One year after Madagascar developed postpartum family planning (PPFP) action plans specific to the needs of this beautiful island nation, I had the chance to visit. The Madagascar country team was one of 16 to leave the 2015 Accelerating Access to Postpartum Family Planning meeting in Thailand with designs to ensure that every woman be offered a means to prevent an unintended pregnancy in the two years after a birth. I was eager to see what had happened since.
We are now in a reinvigorated period for family planning, with donors, countries and Family Planning 2020 focused on expanding related programs, services and supplies to the additional 20 million women globally with an unmet need for family planning. PPFP presents a unique opportunity to meet the overwhelming desire of women and girls to delay or limit another pregnancy at a time when their need is often underestimated: following the birth of a child.
Meeting with Dr. Haingonirina Ramananjanahary, Head of the Family Planning Division at the Madagascar Ministry of Health, confirmed that enthusiasm for PPFP remains high in the country. In the last 12 months, she listed many notable achievements:
- Ensuring PPFP is an integral part of the Madagascar FP2020 commitment.
- Including PPFP in national family planning communication strategies.
- Developing a new national family planning agenda — soon to be costed with support from USAID’s Health Policy Plus program.
- Updating nationally approved family planning training materials, including the addition of PPFP content, with help from USAID’s flagship Maternal and Child Survival Program (MCSP).
- As part of a September campaign, printing and distributing PPFP messages at both facility and community levels within the 15 regions of the country that are underperforming in family planning indicators.
- Increasing financial and technical commitments to PPFP demonstrated by Madagascar’s partners. (For example, with support from USAID, UNFPA and the French Development Agency, 19 of 22 regions will train health workers on PPFP updates. USAID partners are also taking PPFP to the community level, while UNFPA conducted a nationwide assessment of integration.)
I’m inspired by the clear, growing movement in Madagascar to improve the lives of women and their families; however, we must not lose momentum if we are to reach our goals. Health and wellbeing, food security, economic empowerment, environmental sustainability, peace and justice — all of these hinge on the ability of women and girls to shape their own lives and take charge of their fertility. By accelerating PPFP, we can reach the nearly 65% of women in developing countries in their first year postpartum who have an unmet need for family planning, with long-term benefits to these women and their children.
Much remains to be done to ensure that all postpartum women in Madagascar understand the benefits of healthy timing and spacing of pregnancies, and have access to the PPFP contraceptive method of their choice. Dr. Ramananjanahary noted that more resources are needed to take provider training to scale. Currently, training is only reaching a portion of the country’s 1,680 health facilities that provide antenatal care and delivery services. Demand creation also remains a challenge. Well-designed communication strategies will be required to inspire women, their partners, and influential family members to adopt PPFP for its health and economic benefits.
In the meantime, providers are beginning to systematically offer PPFP counseling both during pregnancy and the immediate postpartum period. One such provider, Nurse Mariame Rasaminirina, is exemplary of this kind of care. In the three months since completing an MCSP PPFP clinical training, she has inserted 27 contraceptive implants and 3 IUDs, and provided 3 women with Depo-Provera® injections at their 6-week postnatal visits. She has counseled the remaining 28 women she’s seen on healthy timing and spacing of pregnancies as well as the Lactational Amenorrhea Method (LAM)—an effective method of contraception for women with children under six months of age, who are exclusively breastfeeding and who have not yet seen their menses return.
Her statistics are proudly posted on the wall of her consultation room: since January, 48% of the women she assisted at birth (a total of 69 women) left the facility with a PPFP method other than LAM. Nurse Mariame has taken #ActionPPFP, demonstrating high-quality care by putting her #FPClients1st!
MCSP is helping to reduce maternal and neonatal mortality in Madagascar with a focus on evidence-based interventions along the continuum of care—from pregnancy to the postpartum period. We are working at all levels of care to improve the capacity of health providers and strengthen linkages between the community and health services. And we’re coordinating closely with the Ministry of Health to ensure that policies are updated and aligned with key, globally accepted standards.
To date, MCSP has trained more than 75 Malagasy trainers and nearly 300 health providers in PPFP counseling, and more than 60 in clinical skills for postpartum insertion of IUDs and implants. Thanks to leadership from the Madagascar Ministry of Health—along with additional providers trained by UNFPA, PASMI and other USAID partners—the PPFP movement is growing in this country.
Anne Pfitzer
MCSP Family Planning Team Lead
