Cameroon: Providing Comprehensive Postpartum Family Planning
Postpartum family planning (FP) is part of a scalable, comprehensive maternal, newborn and child health approach to reaching women with critical, life-saving information and services. Research demonstrates that more than 90 percent of women during their first year postpartum either want to delay the next pregnancy for at least two years or avoid future pregnancies all together. Preventing unintended pregnancies is an important strategy for reducing maternal mortality; by preventing pregnancies, exposure to obstetric risk is also reduced.
In Cameroon, the modern contraceptive prevalence for all women remains low at 16.1 percent (DHS, 2011). To respond to this need, USAID is supporting the Evidence to Action for Strengthened Family Planning and Reproductive Health Services for Women and Girls Project (E2A) and Management Sciences for Health (MSH) to implement a comprehensive postpartum FP program at the four largest hospitals in Cameroon’s capital city of Yaoundé and two rural hospitals. The program offers a full range of contraceptive options to women, with a focus on adolescent and young mothers aged 15-24 years.
The E2A Postpartum FP project addresses both the supply of and demand for family planning among women in communities served by four project hospitals. On the supply side, E2A works with the ministry of health to ensure that supportive elements (e.g. training guidelines, support supervision, and training on data quality and utilization of monitoring data on FP uptake) are in place.
Thus far, 38 providers from the four Yaoundé facilities were trained in FP counseling and services with focus on postpartum IUD, implants, permanent methods, capacity building and contraceptive provision. E2A procured all required equipment and supplies (e.g. insertion kits, commodities, etc.) along with a three months’ supply of essential consumables.
Starting in February 2015, trained providers began offering postpartum FP services in the four facilities in Yaoundé and E2A began supportive supervision of providers in the facilities. Each facility has four functioning points of contact offering FP counseling and services: 1) antenatal care; 2) delivery room; 3) immunization room; and 4) FP room.
Long-acting contraceptive methods, such as post-partum implants and IUDs, and all other methods are now offered at the four facilities. At the end of September 2015, a total of 6,698 women received FP counselling in the four facilities. 3089 women accepted a method of FP, including 725 young women aged 15-24. Nearly two-thirds of these women (62 percent or 1915 of 3039) chose the implant, or an IUD. Uptake among postpartum women also was substantial: 403 women who gave birth left the hospital with a method of FP, and 1,966 women who had given birth in the previous 12 months accepted FP.
An important theme in the final year of the project is engaging the community to generate demand and to affect social norms around contraceptive use. In the Cameroon context, where large families are still valued and seen as the norm, it will be important to frame FP as healthy timing and spacing of pregnancy rather than as limiting family size. Ensuring that sexually-active adolescent girls and young women have equitable access to FP information and services will also be a focus.
From the supply side, increasing provider’s knowledge and skills for postpartum FP, especially the immediate postpartum period, will be crucial for expanding availability of services. Refresher trainings will be held in early 2016 and expansion to two rural district hospitals should afford important lessons in rolling out and scaling up postpartum FP services in rural areas of Cameroon.