Postpartum family planning (PPFP) demand generation and social and behavior change communication (SBCC): The role of CHWs

By: Chelsea Cooper, Indrani Kashyap and Elaine Charurat

In recognition of World Contraception Day on September 26^th, this month’s conversation will focus on the role of CHWs in postpartum family planning demand generation and social and behavior change communication.

Women within the first year postpartum have special needs and concerns when it comes to contraception. Postpartum family planning (PPFP) is a package of information, counseling, and services that address the unique concerns and contraceptive needs of women within the first year after childbirth. PPFP enables women to prevent or limit pregnancies if they desire to do so. PPFP is a life-saving measure, helping to prevent maternal, newborn, and child death and disability, and reduces the chances that infants are born too soon or too small. An analysis of data from 17 countries revealed a higher than 60% average rate of unmet need for FP during the first year postpartum. Clearly, there is a need for more dedicated focus on increasing FP access and uptake during the postpartum period.

The USAID-funded Maternal and Child Health Integrated Program (MCHIP) has focused on PPFP efforts at both the facility and community levels. Specifically, MCHIP has worked with CHWs to provide information during pregnancy and after delivery about fertility return, return to sexual activity, and healthy spacing of the next pregnancy. CHWs also discuss FP choices available to women during the postpartum period, including the lactational amenorrhea method (LAM) and the importance of timely transition to another modern FP method. During postpartum visits, CHWs may also provide counseling and distribute contraceptives, depending on the country context.

Developed under the ACCESS-FP project, the PPFP Learning Resource Package for CHWs outlines the key roles of CHWs in promoting healthy spacing of pregnancy, PPFP counseling skills, FP method provision and referral, and strategies for addressing myths and misconceptions. This integrated community-based approach has been implemented in many countries in Asia and Africa, including Nigeria, Kenya, Tanzania, India, Bangladesh and Afghanistan. “A Guide for Developing Family Planning Messages for Women in the First Year Postpartum” also describes the importance and key steps for tailoring SBCC messages to the postpartum period.

It should be noted that it often takes more than a message to promote behavior change. Decisions about whether to access PPFP services and select a contraceptive method are often deeply influenced by social factors, such as social norms around postpartum sexual activity and use of FP services, religious beliefs, social support, cultural traditions, myths and rumors, local or national policies, and the role of women in reproductive health decision-making. CHWs, who generally reside in the same community that they serve, often have a unique ability to overcome social and cultural barriers to PPFP information and service provision, due to their understanding of the local context and trust placed in them by those they serve.

Discussion Questions:

Are there any other lessons learned that you would like to share regarding the role of CHWs in SBCC and demand generation for PPFP?
How can institutions more effectively integrate PPFP with other MNCH activities at community-level, in order to reduce missed opportunities?
What are some strategies that can be used to help strengthen the link between community and facility in delivering PPFP information and services? How can referral linkages in particular be strengthened to increase follow-through on FP referrals?
What are some strategies for effectively engaging partners, mothers-in-law, and other behavioral influencers around PPFP, especially in conservative settings?

Chelsea Cooper currently serves as Behavior Change Communication Advisor for the Maternal and Child Health Integrated Program (MCHIP) Family Planning team. She provides support for integrated programs/studies in Liberia, Kenya, Tanzania, Bangladesh, Egypt, and India. She also co-leads the Family Planning and Immunization Integration Working Group. Prior to joining Jhpiego, she worked with the American Refugee Committee where she managed the USAID-funded participatory communication program “Through Our Eyes” and provided social and behavior change technical support for ARC’s reproductive health and gender-based violence programs. She received her master’s in international health with a concentration in social and behavioral interventions from Johns Hopkins School of Public Health.

Indrani Kashyap has more than 10 years of experience in communications, program design and planning. Indrani joined Jhpiego in August 2011 as the Communications Officer for its India office and is responsible for the strategic planning and implementation of all its communication activities. Indrani began her career in the private sector. She was responsible for designing communication strategies and plans for several large private sector firms. Ms. Kashyap made her shift to the development sector with a non-profit cultural organization, following which she served as the Communications Officer of Telecentre.org Foundation, an international NGO in the field of ICT4D which is funded by the Canadian IDRC and Microsoft. Ms. Kashyap holds a master’s degree in economics and is fluent in English, Hindi, and Bengali.

Elaine Charurat currently serves as a Senior Program Officer for MCHIP. Elaine has more than eight years of experience in program planning, monitoring and evaluation, portfolio management, and program implementation in areas of cervical cancer prevention (CECAP), HIV/AIDS, family planning/reproductive health and other health issues in diverse culture and developing nations. Prior to joining Jhpiego, she was the technical and program manager on the Monitoring and Evaluation team for USAID-supported Microbicide Research and Development project. She earned her master’s in international health and business administration at the Johns Hopkins University.