Integrating family planning into postpartum care through modern quality improvement: experience from Afghanistan

Abstract

Modern quality improvement approaches enabled hospital staff to analyze barriers and identify solutions for ''how'' to integrate family planning into postpartum care. Private spaces for postpartum family planning (PPFP) counseling, along with involving husbands and mothers-in-law in counseling, substantially increased the percentage of women receiving PPFP counseling and their preferred method before discharge. Self-reported pregnancy was also significantly lower up to 18 months post-discharge compared with women receiving routine services. ABSTRACTTo address low contraceptive use in Afghanistan, we supported 2 large public maternity hospitals and 3 private hospitals in Kabul to use modern quality improvement (QI) methods to integrate family planning into postpartum care. In 2012, QI teams comprising hospital staff applied root cause analysis to identify barriers to integrated postpartum family planning (PPFP) services and to develop solutions for how to integrate services. Changes made to service provision to address identified barriers included creating a private counseling space near the postpartum ward, providing PPFP counseling training and job aids to staff, and involving husbands and mothers-in-law in counseling in person or via mobile phones. After 10 months, the proportion of postpartum women who received family planning counseling before discharge in the 5 hospitals increased from 36% to 55%, and the proportion of women who received family planning counseling with their husbands rose from 18% to 90%. In addition, the proportion of postpartum women who agreed to use family planning and left the hospital with their preferred method increased from 12% to 95%. Follow-up telephone surveys with a random sample of women who had received PPFP services in the 2 public hospitals and a control group of postpartum women who had received routine hospital services found significant differences in the proportion of women with selfreported pregnancies: 3% vs. 15%, respectively, 6 months after discharge; 6% vs. 22% at 12 months; and 14% vs. 35% at 18 months (P , .001). Applying QI methods helped providers recognize and overcome barriers to integration of family planning and postpartum services by testing changes they deemed feasible.

Postpartum family planning: current evidence on successful interventions

“…Shaaban et al 28 (described in “PPFP use”) found significantly fewer self-reported pregnancies at 6 months in the LAM-EC group (0.8%) than the LAM-only group (2.6%) ( P =0.0005). Tawfik et al 37 randomly selected women from two hospitals in Afghanistan to receive either PPFP counseling in the maternity ward before discharge or standard postpartum care, which means they did not receive systematic PPFP counseling. This intervention was a substudy of a larger PPFP quality improvement effort.…”

“…At 18 months, the difference between the counseling (14.1%) and SOC groups (43.7%) remained significant ( P <0.001). 37 …”

“…These pregnancies should be considered failed LAM. Tawfik et al 37 was of moderate quality (Type II, Fair). The researchers did not collect information on whether reported pregnancies were unplanned or unwanted.…”

“…27 Several interventions to promote FP at the postnatal visit had positive results. 28 , 30 , 37 In general, this review provides some evidence for pursuing the strategies outlined in Vernon’s overview of programs.…”

Improving Afghanistan Midwifery - Midwifery Care during Childbirth and Postpartum Period in Afghanistan: Based on the Results of the Interviews Conducted in Estonia

“…The health indicators of the Afghan women are significantly different from the global standards [1]. Lack of accessibility to quality obstetrics causes many childbirths resulting in deaths, that could have been prevented in case of obstetrics of better quality [2].…”