In low-resource settings, midwives and nurses are often the frontline service providers for women during childbirth. In many countries, however, only physicians are trained and authorized to provide contraceptive services in the immediate postpartum. As a result, the majority of women whose birth is not attended by a physician have no access to immediate postpartum family planning (PPFP).
A strong advocate for task-shifting, Jhpiego has supported and empowered midwives and nurses to provide PPFP that includes postpartum intrauterine contraceptive device (PPIUCD) services. Jhpiego has also helped governments and institutions enact policies and guidelines that authorize midwives and nurses to provide these services. In addition, we have developed training courses to teach the necessary skills and provided support in service delivery and quality improvement.
In Kenya, Jhpiego successfully led the effort to revitalize PPIUCD services through capacity-building and creation of nurse-midwife champions. Results from an assessment demonstrated that midwives and nurses can confidently provide high-quality PPIUCD services that include counseling on all PPFP methods and insertion for those women who choose PPIUCDs. Since the program’s inception in Embu District in 2007, inclusion of PPIUCDs as part of PPFP options was scaled up to additional provinces in Kenya. A similar model was later introduced in Rwanda, Tanzania, Zambia and other countries.
In India, empowering midwives and nurses to provide immediate PPFP, including PPIUCDs, has been especially crucial, as the government has instituted an incentive program to encourage facility births. As the numbers of facility births increased dramatically, the provision of PPIUCDs also expanded rapidly over the past few years. Most recently, as a result of Jhpiego’s strong and persistent advocacy, the Ministry of Health and Family Welfare in India granted approval for midwives and nurses to provide PPIUCDs within 48 hours of delivery. This approval creates a tremendous opportunity for additional women to choose a family planning method that is long acting, reversible and does not interfere with breastfeeding—before leaving the birthing facility.
By empowering midwives and nurses to provide immediate PPFP services, an ever-increasing number of women have access to family planning services in the vulnerable postpartum period.