Postpartum family planning counselling and contraception improves health outcomes for women and their families
Over 60,000 women have received postpartum family planning counselling and contraception after giving birth across 20 healthcare facilities in Tanzania and South Africa, as part of a highly successful global health programme launched by the Royal College of Obstetricians and Gynaecologists.
Leading Safe Choices was established in 2015 to address the unmet need in postpartum family planning (PPFP) in health facilities in South Africa and Tanzania. It was delivered in collaboration with The Health Foundation in South Africa, and Management and Development for Health in Tanzania.
Healthcare professionals in 20 facilities across the two countries were trained in counselling and the provision of postpartum contraception made available free to women, with a focus on long-acting reversible contraception (LARC) methods – particularly the intrauterine device (IUD), also known as the ‘copper coil’. LARC (implants and intrauterine devices) are the most effective methods of contraception with low failure and complication rates.
An evaluation of the programme, published in BJOG: An International Journal of Obstetrics and Gynaecology, found:
- In total, 60,503 women received postpartum family planning (PPFP) across 20 health facilities after birth between 2015 and 2018
- The proportion of women who received PPFP in the health facilities rose from 1% to 59% in Tanzania and from 82% to over 97% in South Africa
- 22,387 women received an long acting contraceptive (LARC) method, a 36% increase for LARCs in Tanzania and 20% increase in South Africa
- 4,738 postpartum IUDs (PPIUDs) were inserted in Tanzania and 3,898 PPIUDs in South Africa, comprising 8% and 13% of all deliveries, respectively
- 95% of women said they would recommend the PPIUD
- In total, 632 healthcare professionals received training in PPFP methods – 266 in Tanzania and 366 in South Africa
- Additionally, 526 healthcare professionals received training in PPFP counselling – 148 in Tanzania; 378 in South Africa.
Professor Alison Fiander, Clinical Lead for Leading Safe Choices and co-author of the BJOG study, said:
“With an increasing number of babies being delivered in healthcare facilities in low- and middle-income countries, postpartum family planning has the potential to improve access to contraception, particularly among poorer women from rural areas, and lead to better health outcomes for women and their families.
“Taking advantage of the window of opportunity to provide family planning when women access health facilities during childbirth, the Leading Safe Choices programme demonstrates how adverse outcomes can be avoided by inexpensive training and support which can be incorporated into most healthcare settings. The provision of PPFP may be quite literally life saving by preventing another pregnancy too soon after delivery.
“Commitment to changing training curricula for healthcare professionals in South Africa and institutionalising PPFP within facilities in Tanzania means that improvements in provision of PPFP and the benefits to women should continue.”
Every day, 830 women die from complications of pregnancy and childbirth, mostly in low- and middle-income countries. Over the past 20 years, 40% of the reduction in maternal mortality in low-income countries is attributed to the increased use of contraception.
Yet in 2016, one in five women in Tanzania and almost one in seven in South Africa had an unmet need for contraception.
Women who have recently given birth have one of the highest unmet need for contraception. Studies have shown 90% of women who are up to 12 months postpartum want to avoid another pregnancy in the next 24 months, but 70% of them are not using contraception.
Pregnancies in the postpartum period – the first 12 months after birth – have the greatest risk for women and their babies, including premature births, smaller babies and increased maternal and infant mortality. The World Health Organization recommends a gap of 18 to 24 months between pregnancies.
The RCOG’s Leading Safe Choices selected health facilities in collaboration with the Department of Health for the Western Cape in South Africa and the Ministry of Health, Community Development, Gender, Elderly and Children in Tanzania.
The training method is also applicable to a developed country setting and a UK pilot in Edinburgh using LSC training materials is ongoing.
Professor Lesley Regan, Director of Leading Safe Choices and President of the Royal College of Obstetricians and Gynaecologists, said:
“We are absolutely thrilled by the tremendous success of the Leading Safe Choices programme. It has trained hundreds of doctors, midwives and nurses to empower many thousands of women with information and choices on high quality contraception after birth – and has achieved incredible results by giving these women control over their fertility, and to give their families the best possible start. We are proud of the positive impact on maternal, perinatal and child health outcomes that this programme has helped to achieve.”
About Leading Safe Choices
The final year of the Leading Safe Choices programme focused on embedding the programme within health systems to ensure sustainability of impact.
The Leading Safe Choices programme also worked on comprehensive abortion care in South Africa, and comprehensive postabortion care in Tanzania. For more information, please visit: https://www.rcog.org.uk/leadingsafechoices
BJOG: An International Journal of Obstetrics and Gynaecology is owned by the Royal College of Obstetricians and Gynaecologists (RCOG) but is editorially independent and published monthly by Wiley. The journal features original, peer-reviewed, high-quality medical research in all areas of obstetrics and gynaecology worldwide. Please quote ‘BJOG’ or ‘BJOG: An International Journal of Obstetrics and Gynaecology’ when referring to the journal. To keep up to date with our latest papers, follow @BJOGTweets.
About the RCOG
The Royal College of Obstetricians and Gynaecologists is a medical charity that champions the provision of high quality women’s healthcare in the UK and beyond. It is dedicated to encouraging the study and advancing the science and practice of obstetrics and gynaecology. It does this through postgraduate medical education and training and the publication of clinical guidelines and reports on aspects of the specialty and service provision. www.rcog.org.uk
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