Post-partum family planning interventions in Burkina Faso
Authors: Georges Guiella
Journal: The Lancet Global Health (2019)

In their Article1Nguyen TT Seuc A Coulibaly A et al.Post-partum family planning in Burkina Faso (Yam Daabo): a two group, multi-intervention, single-blinded, cluster-randomised controlled trial.Lancet Glob Health. 2019; 7: e1109-e1117Google Scholar in The Lancet Global Health, Nguyen Toan Tran and colleagues assess the effect of a post-partum family planning intervention on modern contraceptive use at 12 months postpartum in Burkina Faso. Burkina Faso is one of the sub-Saharan African countries where modern contraceptive prevalence is low2Ahmed S Choi Y Rimon JG et al.Trends in contraceptive prevalence rates in sub-Saharan Africa since the 2012 London Summit on Family Planning: results from repeated cross-sectional surveys.Lancet Glob Health. 2019; 7: e904-e911Summary Full Text Full Text PDF PubMed Scopus (43) Google Scholar and high maternal and child mortality exists. The intervention in the eight health facilities where this study took place consisted of implementing a package of six low-technology interventions aimed at strengthening existing primary health-care services and enhancing demand. These included provider refresher trainings, development of a counselling tool, providing more supportive supervision to health care providers, increasing availability of contraceptive services to 7 days a week, client appointment cards, and invitation letters for women's partners. Using a cluster-randomised control design in which the eight primary health-care centres were randomly allocated to intervention or control clusters in a 1:1 ratio, the authors found that at 12 months post partum, modern contraceptive prevalence was 55% among the 286 women who received the intervention, compared with 29% in the 285 others who received routine care in control clusters (adjusted prevalence ratio 1·79, 95% CI 1·30–2·47). These results highlight three key messages. First, they show couples' awareness that the erosion of traditional practices such as post-partum spousal separation and post-partum abstinence means that such practices are no longer sufficient to prevent unwanted pregnancies and closely-spaced pregnancies during the first 12 months after delivery.3Rossier C Hellen J Traditional birthspacing practices and uptake of family planning during the postpartum period in Ouagadougou: qualitative results.Int Perspect Sex Reprod Health. 2014; 40: 87-94Crossref PubMed Scopus (29) Google Scholar Thus, this time period is an important opportunity to boost prevalence of uptake, especially in rural areas. Second, these results once again show the importance of service quality through adequate training of providers in people's adherence to health care, particularly in reproductive health. They also reinforce the necessity of offering a wide range of contraceptive methods to enable choice and provide adequate counselling and education about side-effects. This is of particular importance in a pronatalist context in which rumours about contraceptive side-effects4Ochako R Mbondo M Aloo S et al.Barriers to modern contraceptive methods uptake among young women in Kenya: a qualitative study.BMC Public Health. 2015; 15: 118Crossref Scopus (143) Google Scholar strongly discourage couples from using them.5Senderowicz L Side-effects and contraceptive uptake in urban Burkina Faso.Contraception. 2015; 92: 364Summary Full Text Full Text PDF Google Scholar Third, involving women's partners though invitation letters (the sixth component of the intervention package) is novel. Although the trial's design does not allow us to distinguish which intervention in the package of services offered had the greatest effect on contraceptive use, this strategy has undoubtedly facilitated male involvement, which is one of the major barriers to contraceptive uptake in Burkina Faso.6MacLachlan E Atuyambe LM Millogo T et al.Continuation of subcutaneous or intramuscular injectable contraception when administered by facility-based and community health workers: findings from a prospective cohort study in Burkina Faso and Uganda.Contraception. 2018; 98: 423-429Summary Full Text Full Text PDF Scopus (8) Google Scholar The modern contraceptive prevalence among women who received the intervention package would probably not have reached 55% without this component aimed at addressing male involvement. However, despite the relevance of these results, there remain unanswered questions that future studies could address. As the authors acknowledge, to definitively confirm the effectiveness of this intervention, continued follow up of the 286 women who received the full intervention package through at least 2 years post partum would have been helpful to assess whether they continue to be more successful in spacing or limiting pregnancies compared to the control group. In addition, if the costs of the package of the six low-technology post-partum family planning interventions were known, this would have allowed an estimation of the cost-effectiveness of the intervention, its programmatic and financial implications, as well as its overall sustainability. Notwithstanding some of the limitations raised by the authors, one of the advantages of this package of interventions is that it was designed to strengthen existing antenatal care and postnatal services in primary health facilities rather than creating a parallel intervention programme. Furthermore, these results show that there might not be a single intervention that can positively influence the use of post-partum family planning. Instead, there might be a combination of low-cost interventions that operate at the health system level as well as individual and societal levels to overcome barriers to post-partum family planning uptake in Burkina Faso. I declare no competing interests. Post-partum family planning in Burkina Faso (Yam Daabo): a two group, multi-intervention, single-blinded, cluster-randomised controlled trialA package of six low-technology interventions, aimed at strengthening existing primary health-care services and enhancing demand for these services, can effectively increase modern contraceptive use for up to a year post partum in rural settings in Burkina Faso and has the potential to be suitable in similar settings in this country and others. Full-Text PDF Open Access