Expansion of postpartum/postabortion contraception in Honduras

Abstract

In Honduras, 54 percent of deliveries are assisted by medical staff and 39 percent of deliveries take place at Ministry of Health of Honduras (MOH) health centers or hospitals. Although the unmet need for family planning services is relatively high (11% of women) and family planning helps protect mothers' and children's health, hospitals in Honduras rarely offer postpartum/postabortion contraceptive services.Between 1996 and 1999, the Ministry of Health and the Population Council's INOPAL III Project tested the acceptability of postpartum/postabortion contraception at the Escuela Hospital, the largest in the country. The project showed that more than 30 percent of the women seen for a delivery or a complication due to abortion, were interested in adopting a contraceptive method prior to discharge from the hospital. Given the success of the project, the MOH asked the Population Council's FRONTIERS Program for technical and financial support to extend those services to five additional hospitals in the country.As a first step, a baseline situational analysis study was carried out in seven hospitals in order to detect needs and identify the hospitals in which postpartum/postabortion contraceptive services could be most easily introduced or strengthened. In the five hospitals selected, the results of the diagnostic study were presented, staff were trained, equipment, clinical and educational materials were provided, surveys were conducted, and quarterly meetings were held to analyze achievements and plan new activities.The baseline diagnosis showed that a great demand existed for contraceptive methods before discharge from the hospital. Only 35 percent of the women who had given birth had planned the pregnancy, and close to one-half said they would have preferred to wait longer or not become pregnant. Seventeen percent were using a method of contraception when they became pregnant. Only 44 percent wished to become pregnant in the future, and 92 percent of these women wanted to space their next pregnancy for more than two years. Important improvements were found for the four indicators used to evaluate the project: 1) the proportion of women who received information about contraceptive methods during their hospital stay increased from 43 percent to 87 percent; 2) the proportion of women who were offered a contraceptive method increased from 42 percent to 82 percent; 3) the proportion of women who received a contraceptive method during their stay increased from 10 percent to 33 percent; and finally, 4) the proportion of women who had delivered and wanted a method before leaving the hospital but did not receive it decreased from 41 percent to 7 percent. Among the women who had been treated for an abortion (close to 10% of those who had delivered), the results were even better: information increased from 17 percent to 85 percent; offering of methods increased in the same proportion; acceptance of methods increased from 13 percent to 54 percent; and unmet need decreased from 48 percent to 21 percent. In both cases, the

Meeting the Family Planning Needs of Postpartum Women

“…In five countries in Latin America and the Caribbean, about half of pregnant women receive some family planning information during antenatal care visits. Likewise, the proportion of women who receive information on danger signs and symptoms, breastfeeding, immunizations, and other important information for preserving their own and their children's health varies widely within sub-Saharan Africa and Latin America and the Caribbean, but never approaches 100 percent (Medina et al 2001;Brambila et al 2002;Jacobs et al 2002;Rivero-Fuentes et al 2007;Solís et al 2007).…”

“…Thus, to increase the proportion of fully informed clients, programs may need to offer information, counseling, and services at all contact points between clients and the maternal health-care system through the complete maternal cycle. This practice would also be aligned with women's preferences: surveys in health-service-delivery outlets around the world have shown that of the women who wish to start using a contraceptive method in the first year after delivery, more than half would prefer to begin using it immediately after delivery or at six weeks; the rest would prefer to begin use between six weeks and one year after delivery, most often at six months or when menses returns Medina et al 2001;Quiterio et al 2007;Rivero-Fuentes et al 2007;Solís et al 2007;Warren et al 2008a and.…”

“…Apart from the lack of political will to make the services available, the greatest barrier to introducing postpartum contraception appears to be the necessity of training a large number of providers who must coordinate their services. For this reason, wholesite training approaches seem to work best (Vernon et al 1993;Bradley et al 1998;Medina et al 2001). Other common barriers to the institutionalization of services include the lack of continuous supervision in the early stages, and service-delivery guidelines that restrict obstetric nurses, general nurses, and nurse auxiliaries from performing IUD insertions and providing other contraceptives, despite their being the agents who most frequently attend and assist deliveries (see, for example, Medina et al 2001).…”

“…Two-thirds of these women do not want to become pregnant but are not using a contraceptive method; nearly 40 percent plan to use a method but have not done so.Other surveys have shown that, among women attending hospitals and clinics in Africa and Latin America, between 50 and 96 percent report that they plan to use a method in the first year after delivery, and among women who either have just had a delivery at a hospital or are visiting a health center in the first six months after delivery, the combined proportion of those who are already using a method and those who report wishing they were using one is consistently more than 50 percent. If offered a method in the first year (and particularly in the first few months) after delivery, many women will choose to begin using it (see, for example, Brambila et al 2002;Medina et al 2001;Quiterio et al 2007;Rivero-Fuentes et al 2007;Solís et al 2007; andWarren et al 2008a and.Offering contraceptives in the immediate postpartum period leads to higher contraceptive rates at six months postpartum (Foreit et al 1993) and is more cost-effective than providing them after the six-week postdelivery period (Foreit et al 1993;Khan 2003). In areas of high HIV prevalence, providing contraceptives and advice to prevent the transmission of HIV from mother to child is also critical to postpartum care; preventing unintended pregnancies for HIV-infected women is more cost-effective than using nevirapine as a means to avoid HIV transmission during pregnancy or childbirth (Reynolds and Wilcher 2006).…”

“…Other surveys have shown that, among women attending hospitals and clinics in Africa and Latin America, between 50 and 96 percent report that they plan to use a method in the first year after delivery, and among women who either have just had a delivery at a hospital or are visiting a health center in the first six months after delivery, the combined proportion of those who are already using a method and those who report wishing they were using one is consistently more than 50 percent. If offered a method in the first year (and particularly in the first few months) after delivery, many women will choose to begin using it (see, for example, Brambila et al 2002;Medina et al 2001;Quiterio et al 2007;Rivero-Fuentes et al 2007;Solís et al 2007; andWarren et al 2008a and.…”