Tirana, Albania—Over the years at Koco Gliozheni Maternity Hospital, nurse-midwife Laureta Ramaj would see familiar faces. Women who had given birth just a year before were back again. A veteran of the maternity ward, Ramaj quietly wondered about the frequency of their return visits and how these young mothers were coping at home. After talking to them, Ramaj realized that the mothers had little or no information on how best to plan for their families—they “just got pregnant.”
In Albania, despite its relatively favorable health indicators, Western sensibilities and proximity to modern European capitals, the use of family planning methods and contraceptives has been surprisingly low. Although 70 percent of married women do not want any more children, according to a recent national demographic and health survey, only about 11 percent of Albanian women use modern, effective contraception methods. Although exact numbers are difficult to establish, providers report that many women use abortion as a back-up to failed traditional contraception.
With funding from the U.S. Agency for International Development (USAID), Jhpiego began working in Albania in 2007 with partners to change that scenario and help Albania move toward modern contraception as part of a healthy lifestyle. The goal was to improve family planning services for women after they gave birth or had an abortion, increase the use of intrauterine devices and other modern contraceptive options, and encourage local responses to the unmet need for family planning.
The USAID-funded, ACCESS-Family Planning Initiative helped the Albania government establish national protocols and standards for family planning, developed learning materials for providers and educational brochures for clients, trained health care providers to implement new family planning services and ensured availability of family planning supplies.
In Jhpiego-led trainings, more than 340 nurses and midwives like Ramaj learned to incorporate postpartum family planning in their routine services for pregnant women. The providers learn how to promote healthy birth spacing and effective family planning methods suitable for postpartum women, including the lactational amenorrhea method, an exclusive breastfeeding method that naturally helps avoid pregnancy, and to use client materials to make modern contraception understandable and acceptable for couples. The World Health Organization recommends that women wait two to three years before having another child, a period of time that allows a mother to nurture and provide for a child without compromising the needs of siblings.
At Koco Gliozheni Maternity Hospital in Tirana, where she has been head midwife for five years, Ramaj built on her USAID-supported training and established a counseling room, where she could provide well-baby and family planning information for new mothers in a convenient, accessible and inviting setting. She set her sights on a large, cluttered storage area that was just down the hall from where women gave birth. With help from Jhpiego and hospital staff, Ramaj transformed the storage area into a warm, cheerful resource center for new mothers to meet with doctors and nurses in training.
New mothers stop in at the center to learn about and discuss family planning methods and their babies’ needs. A selection of up-to-date brochures, DVDs and other materials are available for the new mothers, and Ramaj uses them to engage women in conversation and discussions. In any given month, about 40 women on the 18-bed maternity ward will visit the resource center, Ramaj says.
Ramaj’s decision to set up a family planning resource center on the maternity ward may be unique to her hospital, but she is an example of health care providers incorporating their new knowledge into the work place and expanding on it to improve and strengthen health care services to patients. According to a review of Jhpiego-initiated family planning services for postpartum women, 92 percent have discussed family planning while in the hospital and 76 percent left the hospital using (or planning to use) the lactational amenorrhea method at the time of discharge.
“One wishes to have a first baby and a second one, but after that planning is necessary,” Marjola Kupa, a new mother, told ACCESS-FP staff. “We do not want more than two children but they may happen. We now have books and materials that will help us not to have regrets later.”
Added Irida Daci, another new mom: “It was very interesting to know that breastfeeding can be a contraceptive method.”
Another important component of the family planning project in Albania was the integration of family planning services with pediatric care. In Albania, new mothers visit their pediatrician as many as 15 times a year. “Integration of family planning services in pediatrics is essential,” said Dr. Arta Mezezi, a pediatrician in Tirana. “We should use this opportunity to advise mothers how to avoid close spaced pregnancies. I provide information and leaflets to mothers in almost every visit and meeting.”
Ramaj says the needs of her patients motivated her to act.
“You see a woman for the second time with a second child and you say, ‘What are you doing here, I mean you just had a delivery?’ and she says, ‘Well, I got pregnant.’ I ask, ‘Do you protect yourself?’ But they lack information,” says Ramaj, who has two daughters.
“Before this training happened, postpartum women would come to this department and leave without any information on health education or family planning,’’ says Ramaj, referring to the USAID-funded and Jhpiego-implemented project. “But now I provide them with information that is meaningful to them.”
In counseling mothers on postpartum family planning methods, Ramaj also discusses breastfeeding techniques and well-baby messages and reinforces them.
“Patients are very happy and they really thank me a lot.”