers (303 in Ob-Gyn wards and 219 in outpatient services), 2,965 women in antenatal care, 879 following their delivery, 162 in postabortion care, 1,421 in the six-month postpartum period, and 156 at HIV integral care units. In five facilities non-intrusive ethnographic observation were undertaken of the context where services were provided and structured observation of client-provider interactions. In-depth interviews were held with 21 providers and 20 users and three focus group discussions with women in the first six months postpartum. Family planning services are linked to antenatal, delivery and postpartum care in most of the health units visited and, to a lesser degree, to the integral care provided for persons living with HIV. The results have been shared with the MOH directors of maternal and child health services (DIGEMIA), and with the directors of planning and of the program to prevent mother-to-child transmission of HIV in the HIV/STI department (DIGECITSS); and also with the USAID mission, CONECTA (the Reproductive Health Division of the Dominican Institute of Social Security) and the UNFPA representative. Key findings include the following:  Health centers and outpatient services in hospitals are well prepared for offering family planning services in the perinatal period. Most of the providers have received training, and family planning counseling is well established in antenatal care.  Ob-Gyn wards, by contrast, are not sufficiently ready for provision of family planning services to postpartum and postabortion women. Even when 97 percent of the women interviewed during delivery said that they were interested in using a method postpartum, only 12 percent received one before hospital discharge. A further 63 percent said that they would have liked to receive a method before leaving the hospital. Key recommendations for improving PMTCT services include:  Inform all pregnant women who have a blood sample taken which tests will be conducted.  Design and establish a mechanism to allow providers to identify women who have already had voluntary counseling and testing during antenatal care and the result of the test, while maintaining women's ...