Outreach and integration programs to promote family planning in the extended postpartum period

Abstract

Background WHO recommends birth spacing to improve the health of the mother and child. One strategy to facilitate birth spacing is to improve the use of family planning during the first year postpartum. Objectives To determine from the literature the effectiveness of postpartum family-planning programs and to identify research gaps. Search strategy PubMed and the Cochrane Central Register of Controlled Trials were systematically searched for articles published between database inception and March 2013. Abstracts of conference presentations, dissertations, and unpublished studies were also considered. Selection criteria Published studies with birth spacing or contraceptive use outcomes were included. Data collection and analysis Standard abstract forms and the US Preventive Services Task Force grading system were used to summarize and assess the quality of the evidence. Main results Thirty-four studies were included. Prenatal care, home visitation programs, and educational interventions were associated with improved family-planning outcomes, but should be further studied in low-resource settings. Mother–infant care integration, multidisciplinary interventions, and cash transfer/microfinance interventions need further investigation. Conclusions Programmatic interventions may improve birth spacing and contraceptive uptake. Larger well-designed studies in international settings are needed to determine the most effective ways to deliver family-planning interventions.

Effectiveness of post-partum family planning interventions on contraceptive use and method mix at 1 year after childbirth in Kinshasa, DR Congo (Yam Daabo): a single-blind, cluster-randomised controlled trial

“…The rationale for our trial approach is based on WHO's seminal 2013 publication of programmatic strategies for post-partum family planning 2 and three other systematic reviews (without meta-analysis) on post-partum family planning interventions in low-income and middle-income countries published between 2014 and 2016. [6][7][8] These publications suggest that the following interventions could have a positive effect on post-partum contraceptive uptake: counselling activities during antenatal care; provision of post-partum family planning information, education, and counselling materials before women are discharged from health facilities after birth, including provision of emergency contraception for women using the lactational amenorrhoea method; promotion by community-based counsellors of exclusive breastfeeding practices before 5−6 months post partum; access to contraceptive methods immediately after birth, including intrauterine devices; provider competencies in quality counselling and the provision of quality services with several readily available products; and long programmes with several contact points between providers and clients across the continuum of care versus short antenatal interventions.…”

“…5 According to various literature reviews, the evidence is often weak or incomplete in terms of research design and quality, details about the interventions, or women's pers pectives. [6][7][8] There is also a paucity of studies looking at operationally feasible ways to integrate post-partum family planning into existing antenatal and postnatal care, for example through meaningful involvement of community actors. 2 In response, the Yam Daabo trial (meaning "your choice" in Mooré, one of the local languages in Burkina Faso) was designed to test the effectiveness of a low-technology, postpartum family planning intervention package, established using participatory action research, on contraceptive uptake.…”

Interventions to Improve Postpartum Family Planning in Low‐ and Middle‐Income Countries: Program Implications and Research Priorities

“…A systematic review of outreach and integration programs to promote postpartum contraception identified 34 publications, of which about half related to developing countries and seven were additional to those included in the Cochrane reviews (Sonalkar, Mody, and Gaffield 2014). An earlier review of family planning integration with other health services described four studies related to postpartum contraception, two of which were not included in the 2014 review by Sonalkar and colleagues (Kuhlmann, Gavin, and Galavotti 2010).…”

It's about time: WHO and partners release programming strategies for postpartum family planning

“…The expert group of 180 stakeholders identified PPFP service integration mechanisms and the development of effective strategies to overcome barriers to contraceptive uptake during the postpartum period as the second and fourth highest research priorities among a list of 47 topics. A new review of 34 PPFP programs confirms the difficulty of assessing program effectiveness without rigorous research designs and outlines the plethora of PPFP interventions that have not been studied systematically 15 . There is an urgent need to scientifically investigate why certain PPFP interventions work—and why others do not—and why some integration opportunities that seem obviously beneficial, such as those at immunization visits, have shown weaker results than expected.…”