Integrating FP into Routine Postpartum Care in Afghanistan
I truly love it when, despite seemingly insurmountable obstacles, quality improvement teams in low resource settings develop change ideas and discover through testing that they actually work! Such was the case with integrating family planning (FP) into routine postpartum care in five hospitals in Kabul, Afghanistan, a definitively low resource setting.
We know the postpartum period is a golden opportunity for introducing FP, given that women have a high demand for both limiting and spacing their pregnancies in this period, plus births that are too closely spaced present significant health risks for the mother and child. The quality improvement teams in Kabul applied root cause analysis for not providing family planning counseling and services to postpartum women in their respective maternity wards and identified the reasons for such causes. Subsequently, the teams suggested changes to the process of providing services to make FP counseling and service provision an integral part of services offered to postpartum women before leaving the hospital.
One of the causes identified by the teams was lack of a private counseling space where postpartum women could receive family planning counseling before hospital discharge. It was also discovered that husbands and mothers-in-law were influential family decision makers in regards to family planning, and it was critically important to include them in the counseling process. Without a private counseling space, this was impossible. Involving the hospital administration from the very beginning paid off in a most unexpected way- construction by the hospital administration of a private counseling room near the postpartum ward in the two public hospitals, and designated private rooms for counseling in the three private hospitals.
We must be careful about our preconceived notions. One of my preconceived notions was that Afghan men might not be interested or motivated to participate in family planning for cultural reasons. Nothing could have been further from the truth! When given the opportunity, Afghan men enthusiastically participated in FP counseling sessions with their wives. When educated about FP methods, they felt free to express their preferences!
Another cause identified by the quality improvement teams for postpartum women not leaving the hospital with a modern FP method of their choice was the lack of referral of PP women to a family planning clinic. This when the Afghanistan Family Guidance Association, or AFGA, was located right on the hospital grounds! When an arrangement was worked out with AFGA to accept referrals of postpartum women, the number of postpartum women seen for PPFP services at the AFGA clinic rose from approximately 6 per month to over 100 per month. By May of 2013, over 90% of women reported leaving the facility with their family planning method of choice, up from 18% in January 2012, when the intervention began.