Date/Time: Thursday, November 14, 2013 Session:

Author(s): Title of Abstract:

2.1.10 Effective Communication on Family Planning

Zonobia Zafar, Jhpiego Fauzia Assad, Jhpiego The Importance of Effective Counseling in the Extended Postpartum Period to Improve Client Acceptance Contraception: An Analysis of Target Facilities Findings Research Abstract Innovations in contraceptive service delivery

Abstract Type: Topic:

Significance/background
BACKGROUND: Despite the availability of a wide variety of technologies, CPR in Pakistan has unfortunately stalled at 34%. Data from the recent 200607 Pakistan Demographic and Health Survey indicates that 34% of births in Pakistan occur within short birth intervals of less than 24 months, and another 34% occur between 24 and 35 months. Among women in the first year postpartum only 12% desire another birth in the next two years, 64 % report an unmet need for contraception but only 22% are using any FP methods. These data suggest that Pakistani FP initiatives have not paid enough attention to unmet need for FP during the 1st 12 months postdelivery or the extended postpartum period. Unintended pregnancies can lead to poor maternal and child health outcomes. PPFP is a relatively new concept and prior to this initiative; the baseline data on use of contraception in the postpartum period was negligible as the service providers and the client were not aware of it. Family planning use initiated during the postpartum period has the potential to significantly reduce at least some of these unintended pregnancies.

Main question/hypothesis
MAIN QUESTION/HYPOTHESIS: This analysis reflects the relationship of counseling and use of modern contraceptive methods in postpartum duration. Specifically, it deals the use of quality messages on Healthy Timings &Spacing of Pregnancy, Return to Fertility and benefits of PPFP as a healthy practice in the effectiveness of counseling. It presents the results from a secondary data analysis and the finding suggests the importance of effective counseling in the extended postpartum period.

Methodology
A cross-sectional analysis was conducted between September 2012 and February 2013 in 21 cluster/targeted facilities of project district Mandibahauddin, Punjab. The facilities were purposively sampled since it includes the centers of the Population Welfare Department, basic health units, rural health unit and their referring Tehsil and District headquarter hospital. It also involved the lady health workers from the community. They provide maternal and newborn care services and the average rates of deliveries were 30/month. The study population included mothers counseled on Healthy Timing and Spacing of Pregnancy (HTSP), Return to Fertility (RTF) and Postpartum Family Planning (PPFP) during antenatal clinic visits and are referred for delivery at health facilities. Additionally, all mothers in the postnatal wards of the hospital following a normal delivery with both the mother and baby in stable condition were included for counseling session. About 9 of every 10 providers at these facilities were prepared to offer PPFP counseling (including information on HTSP, return of fertility and PPFP methods) when a woman delivers her child. Data analysis was managed using SPSS. Descriptive statistics were computed for the understanding of these mothers who have been counseled in antenatal period for all method mixed choice of PPFP and have been stamped on their antenatal card for that. The knowledge of postpartum family planning among the mothers was very low as this concept was new to them.

Results/key findings
Updated PPFP messages were incorporated within existing FP communication and counseling framework such that the newer messaging and concept of PPFP gradually percolated among the mothers in antenatal/post natal period. The analysis suggests that there is an increase of PPFP counseling across all facilities. In September 2012, only 1 of every 4 or 24.7% of mothers received counseling messages. After the intervention, in stepwise fashion, counseling rate improved to 3 of every 4 or 68.7% by February, 2013. PPFP counseling coverage for antenatal was 52% of all pregnant women visiting cluster facilities while for extended postpartum period was 40%who were followed up. This is a significant increase among mothers who preferred to seek advice on PPFP from the service provider in an area where there was no baseline concept of PPFP. As a result of effective counseling, PPFP methods were used by the mothers in extended postpartum period: 9.9% used postpartum family planning, with 19% using injectable while 21% had pills. About 2% had PPIUCD as their choice while permanent method was at 5.5% in postpartum period. This analysis has several limitations that should be mentioned. The study design is descriptive, and neither causality nor strength of effect can be ascertained. Finally, the results are based on primary data received from the target facilities

Knowledge contribution
The analysis suggested that effective counseling on HTSP, return to fertility and benefits of family planning in the extended postpartum period of mothers is a major factor influencing their

acceptance to use postpartum contraception. The involvement of vaccinators, general physician (male) and LHWs in delivering the messages and counseling of PPFP has remarkable impact on the uptake of PPFP methods. The current study in a snapshot of initial outcomes achieved after introduction of PPFP services in a district in Punjab by using existing resources to help bridge the gap on achieving MDG 4 and 5. The intervention has proved successful in creating awareness and demand for postpartum contraception. Acceptance of services has achieved a greater percentage than baseline measures with expansion of choice. However, there is need to disseminate knowledge on extended postpartum contraceptives to enable mothers make informed choices, which can be facilitated by further strengthening client-provider interaction especially through maternal and child health services such as ANC, Postnatal care and child immunizations. There is great need for family planning programs and policies to focus on the use PPFP as a measure of contraceptive demand in addition to unmet need.