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      Participatory action research to identify a package of interventions to promote postpartum family planning in Burkina Faso and the Democratic Republic of Congo


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          The YAM DAABO study (“your choice” in Mooré) takes place in Burkina Faso and the Democratic Republic of Congo. It has the objective to identify a package of postpartum family planning (PPFP) interventions to strengthen primary healthcare services and determine its effectiveness on contraceptive uptake during the first year postpartum. This article presents the process of identifying the PPFP interventions and its detailed contents.


          Based on participatory action research principles, we adopted an inclusive process with two complementary approaches: a bottom-up formative approach and a circular reflective approach, both of which involved a wide range of stakeholders. For the bottom-up component, we worked in each country in three formative sites and used qualitative methods to identify barriers and catalysts to PPFP uptake. The results informed the package design which occurred during the circular reflective approach – a research workshop gathering service providers, members of both country research teams, and the WHO coordination team.


          As barriers and catalysts were found to be similar in both countries and with the view to scaling up our strategy to other comparable settings, we identified a common package of six low-cost, low-technology, and easily-scalable interventions that addressed the main service delivery obstacles related to PPFP: (1) refresher training of service providers, (2) regularly scheduled and strengthened supportive supervision of service providers, (3) enhanced availability of services 7 days a week, (4) a counseling tool, (5) appointment cards for women, and (6) invitation letters for partners.


          Our research strategy assumes that postpartum contraceptive uptake can be increased by supporting providers, enhancing the availability of services, and engaging women and their partners. The package does not promote any modern contraceptive method over another but prioritizes the importance of women’s right to information and choice regarding postpartum fertility options. The effectiveness of the package will be studied in the experimental phase. If found to be effective, this intervention package may be relevant to and scalable in other parts of Burkina Faso and the DRC, and possibly other Sub-Saharan countries.

          Trial registration

          Retrospectively registered in the Pan African Clinical Trials Registry ( PACTR201609001784334, 27 September 2016).

          Electronic supplementary material

          The online version of this article (10.1186/s12905-018-0573-5) contains supplementary material, which is available to authorized users.

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          Most cited references23

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          Family planning: the unfinished agenda.

          Promotion of family planning in countries with high birth rates has the potential to reduce poverty and hunger and avert 32% of all maternal deaths and nearly 10% of childhood deaths. It would also contribute substantially to women's empowerment, achievement of universal primary schooling, and long-term environmental sustainability. In the past 40 years, family-planning programmes have played a major part in raising the prevalence of contraceptive practice from less than 10% to 60% and reducing fertility in developing countries from six to about three births per woman. However, in half the 75 larger low-income and lower-middle income countries (mainly in Africa), contraceptive practice remains low and fertility, population growth, and unmet need for family planning are high. The cross-cutting contribution to the achievement of the Millennium Development Goals makes greater investment in family planning in these countries compelling. Despite the size of this unfinished agenda, international funding and promotion of family planning has waned in the past decade. A revitalisation of the agenda is urgently needed. Historically, the USA has taken the lead but other governments or agencies are now needed as champions. Based on the sizeable experience of past decades, the key features of effective programmes are clearly established. Most governments of poor countries already have appropriate population and family-planning policies but are receiving too little international encouragement and funding to implement them with vigour. What is currently missing is political willingness to incorporate family planning into the development arena.
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            Effects of birth spacing on maternal, perinatal, infant, and child health: a systematic review of causal mechanisms.

            This systematic review of 58 observational studies identified hypothetical causal mechanisms explaining the effects of short and long intervals between pregnancies on maternal, perinatal, infant, and child health, and critically examined the scientific evidence for each causal mechanism hypothesized. The following hypothetical causal mechanisms for explaining the association between short intervals and adverse outcomes were identified: maternal nutritional depletion, folate depletion, cervical insufficiency, vertical transmission of infections, suboptimal lactation related to breastfeeding-pregnancy overlap, sibling competition, transmission of infectious diseases among siblings, incomplete healing of uterine scar from previous cesarean delivery, and abnormal remodeling of endometrial blood vessels. Women's physiological regression is the only hypothetical causal mechanism that has been proposed to explain the association between long intervals and adverse outcomes. We found growing evidence supporting most of these hypotheses.
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              Effects of birth spacing on maternal health: a systematic review.

              The objective of the study was to explore the association between birth spacing and risk of adverse maternal outcomes. The study was a systematic review of observational studies that examined the relationship between interpregnancy or birth intervals and adverse maternal outcomes. Twenty-two studies met the inclusion criteria. Overall, long interpregnancy intervals, possibly longer than 5 years, are independently associated with an increased risk of preeclampsia. There is emerging evidence that women with long interpregnancy intervals are at increased risk for labor dystocia and that short intervals are associated with increased risks of uterine rupture in women attempting a vaginal birth after previous cesarean delivery and uteroplacental bleeding disorders (placental abruption and placenta previa). Less clear is the association between short intervals and other adverse outcomes such as maternal death and anemia. Long interpregnancy intervals are independently associated with an increased risk of preeclampsia. Both short and long interpregnancy intervals seem to be related to other adverse maternal outcomes, but more research is needed.

                Author and article information

                BMC Womens Health
                BMC Womens Health
                BMC Women's Health
                BioMed Central (London )
                5 July 2018
                5 July 2018
                : 18
                : 122
                [1 ]ISNI 0000000121633745, GRID grid.3575.4, Department of Reproductive Health Research, , World Health Organization, ; Avenue Appia 20, 1211 Genève 27, Switzerland
                [2 ]ISNI 0000 0001 2322 4988, GRID grid.8591.5, Institute of Demography and Socioeconomics (IDESO), , University of Geneva, ; Boulevard du Pont d’Arve 40, 1211 Geneva, Switzerland
                [3 ]ISNI 0000 0004 1936 7611, GRID grid.117476.2, Australian Centre for Public and Population Health Research, , Faculty of Health, University of Technology, ; PO Box 123, Sydney, NSW 2007 Australia
                [4 ]ISNI 0000 0004 0564 0509, GRID grid.457337.1, Institut de Recherche en Sciences de la Santé, ; 03 B.P. 7192, Ouagadougou 03, Burkina Faso
                [5 ]Institut Africain de la Santé Publique, 12 B.P. 199, Ouagadougou, Burkina Faso
                [6 ]ISNI 0000 0000 9927 0991, GRID grid.9783.5, School of Public Health, , University of Kinshasa, ; Kinshasa, Democratic Republic of the Congo
                [7 ]World Health Organization Country Office in Burkina Faso, 158 Av. de l’Indépendance, 03, Ouagadougou 03, BP 7019 Burkina Faso
                [8 ]World Health Organization Country Office in the Democratic Republic of Congo (DRC), Avenue des Cliniques N°42, BP 1899 Kinshasa I, Democratic Republic of the Congo
                [9 ]Centre Médical de Bokin, District sanitaire de Yako, Région du Nord, Burkina Faso
                [10 ]Centre Mère et Enfant (CME) de Bumbu, avenue Mafuta 48/49, Commune de Bumbu, Province de Kinshasa Democratic Republic of the Congo
                Author information
                © The Author(s). 2018

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                : 29 January 2017
                : 21 May 2018
                Funded by: Government of France, in the context of the Muskoka Initiative on Maternal and Child Health
                Research Article
                Custom metadata
                © The Author(s) 2018

                Obstetrics & Gynecology
                postpartum family planning,pregnancy,antenatal care,postnatal care,public health intervention package,health service strengthening,contraceptive uptake


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