How helping women access post-pregnancy family planning makes us accountable for our mandate – Maternal Health Task Force

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Of: Emi Nurjasmi,; Pandora Hardtman,

Dr. Pandora Hardtman CNM, FACNM, FAAN is the chief of obstetrics and nursing, Jhpiego and Dr. Emi Nurjasmi, MPH, RM, is the President, Indonesian Midwifery Association

As midwives, we are passionate about the holistic role that those who play our profession play in supporting the wants and needs of women and girls during their reproductive years and beyond. At the heart of this is the understanding that what midwives do – or fail to do – for women in the months during and after pregnancy has far more impact than this limited time frame.

A midwife caring for a pregnant woman. Midwives are one of the strongest bonds with women. Photo source: Jhpiego

The opportunity awaits you

It is well known that access to effective family planning methods can have far-reaching effects on women’s overall health and well-being. It affects how they care for their children and families, which in turn has an impact on the health of communities, economies and countries.

Offering contraceptive counseling and services as part of perinatal care at the facility before discharge is also recognized as a high impact practice that can dramatically improve maternal and child health outcomes and save lives. However, post-pregnancy is the period of greatest unmet need for contraception in a woman’s entire life: 61% of postpartum women wish to distance or prevent their next pregnancy within the first year after delivery, but do not use the family planning.

This window offers a vital opportunity to advise women and their families about their options and ensure that those who desire contraception leave the facility in a method that suits them. By extension, this same intervention could play a transformative role in unlocking many of the most pressing development priorities, including greater access to education, economic empowerment and food security.

Map of Kenya

“In Kenya, the main reason women did not engage in family planning after giving birth was the feeling of needing to heal first. This offers a propitious opportunity to advise postpartum women on contraceptive safety and the benefits of healthy spacing on maternal and neonatal health outcomes. “

Midwives are one of the strongest ties to women, particularly now during the COVID-19 pandemic with so many routine health services delaying and when women can benefit from the closeness and dependability midwives offer. We must seize this moment when women are in our care to offer the full range of services they want and need to thrive. This is our calling and our mandate.

Findings from a groundbreaking five-year study offer compelling new evidence that should encourage every midwife to rethink their routine postpartum care and larger work environment. Led by Jhpiego and funded by the Bill & Melinda Gates Foundation and MSD for Mothers, Post-Pregnancy Family Planning Choices or PPFP Choices, it set out to generate actionable evidence to increase access and use of family planning by women immediately after pregnancy. Now, in the final months, he was briefed by health care providers, facility managers, community leaders, policy makers and some 9,000 clients in Indonesia and Kenya. It looked at both public and private healthcare facilities in both countries, whose very different contexts have yielded important and varied insights.

In Kenya, the obstetric community now has a clearer picture of how cultural or religious beliefs cause perception of low PPFP demand among private sector providers. Many of these suppliers also claim that they are not aware of guidelines recommending PPFP, and who are “excluded” from critical training opportunities. In Indonesia, the lack of coordination on education, training and PPFP delivery was a commonly cited barrier and bureaucracy in the insurance system created “extra work” for suppliers. With proper training and support for midwives, whether they work in public or private settings, PPFP can more easily integrate into standard care.

A midwife takes time to counsel a patient

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Midwives must build upon their valuable relationships to educate the women and families in their care. Photo Source: Jhpiego

” data-medium-file=”https://cdn1.sph.harvard.edu/wp-content/uploads/sites/2413/2021/11/dsc09351_48705908187_o-300×200.jpg” data-large-file=”https://cdn1.sph.harvard.edu/wp-content/uploads/sites/2413/2021/11/dsc09351_48705908187_o-1024×683.jpg” loading=”lazy” class=” wp-image-49557″ alt=”A midwife who advises a patient” width=”564″ height=”376″ srcset=”https://cdn1.sph.harvard.edu/wp-content/uploads/sites/2413/2021/11/dsc09351_48705908187_o-300×200.jpg 300w, https://cdn1.sph.harvard.edu/wp-content/uploads/sites/2413/2021/11/dsc09351_48705908187_o-1024×683.jpg 1024w, https://cdn1.sph.harvard.edu/wp-content/uploads/sites/2413/2021/11/dsc09351_48705908187_o-768×512.jpg 768w, https://cdn1.sph.harvard.edu/wp-content/uploads/sites/2413/2021/11/dsc09351_48705908187_o-1536×1025.jpg 1536w, https://cdn1.sph.harvard.edu/wp-content/uploads/sites/2413/2021/11/dsc09351_48705908187_o-2048×1366.jpg 2048w, https://cdn1.sph.harvard.edu/wp-content/uploads/sites/2413/2021/11/dsc09351_48705908187_o-450×300.jpg 450w, https://cdn1.sph.harvard.edu/wp-content/uploads/sites/2413/2021/11/dsc09351_48705908187_o-500×334.jpg 500w, https://cdn1.sph.harvard.edu/wp-content/uploads/sites/2413/2021/11/dsc09351_48705908187_o-1200×801.jpg 1200w” sizes=”(max-width: 564px) 85vw, 564px”/>

Midwives must build on their valuable relationships to educate the women and families in their care. Photo source: Jhpiego

The advice imperative

We also have a more nuanced understanding of the barriers women face, both large and small. In Kenya, the main reason women did not engage in family planning after giving birth was the feeling of needing to get well first. This provides a propitious opportunity to advise postpartum women on contraceptive safety and the benefits of healthy spacing on maternal and neonatal health outcomes. In Indonesia, when counseling was provided during antenatal visits, at the time of delivery, shortly after birth or six months later, people’s likelihood of using contraception significantly increased. It is clear that advice makes a difference.

For many women, the period immediately following pregnancy is the most likely time they will meet a healthcare professional. Therefore, it is imperative that the idea Other resources for family planning are introduced and available after birth or termination of pregnancy.

Midwives need to build on their valuable relationships to educate women and families about their care, and together encourage awareness and use of family planning for those wishing to space out or limit their upcoming pregnancy. As demand increases, public and private facilities, regulatory bodies, midwifery schools and governments alike will be forced to elevate and prioritize post-pregnancy family planning along the care continuum: in education. midwife, in continuing education and support; in budgets and funding; and in the services and supplies available in public and private structures.

Through PPFP, midwives can more fully embrace their role as trusted health care providers and strengthen their partnership with the women in their care. In this way they fulfill their professional responsibility and their personal commitment to women, embracing the whole range of their competences. What may follow is a beautiful and transformative experience for midwives and women, and indeed a world where babies are born by choice, not by accident.

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