By: Madeline Taskier, Partnership Coordinator at Women Deliver
Last month I attended a session at the 38th Annual Global Health Council Conference on immunization as a platform for family planning integration. Today I’d like to highlight a program featured at this session: a project aiming to reach high-need, postpartum women in Bamako, Mali with family planning services and counseling. Read more...
In Mali, the lifetime risk of maternal death is 1 in 22 and the national contraceptive prevalence rate (CPR) is just 8.2 percent. For women living in Mali, especially the capital, Bamako, the CPR has decreased in the last ten years from 19 to 16 percent. Unmet need for family planning is most significant among new mothers just after childbirth at 79 percent. The Family Planning Child Immunization Program seeks to link new mothers in Bamako with family planning counseling, services, and long-acting methods while they get their new babies immunized. The program puts emphasis on reaching postpartum women to encourage birth spacing.
In 2009, this program was born out of Population Services International (PSI/Mali), which aimed to expand its existing family planning programs to include promotion and delivery of long-acting contraceptive methods. PSI/Mali saw a unique opportunity to catch its target audience at immunization clinics where new mothers were regularly bringing their babies. Fortunately, the waiting area where mothers spent hours waiting for a five minute immunization appointment proved to be an ideal spot for presentations, counseling, and service provision.
Long-acting reversible contraception (LARC) has many benefits for women. Compared to oral contraceptives (a short acting method), LARC has significantly lower unintended pregnancy rates associated with one year of use (0.8 percent compared with 8 percent). A LARC, such as an intrauterine device (IUD) or a contraceptive implant, requires little to no action from the woman for extended periods of time—up to 5 years for implants and 12 for IUDs. These methods are generally hidden on the body which allows women to keep their contraceptive use private. Among Malian woman, LARC use is less than 1 percent.
The program operates in series of events that are scheduled during immunization days at local clinics to ensure maximum turnout of postpartum women. Starting in 5 out of 53 private ProFam clinics in Bamako, PSI midwives and clinic staff conduct a 30-45 minute presentation on the importance of family planning, maternal and child health for those mothers waiting to get their children immunized.
After the presentation, the midwives engage the women in a Q&A period, dispelling myths and concerns about contraceptives and long-acting methods. Women who are interested in receiving family planning are able to do so on site while they wait for their baby to be immunized. Women who opt into the program receive counseling, a physical exam to determine eligibility, and the application of a long-acting method. PSI/Mali provides an implant or IUD at a subsidized rate of about $1 (500 CFA).
Since its inception, the family planning presentation has reached 35,800 women in the clinics, resulting in 20% of the women selecting long-acting methods. In 2009 alone, the program provided 3,997 implants and IUDs to women attending the clinics. The projections for 2010 and 2011 are higher as PSI/Mali has expanded to program to include events days at public sector clinics.
This program has been made possible with the support of the Dutch Government under the Strategic Alliance with International Non-Governmental Organizations (SALIN).