Celebrate Solutions: Creating a "One-Stop Shop" to Encourage Postpartum Contraception 

June 1, 2015

By: Claire Watt Rothschild, former Research Fellow

In June 2015’s 'Celebrate Solutions' columns, Women Deliver is highlighting Jacaranda Health's efforts to change the way family planning decision-making happens in the postpartum period among low-income women in Kenya. As a maternity health care organization, Jacaranda Health works to make pregnancy and childbirth safer for women and newborns by building a new model of maternity care in East Africa; one that is respectful, high-quality and patient-centered.

Everyone said she could not become pregnant while breastfeeding. This is what Wanjiru*, a new mother, told a nurse midwife at Jacaranda Health's Ruiru maternity hospital. When she became pregnant just 3 months after the birth of her first baby, she felt lied to. Family planning use in the first year after childbirth - known as the postpartum period - is both essential and rare in Kenya. At Jacaranda Health, the aim is to make family planning acceptable and convenient for new mothers and their families in a setting where 90 percent of women are not using postpartum family planning at all or until after they are already at risk of pregnancy.

Jacaranda Health provides care to thousands of pregnant low- and middle-income women and their newborns in and around Nairobi, Kenya. Many Kenyan mothers are shocked by how soon after delivery a woman can become pregnant again. When Wanjiru came to Jacaranda during her second pregnancy, she received family planning counseling - including correct information about how to use breastfeeding as an effective contraceptive method - beginning at her first antenatal visit and continuing until she chose a family planning method 6 weeks after her delivery.

It can be extremely serious for the health of both mother and baby if a woman gets pregnant too soon after giving birth. Spacing childbirth and subsequent pregnancy by at least 2 years - a practice called healthy birth spacing - has the potential to reduce maternal mortality globally by more than 30 percent and prevent 10 percent of all child deaths. Postpartum family planning is the best tool to ensure that families space their pregnancies healthily.

That's why it's important to expand access to postpartum family planning tools and information for clients.

First, Jacaranda Health makes sure that conversations about family planning occur early and often. The data suggests that a woman is more likely to use postpartum contraception when there are more "touchpoints" with providers, whether it be during antenatal care, at discharge after delivery, or through interactions with a community health worker in the first weeks postpartum.

To encourage frequent dialogue with our clients on family planning, we have created a "one-stop shop" service Kenya Average Jacaranda Delivery Clients delivery model. Family planning counseling and services are streamlined with popular infant care services, for example, so that mothers coming for routine infant vaccinations can easily obtain a family planning method at the same time. This cuts down on time and transportation costs - major barriers to family planning use, especially for families caring for a new baby.

Finally, we find ways to deliver family planning counseling outside of the interaction between women and nurses: All cadres of health care workers at our facilities are trained to provide key family planning counseling from patient care assistants to community health workers. The result is that close to 100 percent of Jacaranda delivery clients receive contraceptive counseling, compared to just 30 percent of women delivering at comparable facilities.