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Celebrate Solutions: How Do We Encourage Healthy Birth Spacing?

In June’s ‘Celebrate Solutions’ columns, Women Deliver is highlighting Jacaranda Health’s efforts to change the way family planning decision-making happens in the postpartum period among low-income women in Kenya.  As a maternity health care organization, Jacaranda Health works to make pregnancy and childbirth safer for women and newborns by building a new model of maternity care in East Africa; one that is respectful, high-quality and patient-centered.

By: Claire Watt Rothschild, Jacaranda Health

Nearly half of women in Kenya who are new family planning users stop within the first year of use. It’s called “contraceptive (or family planning) discontinuation” and the high numbers of women in Kenya who stop using contraception early is of major concern. Family planning discontinuation has been called a “leaky bucket,” and high rates are undermining gains made in the number of women who start taking contraception (called “uptake”). Last week, this blog series highlighted how Jacaranda Health is encouraging family planning among postpartum women to encourage healthy spacing of delivery and pregnancy. While focusing on uptake is important, it is only part of the story. Healthy birth spacing requires women not only to decide to start family planning before the return to fertility, but also to continue using family planning – consistently and correctly – for nearly two years or longer.

Why do women discontinue using their contraception early? Discontinuation is linked to the type of contraceptive method, with the highest rates found for those that require more frequent efforts on the user’s part, such as condoms and oral contraceptive pills. Not surprisingly, discontinuation is lowest for methods that don’t require frequent action: hormonal implants and intrauterine contraceptive devices (IUCD), for example, can be used for up to five years and twelve years, respectively, and (apart from several check-ups to ensure correct placement) do not require anything further from the woman to use correctly.

However, reversible, long-term methods are used by just 16% of women who are currently using family planning in Nairobi. Why?

One barrier to using a long-term method may be lack of information: 60% of current contraceptive users in Kenya report that they were not provided any information or counseling on alternative methods.2 At Jacaranda, all providers are trained to provide patient-centered family planning counseling, which includes discussion of alternative methods and advantages and disadvantages of each. 

A second barrier to more women choosing long-term methods of contraception may be the fear of side effects – and the costs associated with follow-up care. Jacaranda has addressed this by making all follow-up care free for family planning clients who obtain a method from them.

Jacaranda’s efforts to help women access and understand the benefits and drawbacks to long-term contraceptive methods have successfully resulted in more women choosing these methods, as compared to the Kenyan average. 60% of clients who seek family planning services at Jacaranda now decide to use a hormonal implant or an intrauterine contraceptive device (IUCD).

Another key driver of early contraceptive discontinuation is the poor quality of family planning counseling and care that women receive. In Kenya, the quality of side effect counseling is inconsistent and, often, poor: 43% of women who currently use modern contraceptive methods in Kenya report that they did not receive information about side effects or problems prior to obtaining their current method, and half reported that they were not given any information about what to do if they experienced side effects.

Jacaranda Health is piloting an exciting SMS-based m-Health platform to provide ongoing information, counseling, and support to women who are new family planning users. This innovation is aimed at providing educational information and psychosocial support to women who are new contraceptive users. The platform has been designed to be patient-centered – SMS (texts) are tailored to the type of contraception the woman is using and the dates of her visits and include a free call-back option for patients to receive a phone counseling session with a nurse.

So far, the results have been positive. Women who received the SMS texts were more likely to report receiving higher quality care across a range of situations. For example, women receiving the SMS texts were 60% more likely to report having been asked by Jacaranda if they had any questions about family planning, relative to the comparison group. Clients who received the texts were also more likely to report having received all of the key FP counseling messages and were less likely to report having unanswered concerns about family planning.

Women in Kenya deserve access to the care, information, and resources they need for healthy birth spacing. Jacaranda Health is working to plug the “leaky bucket” of discontinuation by addressing the specific barriers to the continued use of contraception—both the type of contraception women use, as well as the quality of family planning care they receive -- until women are ready to return to fertility.

Learn more about our innovative model for delivering low-cost, high-quality maternal and newborn health care at jacarandahealth.org!

To read the rest of the Celebrate Solutions series on Jarcaranda Health please click here.

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