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Thursday, January 10, 2013

Eight is Enough: Preventing pregnancy after childbirth

By Holly Blanchard and Elizabeth Sasser

Photo courtesy of Impatient Optimists

Editor's note: This post was originally published on the Gates Foundation's Impatient Optimists blog. It is republished with permission.

This year, 222 million women worldwide will have an unmet need for modern contraception. And as more women are encouraged to deliver in facilities, there is greater opportunity for immediate postpartum  intrauterine contraceptive device (IUCD) services. 

Abdela Abdosh, a midwife working in Ethiopia, can offer a testament of what this service can mean in a woman’s life. He tells the story of 30-year old Shumba Berisso, a mother who arrived at an MCHIP-supported facility in Ethiopia in labor with her eighth baby. After the delivery, she turned her head away from her newborn and sobbed silently, saying she had no means to care for the baby.

“If only I could have prevented this pregnancy,” Shumba lamented, adding that her other seven children had never set foot in a classroom, instead spending their days toiling on neighboring farms.

For both mothers and infants, there are many benefits to preventing another pregnancy for at least two years after a previous birth.

Abdela understood her concerns and provided counseling and a family planning method of her choice. Through the use of a Postpartum Intrauterine Contraceptive Device (PPIUCD), Abdela was able to help this mother prevent the birth of her ninth, tenth and, perhaps, eleventh child. For the next 12 years, she will be safe from unwanted pregnancy.

“I always feel empty when I remember [Shumba],” he said. “She wanted to use family planning before she came to us, but could not get any. Her story tells me how late we are. It also reminds me of the presence of millions of mothers out there that share her story.”

Abdela believes the postpartum period is the key time to introduce the use of modern family planning methods. “The memory of labor pain is still fresh in newly delivered mothers, and they don’t want to become pregnant too quickly. I don’t think any health professional should miss that opportunity,” he said. In addition, preventing another pregnancy provides a mother the time to breastfeed her baby, which significantly reduces infant morbidity and mortality.

With this in mind, MCHIP is proud to announce the publication of “Program Learning for Postpartum Intrauterine Contraceptive Device (PPIUCD) Integration with Maternal Health Services,” a new technical brief highlighting experiences from PPIUCD programs in multiple countries. Intended for policy makers, program managers, and maternal and child health workers, these are the collective experiences of several organizations—MCHIP, PSI and FHI 360—and provide examples of the essential components needed for successful PPIUCD programs.

The PPIUCD is a highly effective, reversible, and long-acting family planning method that can be initiated during the immediate postpartum period. For both mothers and infants, there are many benefits to preventing another pregnancy for at least two years after a previous birth. Postpartum family planning that includes PPIUCD is helping to meet this need, and reinvigorating family planning programs in several countries.

MCHIP and others have successfully introduced PPIUCDs to more than 65,000 postpartum women around the world. This brief seeks to capture lessons learned from PPIUCD programs in El Salvador, Guinea, India, Kenya, Paraguay, Rwanda and Zambia. 

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