Everyone said she could not become pregnant while breastfeeding. This is what Catherine*, a new mother, told a nurse midwife at Jacaranda’s Ruiru maternity hospital. When she became pregnant just 3 months after the birth of her first baby, she felt lied to. Family planning use in the first year after childbirth – known as the postpartum period – is both essential and rare in Kenya. At Jacaranda, we provide care to thousands of pregnant low- and middle-income women and their newborns in and around Nairobi. We know from these women that many Kenyan mothers are shocked by how soon after delivery a woman can become pregnant again. When Catherine came to Jacaranda during her second pregnancy, she received family planning counseling – including correct information about how to use breastfeeding as an effective contraceptive method – beginning at her first antenatal visit and continuing until she chose a family planning method 6 weeks after her delivery.
Family Planning Program Highlights
More than 70 percent of Jacaranda delivery clients report receiving family planning counseling after childbirth, compared to just 30 percent of women delivering at nearby facilities.
1 in 3 Jacaranda delivery clients use postpartum family planning – nearly three times higher than the national average.
More than half of Jacaranda’s clients decide to use long-term contraceptive methods like the hormonal implant or intrauterine contraceptive device (IUD), compared to just 8% of women in Nairobi overall.
Why is this important?
Catherine wanted a second child, eventually. How serious is it that she became pregnant earlier than she anticipated? It turns out that it is very serious for the health of both mother and baby. Spacing childbirth by at least 2 years – a practice called healthy birth spacing – has the potential to reduce maternal mortality globally by more than 30 percent and prevent 10 percent of all child deaths. Healthy spacing reduces risk of complications for the mother during pregnancy and delivery, and lowers the chance of premature and low-birthweight newborns. Postpartum family planning is the best tool at our disposal to ensure that families space their pregnancies healthily.
Jacaranda is designing, implementing, and evaluating new ways to deliver family planning services to new mothers. In a setting where 90% of women are not using postpartum family planning at all or until after they are already at risk of pregnancy, we have our work cut out for us. Our goal is to make family planning acceptable and convenient for new mothers and their families.
We are innovating family planning care in 4 major ways:
1. Jacaranda has created a “one-stop” shop for mother and baby
Jacaranda begins family planning counseling in the first antenatal care visit, and integrates key counseling messages and information into every subsequent client interaction. Family planning counseling and services are streamlined with popular infant care services, so that mothers coming for routine infant vaccinations can easily obtain a family planning method at the same time. This cuts down on time and transportation costs – major barriers to family planning use, especially for families caring for a new baby.
2. We engage male partners in family planning discussions.
It is difficult for many of our clients to talk about family planning decisions with their partners. Evidence suggests that increased partner communication and joint decision-making lead to higher family planning uptake, continuation and, in the long-term, fewer unintended pregnancies. To promote partner involvement, we have developed educational materials specifically tailored to fathers’ needs that encourage open discussion of postpartum family planning.
3. We ensure human rights-based counseling.
Jacaranda provides family planning counseling based on the Balanced Counseling Strategy Plus (BCS+), an evidence-based, algorithmic counseling technique developed by the Population Council. The BCS+ technique was created to allow providers to focus on the most relevant information to help each client achieve their family planning goals. Using this counseling strategy, our nurses and patient care assistants let mothers lead the discussion, which allows our providers to focus a counseling session on only those methods the client is most interested in. You can find out more about BCS+ here.
4. Jacaranda shifts tasks to minimize costs.
Training all cadres of health care workers – rather than just nurses – to provide key family planning counseling efficiently supports early family planning decision-making and increases Jacaranda’s cost-effectiveness. Jacaranda’s patient care assistants deliver key postpartum family planning counseling to new mothers before they are discharged from the maternity after childbirth, as well as during home visits and phone calls in the first week after delivery.
We’d love to hear your thoughts on the ways we are innovating family planning service delivery or what you or your organization is doing to help increase the number of women who are using family planning postpartum. Start the discussion by posting a comment!
*Catherine is a pseudonym to protect the identity of our client.