In a mini-blog series ICM is highlighting the role of midwives in family planning. The series starts with a guest blog from the partner organisation MCHIP, written by: Anne Pfitzer, MCHIP Family Planning Team Lead, and Katrin DeCamp, MCHIP Communications.
Since the last International Day of the Midwife, global attention has refocused on family planning (FP), with the 2012 London Summit on FP largely to thank for this. USAID’s flagship Maternal and Child Health Integrated Program (MCHIP) continues to highlight the high unmet need of women and families for FP. Too often in the postpartum period, the focus is on potential risks to mothers and newborns without sufficient concern about the return to fertility and another pregnancy at a time when the woman is no longer under care. The multiple contacts women have with the health system during pregnancy, birth and postpartum care offer the opportunity to integrate FP and meet multiple needs at a critical time.
“I am amazed that almost consistently women in the first year postpartum want to avoid another pregnancy for at least two years, often four,” said Holly Blanchard, MCHIP Senior Technical Advisor for FP. In Diéma, district of Kaye in Western Mali, Ms. Blanchard had the opportunity to work with Aissata Tandina, a Malian midwife. Together with additional midwives from the District Hospital—the only public facility that provided implants in Diéma—these midwives successfully developed competency among 30 staff at the community health centers in long-acting FP, and inserted more than 300 implants.
At one of the rural sites, a woman stood out in Ms. Blanchard’s mind: “She had her two-week-old baby with her swaddled in old clothes that were too big for this tiny baby—her eighth child . She was breastfeeding and patiently waited to have her free implant.” [see photo left, photocredit: Jhpiego]
Despite being told that she should return in four weeks, when her baby would be six weeks old, to have her implant, the woman implored Ms. Blanchard: “She said it was hard to come to the clinic so far from her home, she had to take care of her children, and she couldn’t afford another pregnancy any time soon.”
According to the WHO medical eligibility criteria, a progestin-only method is a “Category 3 that requires careful clinical judgment and access to clinical services.” However, the risks for this mother of eight were greater for an unintended pregnancy, unsafe abortion, and other adverse perinatal outcomes. “Swept away by the demands of rural life in Mali and the demands of her children, it was likely that she would not be able to return in time for PPFP prior to another pregnancy,” said Ms. Blanchard. “The woman received her free contraceptive implant that day—a highly effective method of FP—and left happy.”
In drafting and signing the Statement for Collective Action for Postpartum Family Planning (PPFP), USAID’s MCHIP, the International Confederation of Midwives, and other partners have shown their commitment to these types of programs that reach postpartum women, update the knowledge and skills of providers, and offer integrated PPFP services in facilities and communities.
As we celebrate once again the tremendous contributions of midwives around the world, we remember in particular those who help to spread the word about FP—truly lifesaving information and services for millions of women.
PPFP requires maternity providers to begin offering counseling and services in the context of antenatal care, labor and delivery, and postnatal care. Often providers in these roles have not had recent exposure to information about contraceptives.
Above: Ms. Kamunya demonstrating the pressure on the uterus during a postpartum IUD insertion. Photocredit: Jhpiego
In Zambia, midwives Patricia Gomez and Rosemary Kamunya—both Senior Technical Advisors for MCHIP—recently led a long-acting FP training that included immediate postpartum IUDs. As is common, the 17 providers in attendance had little knowledge about these methods before the workshop. “The women who came to the clinics where we had our clinical experience were very eager to use these methods, and I was happy to see that providers also embraced them, especially the IUCD, around which there has been lots of misinformation,” Ms. Gomez said. “The participants will help roll out these services in our Saving Mothers Giving Life work in Mansa District, where they will train providers in 21 clinics and a district hospital. The evidence-based information they learned will go a long way to increasing access to these methods for women in Mansa.”
Ms. Kamunya added: “As a trainer in various fields, I love doing what I do—training, mentorship—to see trainers acquire the skills. Observing them train with confidence is a joy and that is what is important for sustainability in any country. I have trained service providers, too, and following them up and seeing them competently performing a skill gives me joy and pleasure, especially as I witness women being given services by a skilled provider at the antenatal care and maternity, including postnatal care.”
Thank you to midwives all around the world! Would you join us in Collective Action for PPFP? Sign on here!