Batangas City, Philippines—”If I didn’t know that I could use family planning right after giving birth, I would have probably been constantly worried about getting pregnant again,”says Gladys Bulawan, a 20-year-old, first time mother who lives with her sister in this capital city in the southwestern part of Luzon.
“Seeing [my sister] barely managing with four kids I could see how hard it is to raise a child. Even when I was pregnant, my husband and I decided that it’s best to plan our family early and that is why I decided to have an IUD immediately after giving birth.”
By considering family planning, Bulawan and her husband have made a critical, healthy choice for their family. In the Philippines—where maternal mortality increased from 162 to 221 per 100,000 live births between 2006 and 2011—a major contributor to the high number of maternal deaths was lack of access to effective family planning services.
Compared to its neighbors in Southeast Asia, the country faces unique challenges with respect to policy and political support for family planning and reproductive health services. One of the gaps identified is the lack of availability of contraceptive choices, especially long-acting or permanent methods available immediately postpartum. In the postpartum period, use of immediate postpartum IUD (PPIUD) and tubal ligation are indeed viable options for women who want to space or limit child bearing, as they can be made available while women are still in the hospital or birthing facility.
To address this, the U.S. Agency for International Development’s global Maternal and Child Health Integrated Program (MCHIP) is working with the Philippines Department of Health to create an enabling policy environment for postpartum family planning (PPFP) and PPIUD, and to establish resources and capacity for service delivery and training for PPFP/PPIUD adoption and scale-up. The program, supported by Jhpiego, works in 10 geographical areas to develop Centers of Excellence as model service delivery sites that offer PPFP services, including PPIUD, and act as technical/training resources for the regional Department of Health offices. These sites were selected in collaboration with the health department and are strategically placed to provide coverage to the three island groups. All sites have high volume delivery hospitals with interest, capacity and commitment to integrating IUD with postpartum services.
As a result, by August 2013:
- A total of 3,116 PPIUD insertions were done by MCHIP-trained providers, helping to fill the gap in unmet need for FP by increasing access to postpartum women;
- 88,268 women receiving essential maternal, newborn and child health services with integrated FP services; and
- 82 service providers were trained in PPFP/PPIUD.
Batangas Medical Center has been identified as one of the most promising Centers of Excellence candidates, and MCHIP has worked for the past two years to help staff integrate PPFP services into their existing essential maternal and child health program. The facility’s success is attributed to the intense commitment of the medical center’s providers and leadership to adopt and scale up PPFP/PPIUD services in their facility. Key to the demand for PPFP services at Batangas Medical Center are the availability of round-the-clock services, effective counseling from pregnancy through the postpartum period, and positive “word of mouth” stories spread by mothers in the community.
Bulawan learned about the PPIUD at a weekly class for mothers conducted at her local health center. She discussed the family planning option with her husband, who agreed with the decision to use a PPIUD.
“Now, I am assured that I can give my baby all the attention, care and support that he will need in the first five years of his life,” she says. “After this, I plan to get work so that I can help out with the family’s finances. I was told by my doctor that I could have the IUD removed anytime I feel like I’m ready to have another child.”