WHY POSTPARTUM

FAMILY PLANNING
 Objectives

• Discuss methods of Postpartum Family Planning

• Describe the specific situation of postpartum women

• Discuss breastfeeding and LAM

• List opportunities and mechanisms for post partum

FP integration

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 Unmet need for PP FP

• Only 3-8% of post partum woman want to get

pregnant with in 2 years
• Only 40% of post partum woman use FP

• After a live birth, the recommended interval before

attempting the next pregnancy is at least 24 months.
 GLOBAL DATA ON UNINTENDED PREGNANCY
Accounts for 40% of all pregnancies globally

Southeast Asia:
3,779,743
East Africa:
7,202,758
West Africa: Southern Asia:
2,930,569 20,179,913

Source: 1. Sedgh, et. al., 2014; 2. Winfrey & Rakesh, 2014

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 Postpartum Contraception
Postpartum contraception is the initiation and use of
FP methods of their choice in the first year after
delivery starting the expulsion of placenta to prevent
unintended pregnancy particularly in the first 1-2 years
after childbirth, when another pregnancy can be
harmful to the mother or a breastfeeding baby.
 Postpartum Contraception….
 Post-placental – within 10 minutes following delivery of the
placenta.
 Immediate postpartum – within 48 hours after delivery
(usually performing VSC or inserting an IUCD).
 Postpartum before discharge (PPBD) – within 48 hours after
delivery and before the woman leaves the facility where she
delivered.
 Early postpartum period – 48 hours to 6 weeks after delivery.

 Extended postpartum –beyond the 6 weeks after delivery up

to one year.
 Factors influencing return to fertility
Return of Menses, Sexual Activity and Breastfeeding
100%
90%
80%
70%
60%
50%
40% Sexually active
Return to menses
30% Exclusively breastfdg
20%
10%
0%
0-3 4-6 7-9 10-12
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 Considerations with Postpartum FP
Through the first year postpartum
 Timing of return to fertility

 Return to sexual activity

 Breastfeeding and use of various methods

 Timing of various methods

 LAM, concurrent use and transition to other methods

Underlying factors
 Healthy spacing of the next pregnancy

 Integration of FP into other service opportunities

 Return to Fertility
Non breastfeeding:
 As early as 3 weeks postpartum – 21 days postpartum
Breastfeeding
 Using LAM accurately:
- some time after 6 months – variable
 Breastfeeding without using LAM:
- possibly even before 6 months, but again, variable.
- average is 45 days
-5 – 10% of breastfeeding women get pregnant in first
year PP
Remember: fertility returns before menses returns!
 Return to sexual activity
• Physiologically women can resume intercourse
when the perineum is fully healed
• But she should do so when she is ready

• Typically, sexual activity resumes before a woman is

on a effective FP method
• Therefore, the woman is at risk of getting pregnant
 Why Are We Excited About PPFP? Why Now?
• More PPFP options are available than ever before.
• More women across the globe want to plan their
families.
• More pregnant women and girls are delivering with
skilled attendants at health facilities
• More countries are including PPFP in their health
strategies and plans.
• Saving lives of mothers and newborns make it urgent
for us to ACT.
 Methods of Postpartum FP
 LAM

 Condoms

 Combined (Estrogen/Progestin) pills

 Progestin-only pills

 IUCD

 Implants

 Vasectomy

 Tubal ligation

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Postpartum Family Planning 14
 Method Effectiveness and Continuation
Method Failure Rates Continuation at 1
(unintended pregnancy) year

Typical Use Perfect Use

No Method 85% 85%

Withdrawal 27% 4% 43%
Standard Days Method 5% 51%
Male condom 15% 2% 53%
COCs / POPs 8% 0.3% 68%
DMPA 3% 0.3% 56%
CuT380A 0.8% 0.6% 78%
Implanon 0.05% 0.05% 84%
Female Sterilization 0.5% 0.5% 100%
Male Sterilization 0.15% 0.10% 100%
Timing of Initiation FP Methods

Postpartum Family Planning 16

Timing of Initiating FP Methods Postpartum
• LAM – with breastfeeding

• Condoms – when intercourse resumes

• Progestin-only methods - BF & Non-BF – right away

• Combined Oral Pills (Estrogen + Progestin)

― BF: when there is no risk if quantity of milk decreases – 6 months

― Non-BF: when risk of thrombosis is reduced – 3 weeks

• IUCD – when risk of infection and perforation is low - First 48 hours or after 4-
6 weeks

• Tubectomy – when tubal inflammation and risk of infection low:

― First 7 days or after 6 weeks
 Making FP Services Available to the
Postpartum Woman
 Focus on pregnancy spacing and health benefits to family
 Ensure a variety of different methods
 Services now are more certain than referrals for later
 Start during antenatal care
 Remember the specifics of the postpartum period
- Return to fertility
- Resumption of intercourse
-Coordination with breastfeeding
Integrate FP services into PNC, NBC, Immunization, etc
 Postpartum FP Summary
• There are a variety of postpartum FP methods:
– LAM, hormonal methods, Implats, IUCD, condom,
vasectomy
• Considerations of the postpartum woman:
– Return to fertility, resumption, of intercourse
– Use of LAM and changes due to breastfeeding
• Starting FP postpartum
– Counsel early and often – begin during ANC
– Provide numerous opportunities
– Make it part of routine care
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