2011 International Conference on Family Planning
29 November–2 December 2011
"Scaling up integration of family planning into antenatal and postpartum care: A case study from Egypt"
Nahla Abdel-Tawab and Sally Saher
Birth spacing intervals are relatively short in Egypt, with the majority of births in rural Upper Egypt occurring less than three years from a previous birth. Failure to use postpartum contraception and incorrect use of Lactational Amenorrhea Method (LAM) are key reasons for women's failure to achieve healthy timing and spacing of pregnancies (HTSP). Short birth intervals are associated with adverse maternal and neonatal outcomes and pose financial and emotional pressure on the family. The antenatal and postpartum periods are crucial times for information and counseling about birth spacing and postpartum use of contraception since most women get in contact with the health care system during those periods. However, provision of this information often does not take place because MCH and FP services are segregated in the Egyptian health care system.
To respond to this need, the Population Council's Frontiers in Reproductive Health Program (with funds from USAID) in collaboration with the Egyptian Ministry of Health and Population conducted an operations research study to measure acceptability and effectiveness of two models of providing birth spacing messages to low parity women and communities. The first model involved provision of birth spacing and family planning messages to low parity pregnant and postpartum women during antenatal and postpartum care services, while the second model involved the above plus an awareness raising IEC component that targeted husbands and community leaders. The intervention package in the above study included birth spacing and postpartum family planning messages during antenatal care visits in the third trimester along with five home visits to postpartum women by the MCH nurse and/or the RR. In addition to the above intervention, an awareness raising component for men was implemented in each governorate. This component involved seminars, one on e meetings and informal gatherings with men to enhance their knowledge of birth spacing and use of postpartum contraception. The above intervention was pilot tested in a total of 20 health facilities and surrounding villages in Assiut and Sohag governorates. The intervention was associated with improved knowledge and attitudes about birth spacing as well as increased utilization of family planning services by low parity women (36 percent increase for model I, 47 percent increase for Model II versus a 3 percent increase in control clinics).
Based on the success of that intervention and in response to requests of MOHP officials in Assiut and Sohag governorates, the Population Council has scaled up a modified version of the intervention into additional facilities in the above two governorates. The modified intervention targeted all pregnant and postpartum women as opposed to low parity women. Also, the protocol of home visits by6 MCH nurses and Raedat Rifyat (RRs) included a fewer number of visits (day 2, 4, 7, and 21). Scaling up was done through training of trainers (TOT) from health districts to be followed by on the job training (OJT) of staff in health facilities. TOT and OJT were both done by MOH staff from the two health directorates. In addition, monthly monitoring visits the clinics were done by MOHP staff from health districts, the two health directorates and MOHP headquarters, with technical assistance from Population Council and funding from ESD/USAID. IEC materials on breastfeeding, LAM, and birth spacing were developed in collaboration with Communications for Healthy Living (CHL) project. In addition, a home visits manual was developed for nurses and RRs to educate them about the significance of each home visit and tasks to be accomplished on each visit. Scaling up proceeded in phases: (1) 6 facilities in four districts within each of the two governorate, (2) other facilities within the above four districts, (3) other districts within the above two governorates.
By the end of the project the intervention has been scaled up to more than 500 facilities in Assiut and Sohag, serving about 200,000 pregnant and postpartum women per year. More women in scaling up districts knew the three conditions of LAM, at least two benefits of birth spacing and when fertility returns after a live birth. There was also an increase in utilization of FP services in scaling up districts compared to before the intervention. MOHP is currently in the process of scaling up this intervention into other governorates in Egypt to reach more than 2.5 million pregnant and postpartum women all over Egypt.
The presentation will discuss challenges and lessons learned in scaling up of successful interventions. Lessons learned will focus on selection of an intervention for scaling up, involvement of policy makers throughout the process, building partnerships with other organizations to form a constituency of change, using research evidence to educate policy makers and others.
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