The postpartum approach to family planning

Thailand has had a postpartum program since 1966 in 4 large Bangkok hospitals and since 1969 in an additional 11 rural hospitals. The results have been dramatically successful, and a total of 99,434 women have accepted family planning services within 3 months of delivery or abortion, the majority accepting an intrauterine contraceptive device (IUD) or female sterilization prior to discharge from the hospital, usually on Days 2 to 4 post partum. There were more than 48,000 immediately postpartum acceptors of an IUD, which is thought to be the largest series of such cases reported in the literature. One hospital had over 66,000 IUD acceptors (direct and indirect) between 1965 and 1971 and continues to average more than 700 total new acceptors per month. Two rural Maternal and Child Health Centers have had over 70 per cent of obstetric patients to accept family planning services, the vast majority choosing either an IUD inserted prior to the discharge from the hospital or a female tubal ligation. The successes are primarily due to major efforts placed on motivation during the antenatal and postpartum periods. Based on the success of this program, it is recommended that the term “postpartum program” be abandoned in favor of the postpartum “concept,” in which family planning becomes a routine part of postpartum care, offered in all institutions providing maternity services. The fact that the majority of rural women in many parts of the world are delivered at home, supervised only by traditional personnel or relatives, means that the activities must be modified to meet this situation, which will have different requirements and needs from a hospital-based program.