In the postpartum period following a birth, the majority of women want to either space their next pregnancy or have no more children.
For women seeking to space the next birth, the optimal duration is at least 24 months, but in many developing countries 50–60% of women do not have this option because of limited access to an appropriate contraceptive method during the 12 months following a birth.
Moreover, many women and their partners desiring no more children have limited access to permanent or reversible long-acting methods. Addressing the needs of postpartum women has been recognized as an urgent priority in the "Statement for Collective Action for Postpartum Family Planning" (read the statement in French), contributed to and endorsed by the Population Council.
Recognizing that Addressing the family planning needs of postpartum women as an urgent priorityThe —contributed to and endorsed by the Population Council—recognizes .
Population Council focus
A major focus for the Population Council is to increase the availability of, access to, and effective use of long-acting reversible or permanent methods that are appropriate, acceptable, and affordable for women and their partners during the postpartum period.
The Council has developed and introduced several long-acting reversible contraceptive (LARC) methods that are appropriate for postpartum family planning (PPFP), including the copper IUD, the progestogen-based intrauterine system, the implant, and the progesterone vaginal ring.
The Council also supports countries to develop and scale up efforts that increase access to information and services that will enable women to practice family planning during the postpartum period; indeed, the Council first pioneered the delivery of postpartum family planning services in the 1960s in several countries (including Thailand, Japan, Egypt, India, Chile, Iran, and Bangladesh) and continues to do so through generating evidence for innovative strategies and by marshalling existing evidence to provide technical assistance and guidance, both nationally and internationally.
Population Council impact
PPFP-oriented product development
- The Population Council developed a progesterone vaginal ring (PVR) specifically for breastfeeding women, enabling them to extend the contraceptive benefits of lactational amenorrhea for up to a year. The PVR is already in use in Latin America, and the Council is currently conducting acceptability studies to expand the option to India and Africa.
- The Council is in the final stages of developing the contraceptive vaginal ring (CVR), a revolutionary ring which women can use for up to a year, thereby offering an effective alternative for birth spacing.
- Several highly effective LARC technologies have been developed by the Council and are highly useful for both women wanting to space births as well as those who do not want any more children: three models of copper-bearing intrauterine devices, including ParaGard®; Mirena®, a levonorgestrel-releasing intrauterine system; Jadelle®, a two-rod levonorgestrel implant; and Norplant®, a levonorgestrel-releasing implant. More than 120 million women worldwide have relied on these products for family planning.
Global awareness and policy change
- In May 2012, the Population Council, the International Federation of Gynecology and Obstetrics (FIGO), and the Reproductive Health Supplies Coalition (RHSC) hosted a meeting in Bellagio, Italy, to discuss opportunities to increase access to LARCs. Participants collaborated on a set of global recommendations that were featured at the July 2011 London Summit on Family Planning and at a Council-hosted teleconference attended by over 65 participants, and continue to be disseminated and discussed to generate concrete progress.
- Through nearly five decades of operations research experience, the Population Council has been able to learn and build upon valuable lessons of good PPFP programming; a 2009 paper published in Studies in Family Planning and a Council program brief generated during the 10-year FRONTIERS research program provide important policy and programmatic guidance.
Community-based strategies to promote PPFP
- Utilizing community-based strategies, and especially those that engage with male partners and community leaders, is a critical component of encouraging healthy birth spacing and limiting through the use of postpartum FP. In Egypt, the Population Council conducted a six-year project integrating PPFP messaging and delivery into antenatal and postnatal care using a community-based approach. The model significantly increased contraceptive use at 10–11 months postpartum, and the Council subsequently supported its scale up from 20 pilot facilities to over 540 facilities throughout two governorates.
- In India, the Council worked for five years to design, test, and scale up a community-based behavior change intervention through which community health workers engaged with women, their husbands, and mothers-in-law and delivered FP methods, which led to a doubling of contraceptive prevalence at 9 months postpartum to almost 60%. The Meerut district health authorities adapted the model, and the Council supported its district-wide expansion to cover more than one million people.
Responding to the unique PPFP needs of HIV-positive women
- The Balanced Counseling Strategy Plus, an interactive, client-friendly counseling tool for providing women with high-quality, comprehensive counseling on family planning methods in HIV-prevalent areas, is an important strategy for assisting women (particularly HIV-positive women) in planning their families and spacing births postpartum.
- The INTEGRA project, a collaborative effort in Swaziland and Kenya, is exploring the costs and benefits of integrating FP and HIV services during the postpartum period.
System readiness and needs assessment
- Ensuring system readiness to provide PPFP services can be equally as important as providing the services themselves. The Council’s Assessing Integration Methodology (AIM) Handbook provides practical guidance to program managers and policymakers for undertaking health facility assessments for assessing the functioning and quality of postpartum care.
- The Council conducted large-scale studies of behavior change communications in Bihar and Uttar Pradesh, India, that assessed the factors influencing women's utilization of PPFP methods.
Projects
Assessing the Acceptability of the Progesterone Vaginal Ring in Sub-Saharan Africa (more)
To expand contraceptive options for women in sub-Saharan Africa we are evaluating the acceptability of the progesterone vaginal ring, a user-controlled contraceptive method for lactating women, and exploring strategies for how to introduce the new technology.
(10/2011 - 9/2014)
Kenya, Nigeria, Senegal
Responding to the Need for Family Planning through Expanded Contraceptive Choices and Program Services (RESPOND) (more)
Council researchers are providing technical assistance in the design, implementation, monitoring, and evaluation of a project to advance the use of long-acting and permanent methods and other reproductive health and family planning services.
(6/2009 - 6/2013)
Bangladesh
Assessing the Benefits of Integrated HIV and Reproductive Health Services in Kenya, Malawi, and Swaziland: The Integra Initiative (more)
The Council is collaborating with the London School of Hygiene & Tropical Medicine and IPPF to gather evidence and determine the benefits and costs of using different models for delivering integrated HIV and RH services to reduce HIV infection (and associated stigma) and unintended pregnancy.
(1/2008 - 12/2012)
Africa, Kenya, Malawi, Swaziland
Helping Women Achieve Optimal Birth Intervals Through Linking Community-based Postpartum Family Planning with Maternal Health Services in Egypt (more)
In Egypt, Population Council research helped providers integrate birth spacing and postpartum family planning messages into antenatal and postpartum care through a community-based approach.
(7/2005 - 4/2011)
Egypt
Designing a Behavior Change Communication Strategy to Improve Family Health Outcomes in Rural Uttar Pradesh (more)
The Council assisted the Government of India in collecting evidence on the factors influencing behavior change in order to recommend an effective strategy that could contribute to improved reproductive, maternal, and child health outcomes in Uttar Pradesh and other northern states in India.
(11/2008 - 3/2011)
India
Designing a Behavior Change Communication Strategy to Improve Family Health Outcomes in Bihar (more)
Council researchers are assisting the Government of India in assessing the factors that influence family health behaviors in Bihar; from the assessment they will recommend a comprehensive behavior change strategy for implementation.
(1/2010 - 12/2010)
India
Community-based Postpartum Family Planning Through Integrated Public Delivery Systems in India (more)
The Population Council supported the Government of India in designing, testing, and scaling up a community-based intervention to encourage healthier birth spacing in India through increased knowledge and use of postpartum family planning.
(2/2006 - 10/2010)
India
Enhancing Correct Use of Lactational Amenorrhea Method (LAM) and Postabortion Use of Family Planning in Egypt (more)
Researchers with the Council’s FRONTIERS program helped the Egyptian government build its capacity to promote the correct use of the lactational amenorrhea method.
(6/2007 - 1/2008)
Egypt
Resources
"Safe for mothers and babies," Progesterone Vaginal Ring fact sheet (PDF)
Publication date: 2013
"How does the PVR prevent pregnancy?" Progesterone Vaginal Ring fact sheet (PDF)
Publication date: 2012
Country mapping: Kenya (PDF)
Obare,Francis; Liambila,Wilson; Birungi,Harriet; Itombra,Eseoise; Clark,Heather; RamaRao,Saumya
Progesterone Vaginal Ring Technical Report
Publication date: 2012
Country mapping: Nigeria (PDF)
Ishaku,Salisu Mohammed; RamaRao,Saumya
Progesterone Vaginal Ring Technical Report
Publication date: 2012
Country mapping: Senegal (PDF)
Mane,Babacar; Diop,Nafissatou; Termini,Nancy; RamaRao,Saumya; Clark,Heather
Progesterone Vaginal Ring Technical Report
Publication date: 2012
Increasing postnatal care for mothers and newborns (HTML)
Varma,Deepthi S.; Khan,M.E.; Hazra,Avishek; Darmstadt,Gary L.; Tarigopula,Usha Kiran; Ganju,Deepika; Donnay,France
from Shaping Demand and Practices to Improve Family Health Outcomes: Designing a Behavior Change Communication Strategy in India, Volume 1: Uttar Pradesh, pp. 56-89
Publication date: 2012
Increasing postpartum contraception (HTML)
Goel,Shruti; Bhatnagar,Isha; Khan,M.E.; Hazra,Avishek; Darmstadt,Gary L.; Tarigopula,Usha Kiran; Ganju,Deepika; Donnay,France
from Shaping Demand and Practices to Improve Family Health Outcomes: Designing a Behavior Change Communication Strategy in India, Volume 1: Uttar Pradesh, pp. 144-173
Publication date: 2012
Increasing postpartum contraception in rural India: Evaluation of a community-based behavior change communication intervention (abstract) (HTML)
Sebastian,Mary Philip; Khan,M.E.; Kumari,Kaushal; Idnani,Rukma
International Perspectives on Sexual and Reproductive Health 38(2): 68-77
Publication date: 2012
Postpartum unintended pregnancy and contraception practice among rural-to-urban migrant women in Shanghai (abstract) (HTML)
Huang,Yong-mei; Merkatz,Ruth B.; Kang,Jian-Zhong; Roberts,Kevin; Hu,Xiao-Yu; Di Donato,Francis; Sitruk-Ware,Regine; Cheng,Li-nan
Contraception 86(6): 731-738
Publication date: 2012
Role of private sector in delivering birth spacing services in FALAH districts
ul Haque,Minhaj; Miller,Peter C.; Kamran,Iram
Publication date: 2012
The Balanced Counseling Strategy Plus: A Toolkit for Family Planning Service Providers Working in High HIV/STI Prevalence Settings (HTML)
Mullick,Saiqa; Liambila,Wilson; Askew,Ian; Menziwa,Mantshi; Khoza,Doctor; Raney,Laura; Bruce,Linda
Publication date: 2012
Increasing acceptance of spacing methods in rural Bihar: Implications for behavior change communication
Bhatnagar,Isha; Khan,M.E.; Hazra,Avishek
Policy Brief (no. 5)
Publication date: 2011
Increasing postpartum contraception in rural Uttar Pradesh (PDF)
Goel,Shruti; Bhatnagar,Isha; Khan,M.E.; Hazra,Avishek
Journal of Family Welfare 56(special issue): 57-64
Publication date: 2010
Increasing postpartum contraception in rural Uttar Pradesh: Implications for behavior change communication (PDF) (HTML)
Population Council
Shaping Demand and Practices to Improve Family Health Outcomes in Northern India Policy Brief (no. 7)
Publication date: 2010
Progesterone vaginal ring for contraceptive use during lactation (abstract) (HTML)
Nath,Anita; Sitruk-Ware,Regine
Contraception 82(5): 428-434
Publication date: 2010
Promoting healthy spacing between pregnancies in India: Need for differential education campaigns (abstract) (HTML)
Sebastian,Mary Philip; Khan,M.E.; Roychowdhury,Sohini
Patient Education and Counseling 81(3): 395-401
Publication date: 2010
Safeguarding maternal and newborn health: Improving the quality of postnatal care in Kenya (abstract) (PDF) (HTML)
Warren,Charlotte; Mwangi,Annie; Oweya,Erick; Kamunya,Rosemary; Koskei,Nancy
International Journal for Quality in Health Care 22(1): 24-30
Publication date: 2010
Capacity building to enhance postpartum/postabortion use of contraception in Egypt (PDF)
Presentation at the XXVI IUSSP International Population Conference, Marrakech, September
Afifi,Ahmed; Abdel-Tawab,Nahla
Publication date: 2009
Assessing Integration Methodology (AIM): A handbook for measuring and assessing the integration of family planning and other reproductive health services (PDF) (HTML)
Rivero-Fuentes,M.Estela; RamaRao,Saumya; Estrada,Ricardo; Warren,Charlotte; Mullick,Saiqa; Askew,Ian; Birungi,Harriet; Townsend,John W.; Medina,Susana
Publication date: 2008
Clinical guidelines for integrating family planning into postpartum and postabortion care
El-Fikky,Alaa; Abdel-Tawab,Nahla; Afifi,Ahmed
Publication date: 2008
Extending prevention of mother-to-child transmission through postpartum family planning in Lesotho (PDF)
Warren,Charlotte; Phafoli,Semakaleng; Majara,Bosielo; Tsukuluet,Thato
FRONTIERS Final Report
Publication date: 2008
Helping Egyptian women achieve optimal birth spacing intervals through fostering linkages between family planning and maternal/child health services (PDF)
Abdel-Tawab,Nahla; Loza,Sarah; Zaki,Amal
FRONTIERS Final Report
Publication date: 2008
Meeting the family planning needs of postpartum women (PDF)
Vernon,Ricardo
FRONTIERS Program Brief (no. 10)
Publication date: 2008
Promoting postpartum contraception among young low parity women in India
FRONTIERS Asia and Near East Region OR Summary (no. 24)
Publication date: 2008
Promoting postpartum contraception among young low parity women: Some salient findings
Khan,M.E.; Sebastian,Mary Philip; Idnani,Rukma; Kumari,Kaushal
FRONTIERS Asia and Near East Research Update (no. 14)
Publication date: 2008
Situation analysis of the integration of family planning services in postpartum, postabortion and prevention of mother to child transmission programs in Haiti (PDF)
Rivero-Fuentes,M.Estela; Vernon,Ricardo; Boulos,Michaelle; Boulos,Louis-Marie
FRONTIERS Final Report
Publication date: 2008
Situation analysis of the integration of family planning services in postpartum, postabortion and prevention of mother to child transmission programs in Nicaragua (PDF)
Solis,Freddy; del Carmen Rojas,Ana; Gadea,Adilia; Rivero-Fuentes,M.Estela; Vernon,Ricardo
FRONTIERS Final Report
Publication date: 2008
Situation analysis of the integration of family planning services in postpartum, postabortion and prevention of mother to child transmission programs in the Dominican Republic (PDF)
Quiterio,Gisela; Molina,Maritza; Miric,Marija; Vernon,Ricardo; Rivero-Fuentes,M.Estela
FRONTIERS Final Report
Publication date: 2008
Strengthening postnatal care services including postpartum family planning in Kenya (PDF)
Mwangi,Annie; Warren,Charlotte; Koskei,Nancy; Blanchard,Holly
FRONTIERS Final Report
Publication date: 2008
Technical assistance for implementing best practices in the Asia and Near East region (PDF)
Khan,M.E.; Roychowdhury,Sohini; Sebastian,Mary Philip; Sekhar Kar,Sitanshu; Mishra,Anurag; Sharma,Vivek; Narayana,G.; Sharma,Bhawana; Abdel-Tawab,Nahla; Afifi,Ahmed
FRONTIERS Final Report
Publication date: 2008
The Balanced Counseling Strategy: A Toolkit for Family Planning Service Providers (
Algorithm for using the balanced counseling strategy)
(PDF) (HTML)
The Balanced Counseling Strategy: A Toolkit for Family Planning Service Providers
Publication date: 2008
The Balanced Counseling Strategy: A Toolkit for Family Planning Service Providers (Counseling cards) (PDF) (HTML)
Publication date: 2008
The Balanced Counseling Strategy: A Toolkit for Family Planning Service Providers (Trainer's Guide) (PDF) (HTML)
Bruce,Linda; Martin,Antonieta
Publication date: 2008
The Balanced Counseling Strategy: A Toolkit for Family Planning Service Providers (User's Guide) (PDF) (HTML)
Leon,Federico R.; Vernon,Ricardo; Martin,Antonieta; Bruce,Linda
Publication date: 2008
Using operations research to enhance delivery of postpartum/postabortion family planning services in the Arab region (PDF)
Frontiers in Reproductive Health
FRONTIERS Final Report
Publication date: 2008
Profile of birth spacing in Egypt: Who gets pregnant 'too soon'?
FRONTIERS Asia and Near East Region OR Summary (no. 18)
Publication date: 2007
Promoting healthy timing and spacing of pregnancy: Barriers and possible intervention--Observation from a qualitative study in Uttar Pradesh
Khan,M.E.; Sebastian,Mary Philip; Aeron,Aditi
FRONTIERS Asia and Near East Research Update (no. 13)
Publication date: 2007
Promoting postpartum contraception through integrated public delivery systems in India
FRONTIERS Asia and Near East Region OR Summary (no. 22)
Publication date: 2007
Correlates of inter-birth intervals: Implications of optimal birth spacing strategies in Mozambique (PDF)
RamaRao,Saumya; Townsend,John W.; Askew,Ian
FRONTIERS Final Report
Publication date: 2006
Helping Egyptian women achieve optimal birth spacing intervals through maximizing opportunities in antenatal and postpartum care
Abdel-Tawab,Nahla; Youssef,Hala; Loza,Sarah; Zaki,Amal; Faraq,Salwa
FRONTIERS Research Update (no. 9)
Publication date: 2006
Involving men in maternity care increases postpartum contraceptive use: Observations from an operations research study in ESIC, Delhi (abstract) (PDF)
Kalra,Kamlesh; Anand,A.S.; Lal,J.; Caleb-Varkey,Leila; Khan,M.E.
ESI Samachar March 2006: 14-15
Publication date: 2006
Kazakhstan: Promote LAM for postpartum family planning and birth spacing (PDF)
FRONTIERS OR Summary (no. 56)
Publication date: 2006
West Bank/Gaza: Home visits to low parity mothers improves postpartum care utilization
Asia and Near East OR Summary (no. 5)
Publication date: 2005
Effects of IGSS' job aids-assisted Balanced Counseling Algorithms on quality of care and client outcomes (PDF)
Leon,Federico R.; Brambila,Carlos; de la Cruz,Marisela; Bratt,John H.; Gutierrez,Gustavo; Davila,Veronica; Boniato,Carlo; Rios,Alex
FRONTIERS Final Report
Publication date: 2004
Involving men in maternity care: South Africa (PDF)
Kunene,Busi; Beksinska,Mags; Zondi,Simphiwe; Mthembu,Nobuhle; Mullick,Saiqa; Ottolenghi,Emma; Kleinschmidt,Immo; Adamchak,Susan E.; Janowitz,Barbara; Cuthbertson,Carmen
FRONTIERS Final Report
Publication date: 2004
West Bank/Gaza: Promote awareness of the benefits of women's reproductive health (PDF)
FRONTIERS OR Summary (no. 46)
Publication date: 2004
West Bank/Gaza: Promote awareness of the benefits of women's reproductive health [Arabic] (PDF)
FRONTIERS OR Summary (no. 46)
Publication date: 2004
Assessment of pilot health project outcome indicators: West Bank/Gaza (PDF)
Nawar,Laila; Huntington,Dale; Kharboush,Ibrahim; Ali,Nancy; Shaheen,Mahmoud
FRONTIERS Final Report
Publication date: 2003
Enhancing quality for clients: The balanced counseling strategy (PDF)
Leon,Federico R.; Rios,Alex; Zumaran,Adriana; de la Cruz,Marisela; Brambila,Carlos; Bratt,John H.
FRONTIERS Program Brief (no. 3)
Publication date: 2003
Improving postpartum care among low parity mothers in Palestine (PDF)
Center for Development in Primary Health Care (CDPHC),Al Quds University
FRONTIERS Final Report
Publication date: 2003
Contraceptive efficacy and clinical performance of Nestorone implants in postpartum women (abstract) (HTML)
Massai,Rebeca; Diaz,Soledad; Quintero,E.; Reyes,Veronica; Herreros,C.; Zepeda,Ana; Croxatto,Horacio B.; Moo-Young,Alfred J.
Contraception 64(6): 369-376
Publication date: 2001
Expansion of postpartum/postabortion contraception in Honduras (PDF)
Medina,Ruth; Vernon,Ricardo; Mendoza,Irma; Aguilar,Claudia
FRONTIERS Final Report
Publication date: 2001
Honduras: Posparto y post-aborto, momentos para hablar de planificación familiar [Honduras: Postpartum and postabortion, women want to talk about family planning] (PDF)
FRONTERAS Resumen de Investigación Operative (número 17)
Publication date: 2001
Honduras: Postpartum and postabortion patients want family planning (PDF)
FRONTIERS OR Summary (no. 25)
Publication date: 2001
West Bank and Gaza: Stress the importance and cost-effectiveness of postpartum care (PDF)
FRONTIERS OR Summary (no. 20)
Publication date: 2001
Vaginal rings for contraception in lactating women (abstract) (HTML)
Massai,Rebeca; Diaz,Soledad; Jackanicz,Theodore M.; Croxatto,Horacio B.
Steroids 65(10-11): 703-707
Publication date: 2000
Fertility decline and contraceptive use in the International Postpartum Family Planning Program
Sivin,Irving
Studies in Family Planning 2(12): 248-256
Publication date: 1971
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