SUMMARY
This report presents the results of a situation analysis of the provision and use of contraception in Postpartum, Postabortion and Prevention of Mother-to-Child transmission of HIV (PMTCT) Services in Haiti. The Centre d’Evaluation et de Recherche Apliqueé (Center for Evaluation and Applied Research or CERA), a Haitian health research and evaluation consulting firm, was responsible for the data collection, cleaning, and entry processes. FRONTIERS provided CERA with technical assistance throughout these phases and analyzed the data. Data were collected between November and December 2006 from a sample of 41 public, private and mixed health establishments in five of Haiti’s 10 departments, including the three most heavily populated departments. Data were collected through:
1. Content analysis of the National Family Planning and Maternal Health Norms
2. Inventories of equipment, supplies, and service statistics in family planning, antenatal care, delivery care, maternal and child care in the extended postpartum, and PMTCT services
3. Structured interviews with health providers
4. Exit interviews with women in antenatal, delivery, and postpartum care and women in the six-month postpartum period visiting a health outlet for any reason; and with women living with HIV and receiving care in an integral care unit (ICU)
5. Observation of client-provider interactions in antenatal, delivery and postabortion care by non-participants
6. Focus groups with women who had delivered recently, women who had delivered in the last six months and women who did not use reproductive health services.
There is a substantial unmet need for family planning services among postpartum women and many missed opportunities to provide these services during the pregnancy-extended postpartum period continuum. Practically all of the women interviewed wanted to space their next pregnancy for at least two years and 80 percent of those interviewed before discharge following a hospital delivery said that they would like to start using contraception in the following six months (with 54% wanting to start immediately). However, only 26 percent received a method before discharge. Only 17 percent of the women interviewed in the first six months postpartum had started using contraception, which left an estimated 39 percent at risk of an unplanned pregnancy. This was the result of a combination of factors: a) Many women did not deliver in a facility and did not have the opportunity to receive family planning services immediately after childbirth; b) only a fraction of the women who delivered in a facility received family planning counseling and services before discharge; and c) post-delivery contacts with health providers (e.g. for postpartum, vaccination and well-baby care) were not used to offer family planning information or contraceptive methods. The National Service Delivery Norms and Guidelines emphasize the importance of family planning counseling during antenatal, delivery, postpartum and postabortion care. However, the guidelines do not recommend offering contraceptives during postpartum contacts with health providers. Most staff in public and private facilities did not know about the National Service Delivery Guidelines and at least half of the outpatient and inpatient services visited did not have any internal norms or protocols for postpartum and postabortion family planning.