The day a woman becomes a mother might not be an obvious moment to think about contraception — but doing so can save lives. There’s ample evidence that unplanned and closely spaced pregnancies put both mother and child at greater risk, increasing the likelihood of preterm birth, low birthweight and maternal complications.
Every day, around 800 women die from pregnancy and childbirth-related complications. And nearly 2.9 million babies die each year before reaching 28 days. The use of family planning services during the first year postpartum reduces the chances of mortality and improves maternal and child health outcomes.
That’s why FHI 360 is ensuring that postpartum family planning services are available and accessible in the countries where we work. We’re helping communities understand why family planning is essential for protecting and improving the lives of women and children. And we’re strengthening interventions through better measurement, to support health facilities and health systems to provide postpartum family planning.
How we’re reaching mothers in Uganda
Working through health facilities
Research suggests significant unmet need for contraception among postpartum women and recent analyses confirm this in Uganda. Unintended and closely spaced pregnancies are common, and maternal mortality is still unacceptable, at 189 deaths/100,000 live births.
Through the Uganda Health Activity (UHA) and Uganda Maternal and Child Health and Nutrition Activity (USAID MCHN), funded by USAID, FHI 360 trains health care providers in public and private sites on postpartum family planning service provision and reporting. We use a whole-site mentorship approach so staff from different service delivery points can offer this care. Every appointment — during antenatal care, delivery, postnatal care and infant immunizations — is an opportunity for family planning counseling and services.
When we started implementing the USAID UHA at the end of 2022, uptake of immediate postpartum family planning (within 48 hours of delivery) was just 2% across the seven regions where we work. Now it’s 4%. We’ve also seen an increase in mothers seeking family planning within the first six weeks postpartum, from about 12% to 21%.
When a mother and her partner are informed about family planning during antenatal care, they are more likely to ask for it after birth. In Kampala — as a result of training health workers through the USAID MCHN Activity — the percentage of women counseled on postpartum family planning during antenatal care increased from 78% in October 2022 to 100% in August 2023. The uptake of postpartum family planning increased, too, from 11% in December 2019 to 64% in March 2024.
To raise awareness, the USAID MCHN Activity placed television sets in waiting areas with messages emphasizing the importance of family planning and demystifying myths and misconceptions. The team also expanded access to family planning services by linking private health facilities to a government-led initiative for increasing access in the private sector.
For Agnes Namagembe, technical advisor at FHI 360, access and demand must go hand in hand. “We need to see that women feel very comfortable walking into a health facility and asking for any method of their choice,” she says. “They need to know the health care workers will serve them without bias and judgment.”
Branching into communities
Social and cultural norms, namely gender dynamics and religious beliefs, can influence a person’s decision to access family planning. That’s why we involve families and communities — siblings, parents, spouses and in-laws, as well as cultural and religious leaders — in our educational and awareness-raising efforts.
“If the community has adequate information and is not influenced by myths about postpartum family planning, then they’ll be better able to support mothers, including girls, who might need this care,” says Dr. Gloria Ndagire, senior technical advisor at FHI 360.
Better measurement for improved postpartum family planning practices
We know that postpartum family planning is effective. “But there has not been enough consistency in how it’s measured, making it difficult to know how many people are actually reached with the care they need,” says Trinity Zan, associate director of research utilization at FHI 360.
To help programs achieve greater impact, FHI 360 — through the Research for Scalable Solutions (R4S) and SMART-HIPs projects — is measuring the scale, reach, quality and cost of the implementation of immediate postpartum family planning in Uganda, Burkina Faso, Nigeria, Mozambique and Nepal.
“Our research examined how we can make better choices about what gets measured so that, no matter the context, we can understand what is being implemented — and therefore, what can be improved,” says Zan.
We’re using the evidence generated through this research, and input from a range of partners, to recommend improved measurement standards for the implementation and scale-up of high impact practices, which show evidence of positive impact on family planning outcomes, including contraceptive uptake.
A key element of better measurement is better documentation, something that both projects in Uganda prioritize while training health care providers.
“We are still losing way too many mothers and children”
Research has shown that access to family planning has the potential to avert maternal mortality by 32% and childhood deaths by 10%.
Expanding access to family planning will require positive changes in the health system — like consistent measurement of how services are implemented — down to the health provider — like skills training and education. And it will take committed health care workers like Dr. Ndagire, whose dedication to expanding access is personal.
“I’m a beneficiary of good maternal health services — I’m one of those people who is here because my mother was able to access good-quality services,” she says.
She is drawn to the opportunity to make a difference. “We are still losing way too many mothers and children. For me, the fulfillment of my work comes from seeing some of the changes — some big, some small — that we are making in these communities.”