Sukh Initiative

Dr Laila Shah

Access & USAID

Vision

Sukh Initiative empowers women to

access contraception by increasing
knowledge, improving quality of
services and expanding the basket of
choices; contributing to the goals of
FP2020

http://theamanfoundation.org/health/
 Sukh Initiative empowers women to access contraception by increasing knowledge,
Vision improving quality of services and expanding the basket of choices, contributing to the
goals of FP2020

15% increase in use of modern Decrease in unplanned and

Impact methods of contraception unintended pregnancies

Outcome Percentage Percentage of Increase in Women have Clients receive Increase in Increase Polices in
increase in women using proportion of access to improved FP/RH calls number of place to
MWRA using each modern newly married information quality of family (MWRAs and young boys support
modern method of (within last 2 yrs) on modern planning, PPFP, men) from and girls scale up of
methods of contraception couples who are methods of PAC services at intervention (12-19 best
contraception using modern family the health sites to ATH years) have practices in
contraceptives planning centers knowledge Sukh
on family Initiative
life
education

Improved Access to FP Services Ensured long-term sustainability

Strategies Increase Demand for FP/RH (by method) and with Improved of program focus
Quality of

Health Care Involving Advocacy

Door to Door
TeleHealth Facilities Youth
Services

CHW Model LHW Model Public Private

http://theamanfoundation.org/health/
Where is Sukh
What is Sukh today
implemented

One million population

from underserved peri-
urban areas of Karachi
November 2013 August 2018

http://theamanfoundation.org/health/
Who are the
implementers

Program Management Unit

Implementing Partners Collaborating Partners

http://theamanfoundation.org/health/
 PPFP Definitions

Postpartum Family Planning: The initiation and

use of FP during the first year after delivery
Postpartum period: Traditionally 6 weeks after
birth
Extended postpartum period: Extend the
postpartum period to include 1st year after birth
to increase programmatic opportunities to reach
families

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Rationale for including postpartum family planning in MNCH
and FP programs

Women are more receptive to contraceptive counseling during the antenatal period and
around time of delivery

Women often ask about a contraceptive method that can be used soon after
delivery. Contraceptive options need to be discussed as an integral part of the
maternity care package

The objective is to reduce the unmet need for family planning by utilizing the missed
opportunity after childbirth and promoting family planning

http://theamanfoundation.org/health/
PPFP methods(Implant and IUCD)
Advantages and Limitations
Advantages: Limitations:
Very effective, reversible, long-term
method Changes in monthly bleeding
pattern
Safe, convenient and no increased risk Requires special training of
perforation or infection providers
Does not affect the quantity or quality
of breast milk
Greater coverage of population

http://theamanfoundation.org/health/
Barriers to PPFP service and method use
Lack of information Social support
Spousal permission/clandestine use
Lack of awareness of health benefits of
spacing Lack of support from MIL
Shiftsin traditions that protected from
pregnancy postpartum abstinence
Access to services
Lack of knowledge about fertility return
Low mobility particularly for low parity women
40 day period after a birth
Mothers busy schedules influences access
Referrals
Misconceptions
Misconceptions about BF as a method
of FP (LAM)
Supportive environment
Misconceptions about FP for BF women
Religious beliefs

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Key Messages for FP

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 A womans risk of pregnancy after childbirth
YOU CAN BECOME PREGNANT EVEN IF YOUR
MENSES HAS NOT RETURNED!!
Delivery

6 months
postpartum

(sooner if
your menses
has returned)
Your risk of
pregnancy increases If you are
as breastfeeding ONLY
decreases and as Breastfeeding
6 weeks
time passes
Postpartum

If you are
PARTIALLY
Breastfeeding
3 weeks
postpartum

If you are
NOT breastfeeding

11
http://theamanfoundation.org/health/
Lactational Amenorrhea Method (LAM): 3 criteria and the
transition
Three criteria for a PP women to
practice LAM

Only breastfeeding
No menstrual bleeding
Infant is 6 months or less

Transition to another method

should occur when ANY 1 of the 3
criteria changes

Draft LAM Client Brochure: Georgetown University/IRH 12

http://theamanfoundation.org/health/
Postpartum contraceptive options

Message: There
are many FP
methods with no
affect on
breastfeeding.

Adapted from the MAQ Exchange: Contraceptive Technology Update 13

http://theamanfoundation.org/health/
Discuss & choose a PPFP method within the 1st month
postpartum
Key barrier:
Fear of discussion about family planning with
husbands, yet husband is key decision-maker

Key Facilitator:
Male support for spacing for economic reasons

Message: Couples, discuss a family planning method before your baby is 1 month old and obtain more
information from your health provider. An understanding between couples early on, can help prevent
unplanned pregnancies.

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Importance of postpartum visits

15
http://theamanfoundation.org/health/
 PROGRAMMATIC FRAMEWORK: PPFP IN AN INTEGRATED CONTEXT

MATERNAL HEALTH HIV NEONATAL & INFANT

FAMILY PLANNING
HEALTH
Birth Preparedness
PM
ANC TC
TT Immunization
ANC-FP messages-
T
Delivery care
Immediate Neonatal care 6-12
Immediate postpartum hrs
Immediate Post Partum Family
Planning 6-12 hrs Later postnatal
0-48 hours 3-6 days 3-6 days
POSTPARTUM
Postpartum FP 6 weeks Immunization EBF 6wks
6 wk visit
P
E
D Immunization EBF 10 wks
Extended postpartum FP
C
6 weeks to 12 months A
Immunization EBF 14 wks
Opportunities? R
E

Infant feeding 6 mo

Immunization-Measles
9 months
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MNH and PPFP Behavior Change Communication Strategy
and Channels of Communication
3 pronged approach:
1. Influence individual level behaviors through household
counseling:
Channel: Counsel mothers, husbands and mothers-in-law during
antenatal and postpartum period
2. Create a supportive environment:
Channel: Community based activities with religious and community
leaders
3. Reinforce with print materials and existing mass media
programs

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Male involvement

Decision-making at the household

level

Creating a supportive environment

through community level advocacy
activities

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Creating a supportive environment for PPFP
through community advocacy
 CHW referrals for FP at the facility

CHW screening & referral system:

LAM screening & referral during HH
visits (NC- 28, month 2-3 and 4-5 visits)

CHWs ask women if they are still

practicing LAM and if they would like to
transition to another method.

If the mother would like to use

another method, CHW provides a referral
slip for a facility convenient to her
home.
Postpartum Family Planning provides

A Better Chance and Choice for

Mothers, infants and childrens health and survival!

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THANK YOU