Lessons in Mixology: FP and MNH

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Lessons in Mixology FP and MNH

• Catharine McKaig Holly Blanchard, ACCESS-FP
• October 5, 2007

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Session Objectives

• Be able to describe the dilemma of postpartum
  family planning.
• Be able to compare/contrast maternal newborn
  priorities and family planning priorities using
  frameworks from four key resources.
• Be familiar with a framework for integration and
  its application in one setting.
• Be able to describe some key lessons learned in
  integration of MNH and FP from Kenya and
  elsewhere.

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Our Dilemma

• FP and Maternal Mortality
• FP and HIV- PMTCT
• FP and Child Mortality
• Unmet need for FP
• Many women of reproductive age
• Service contacts
• Why so many unintended pregnancies?
• Cant we do better?

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IS INTEGRATION WITH MNH THE WAY TO DO IT?

• Considerations for Integration
• Similar target group
• Similar provider skill levels
• Combination makes programmatic sense
• Policies are supportive

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Group exercise

• Are these easily identifiable?
• Similarities?
• Differences?
• What do you take away?

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PROGRAMMATIC FRAMEWORK PPFP IN AN INTEGRATED
CONTEXT
NEONATAL INFANT HEALTH
HIV
MATERNAL HEALTH
FAMILY PLANNING
Birth Preparedness ANC
TT Immunization
PMTCT
ANC-FP messages-
Delivery care
Immediate Neonatal care 6-12 hrs
Immediate postpartum 6-12 hrs
Immediate Post Partum Family Planning 0-48 hours
Later postnatal 3-6 days
3-6 days
POSTPARTUM
Postpartum FP 6 wk visit
6 weeks
Immunization EBF 4-6wks
PED CARE
Immunization EBF 8 wks
Extended postpartum FP 6 weeks to 12 months
Immunization EBF 12 wks
Opportunities?
Infant feeding 6 mo
Immunization-Measles 9 mo
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PNC-FP Model in Kenya

• Designed to reinvigorate postpartum/postnatal
  care including FP.
• Package designed to follow the MOH guidelines for
  four postnatal care visits.
• The first visit is within 48 hours
• two weeks,
• six weeks and
• six months.

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PNC-FP Package in Kenya

• Intervention
• A three-day training package was developed for
  providers which included
• essential maternal and neonatal care.
• family planning for postpartum women, including
  counseling content on
• return to fertility,
• discussion of fertility intentions,
• healthy pregnancy spacing and
• exclusive breastfeeding practices and lactational
  amenorrhea method (LAM) and transition to modern
  methods.
• Danger signs
• Support and supervision visits post-training

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Integration of Counseling and Care

• Areas that providers improved in postpartum care
  and counseling
• Return to fertility
• LAM
• HTSP
• Danger signs
• Check for TT
• Check BP

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When We Offer Postpartum Services
They begin to come
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Miss no opportunity! At every immunisation
visit, ASK about FP intentions and LAM transition
plan!
Think, and provide the Link!
Family Planning well baby Clinic
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Integration With Other Services
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Integrating Clinical Training

• PPIUCD
• Post-placental after AMTSL
• Reinforce infection prevention
• Safe method for HIV women who request long
  acting methods

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Timing and referral for services

• When we counsel new mothers about waiting two
  years before getting pregnant, almost all say-
  Yes, we want to wait.
• Then they ask us for methods. They say the
  services are far, the FWV isnt available and
  there are no methods there.
• Community newborn health workers

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Family planning as a topic..

• Family planning is sensitive here. We wanted to
  include LAM in our IEC materials, but the
  community leaders said that if we talked about
  breastfeeding as contraception, it would
  discourage women from breastfeeding.
• - Program Manager

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And theres our expertise-

• Family planning is clear to me, but what is all
  this other stuff? Im no expert on newborn
  health. Where are those (ACCESS) people?
• Im not up-to-date on family planning. I work
  in the maternity- the FP clinic is in the
  outpatient ward.

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Whats the issue? The case of LAM

• Child Survival
• EBF
• Longer breastfeeding
• Mother-baby bond
• HIV moms and AFASS
• But fully and mostly fully are not useful
• Spacing or preventing the next pregnancy is not
  the objective

• Family Planning
• Low cost method for 6 months
• Gateway method
• More than 98 effective
• Prevents pregnancies in the first 6 months
• But women can use even if not EBF

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Others???????
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A few lessons learned

• M-Multiple Menus- one wont fit all
• I-Invest in learning- cross-cutting issues
• X- Extra flexibility compromise negotiate
• Small steps- crack open a door
• I-Integration in training, services, monitoring
• N-Note- it wont be perfect
• G-Good local leadership for integration

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MIX AWAY
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Selected resources

• USAID/GH/HIDN/Child Survival and Health Grants
  Program- MAMAN http//www.childsurvival.com/docum
  ents/usaid/maman.cfm
• Family Planning. A Global Handbook for Providers
  http//www.who.int/reproductive-health/publication
  s/fp_globalhandbook/index.htm
• Family Planning for Postpartum Women Seizing a
  Missed Opportunity. Global technical brief.
  http//www.maqweb.org/techbriefs/
• Pregnancy, Childbirth, Postpartum and Newborn
  Care a Guide for Essential Practice
  http//www.who.int/reproductive-health/publication
  s/pcpnc/
• Global E-Learning- www.globalhealthlearning.org
• JSI, More juice from the squeeze Linking
  immunization services with other health
  interventions, Immunization basics SNAPSHOTS
  http//www.immunizationbasics.jsi.com/Newsletter/s
  napshots_new.pdf
• Family Planning Choices for Women with HIV Johns
  Hopkins Bloomberg School of Public Health Info
  Project Center for Communications Population
  Reports August 2007
• http//www.infoforhealth.org/pr/l15/l15.pdf
• Focus on Breastfeeding Decisions for Women with
  HIV Johns Hopkins Bloomberg School of Public
  Health Info Project Center for Communications
  Population Reports INFO Reports April 2007.
  http//www.infoforhealth.org/inforeports/focuson/f
  o_hiv.pdf