Population Council Research that makes a difference

FRONTIERS worked with the Centre d’Evaluation et de Recherche Apliquée (Center for Evaluation and Applied Research, CERA), the Ministry of Health, JHPIEGO, Management Systems for Health, USAID, and various nongovernmental organizations to assess the use of family planning in postpartum, postabortion, and prevention of mother-to-child transmission of HIV (PMTCT) services in Haiti. CERA reviewed policies and previous experiences through diagnostic studies in 10 hospitals and 20 health centers, and conducted qualitative studies with clients of these facilities. The studies showed a substantial unmet need for family planning services.

Only about one-fourth of women who delivered in hospitals went home with a method, though nearly all women interviewed wanted to delay the next pregnancy for two years or more. Most staff in public and private facilities were uninformed about national service-delivery guidelines, and over half of the in- and outpatient services visited had no internal protocols on postpartum and postabortion family planning. Both outpatient and inpatient facilities had the resources to deliver these services. However, three-fourths of women did not receive family planning services, information on breastfeeding, or education on the return of fertility. Family planning services for HIV-positive women were limited. While most outpatient services provided counseling on PMTCT, between half and three-fourths of public and private facilities, respectively, provided HIV testing; and only one-third of outpatient services included antiretroviral therapy during antenatal care.

Recommendations included revising national norms to require facilities to offer family planning to all women who seek services during the extended postpartum or postabortion period, disseminating the revised procedures, screening all postpartum women for contraceptive needs, and developing family planning job aids for providers and outreach materials for clients. Outreach to inform and provide contraception to persons living with HIV is especially urgent.

Banner photo: © Beryl Goldberg