Only 14 percent of reproductive-age women and girls in Cameroon use a modern contraceptive method. The National Health Development Plan cites limited access to contraception among youth and adolescents as a cause of low modern contraceptive use and high rates of unsafe abortion. Young postpartum mothers in resource-poor settings such as Cameroon are particularly underserved by family planning programs. Their demand for contraception is suppressed by their limited decision-making power, young age, and other inequalities. At the same time, family planning services tend to be geared toward older high-parity women. The equation for increasing contraceptive uptake—broadly accessible services delivered by high-performing health workers that are backed by supportive policies and laws—has therefore not yet been widely applied for the benefit of young mothers.
At the same time, research has demonstrated that more than 90 percent of women who have given birth express a desire, during the first year postpartum, to delay the next pregnancy by at least two years or avoid future pregnancies all together. Offering a woman family planning services during that critical year allows her the chance to properly nourish her breastfeeding infant, as well as physically and nutritionally recover from her pregnancy. Postpartum family planning (PPFP) helps to prevent unintended, closely spaced pregnancies, and when delivered as part of a comprehensive maternal, newborn and child health approach, has the potential to reach a large number of women with life-saving information and services. Preventing unintended pregnancies, in turn, protects women from pregnancy-related risks — an important strategy for reducing maternal mortality in Cameroon, which as of 2011 was 782 deaths per 100,000 live births.
Postpartum Family Planning
E2A, through its core partner Management Sciences for Health, implemented a comprehensive PPFP program at the four largest hospitals in Cameroon’s capital city of Yaoundé and 10 rural health facilities in Bafia and Mbalmayo districts. The program offered a full range of contraceptive options to women, including young mothers. This program, which responded to a request from the Ministry of Public Health’s (MOPH) Family Health Division, was implemented in partnership with the MOPH, and offered voluntary family planning counseling and provision of a range of contraceptive methods with focus on immediate and extended postpartum care.
At each health facility, family planning counseling was offered in four places:
- antenatal care
- delivery room
- immunization room
- family planning room
Methods are now available in both the delivery room and in the family planning room.
The MOPH and E2A conducted regular supervision visits to each site to evaluate the capacity of each hospital to offer the services as compared to the minimum standard of care and the quality of the services offered. As part of this process, post-supervision feedback meetings were held with the MOPH, providers, and hospital management in order to resolve outstanding issues.
E2A and the MOPH also offered capacity building in family planning counseling and provision, with particular focus on the provision of long-acting reversible contraceptives during the immediate postpartum period. E2A also held additional training on data collection and reporting, including strengthening the quality of data around PPFP service provision, and procured separate registers for reporting at each hospital. In June 2015, 20 personnel from the 4 hospitals attended a meeting on the harmonization of data, where facilitators from the Regional Delegation of Public Health made a presentation on the importance of high quality data in the Central Region. Participants reviewed all indicators and registers, identified challenges to data collection and reporting, and developed action plans to address those challenges.
E2A addressed both the supply of and demand for family planning among women and young people in communities served by project maternity hospitals and health facilities. On the supply side, E2A worked with the MOPH to ensure that supportive elements are in place such as training guidelines, job aids for facility and community workers, and management information systems, and identified and oriented teams to respond to the integrated package of services.
On the demand side, E2A/MSH program trained community mobilizers who provided information about family planning and referred to the four urban hospitals and 10 rural health facilities for services. The community mobilization work was conducted in partnership with the local organization RENATA (Réseau National des Associations des Tantines), an existing network of youth associations.
Across the14 facilities, from October 2015 to September 2016, 10,497 women received family planning counseling, including 936 adolescents 15-19 years and 2,655 youth 20-24 years. During this same time period, 3,431 women accepted a family planning method, including 236 adolescents 15-19 years and 794 young women 20-24 years. Nearly half (1,658) of these women accepted the implant, Jadelle, or an IUD.