Postpartum Family Planning Services in the Philippines: An Assessment of Current Service Provision and Future Program Requirements by Trinidad S. Osteria and Andrew Kantner. East-West Center Working Papers, Population and Health Series, No. 104. October 1998. 60 pp.

Abstract

The 1998 Philippine Survey of Postpartum Family Planning Services documents the range and quality of family planning services offered to new mothers in the Philippines. The survey assesses the nature and completeness of information supplied by service providers to mothers concerning the initiation and use of individual contraceptive methods. It also reports on postpartum family planning practice, as reported by mothers, in order to determine compliance with protocols of use. The study is divided into two principal components: (1) interviews with 338 providers regarding family planning postpartum care; and (2) interviews with 3,452 mothers who gave birth between January 1994 and December 1997 and who accepted a family planning method within six months of delivery. Information was obtained from 86 clinics in 28 provinces across the Philippines.

Results indicate that the percentage of mothers accepting family planning during the six-month period following delivery is quite low (only 6.7 percent between January 1996 and July 1997 in the clinics covered in this study). The main methods accepted by postpartum clients are IUDs, DMPA, and oral pills.

The study found that the level of provider and client knowledge pertaining to postpartum family planning services is often inadequate. For example, many providers believe erroneously that combination (estrogen-progesterone) pills are safe for breastfeeding women within six months following delivery. Many providers are also unclear about proper compliance in the use of LAM (lactational amenorrhea method) as a method of pregnancy limitation. Interviews with clients suggest that pills (principally estrogen-progesterone combinations) and DMPA may sometimes be initiated too soon following delivery. Client misconceptions regarding LAM include the belief that women can use the method if they are not fully breastfeeding, if their infants are more than six months of age, and after their menses have resumed. Slightly more than one-quarter of LAM users have experienced return of menses less than six months after childbirth but maintain that LAM offers effective contraceptive protection for six months or longer. Clearly, there is considerable potential for unwanted pregnancies.

While clients reported few provider restrictions, medical procedures were not usually followed or explained to clients. Likewise, test results were not clearly reported nor used in selection of a method. Information given to clients was rather minimal, particularly in terms of mode of use. While the primary health care system is supposed to provide a constellation of services, knowledge of their availability is limited. The lack of congruence between provider and client responses on the provision of most service components is noteworthy. The study provides recommendations for (1) more actively promoting postpartum services as essential elements of maternal and child health care in the Philippines; (2) clarifying and disseminating guidelines for the provision of postpartum family planning services to providers and clients; and (3) enhancing training in postpartum family planning care.