Integrating family planning into postpartum care through modern quality improvement: experience from Afghanistan
| Autor: | Malalah Ahmadzai, Mirwais Rahimzai, Evelyn Kamgang, Youssef Tawfik, Phyllis Annie Clark |
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| Rok vydání: | 2014 |
| Předmět: |
Counseling
Postnatal Care Program evaluation medicine.medical_specialty Quality management Developing country Acquired immunodeficiency syndrome (AIDS) Nursing Pregnancy medicine Humans Family business.industry Postpartum Period Afghanistan Original Articles General Medicine medicine.disease Quality Improvement Contraception Family planning Family Planning Services Family medicine Female business Postpartum period |
| Zdroj: | Global Health, Science and Practice |
| ISSN: | 2169-575X |
| DOI: | 10.9745/ghsp-d-13-00166 |
| Popis: | Modern quality improvement approaches enabled hospital staff to analyze barriers and identify solutions for “how” to integrate family planning into postpartum care. Private spaces for postpartum family planning (PPFP) counseling, along with involving husbands and mothers-in-law in counseling, substantially increased the percentage of women receiving PPFP counseling and their preferred method before discharge. Self-reported pregnancy was also significantly lower up to 18 months post-discharge compared with women receiving routine services. To address low contraceptive use in Afghanistan, we supported 2 large public maternity hospitals and 3 private hospitals in Kabul to use modern quality improvement (QI) methods to integrate family planning into postpartum care. In 2012, QI teams comprising hospital staff applied root cause analysis to identify barriers to integrated postpartum family planning (PPFP) services and to develop solutions for how to integrate services. Changes made to service provision to address identified barriers included creating a private counseling space near the postpartum ward, providing PPFP counseling training and job aids to staff, and involving husbands and mothers-in-law in counseling in person or via mobile phones. After 10 months, the proportion of postpartum women who received family planning counseling before discharge in the 5 hospitals increased from 36% to 55%, and the proportion of women who received family planning counseling with their husbands rose from 18% to 90%. In addition, the proportion of postpartum women who agreed to use family planning and left the hospital with their preferred method increased from 12% to 95%. Follow-up telephone surveys with a random sample of women who had received PPFP services in the 2 public hospitals and a control group of postpartum women who had received routine hospital services found significant differences in the proportion of women with self-reported pregnancies: 3% vs. 15%, respectively, 6 months after discharge; 6% vs. 22% at 12 months; and 14% vs. 35% at 18 months (P < .001). Applying QI methods helped providers recognize and overcome barriers to integration of family planning and postpartum services by testing changes they deemed feasible. |
| Databáze: | OpenAIRE |
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