Improving Access to Family Through PNC and Child Welfare Clinic
Duration: 2023 – 2024
Background
Our program addressed critical gaps in postpartum family planning services across Ghana’s northern regions, where contraceptive uptake rates ranked among the nation’s lowest (17.4% in Northern Region, 19.2% in Savannah Region). Recognizing that postnatal care (PNC) and child welfare clinics (CWCs) represented crucial touchpoints where 90% of mothers interact with the health system, we designed targeted interventions for these settings. The initiative emerged from evidence showing integrated family planning counseling could reduce maternal mortality by 30% when provided during routine postpartum visits.
Strategy
The Maternal Health Initiative partnered with Savana Signatures to implement a dual-track pilot program across six facilities in Northern and Savannah Regions through:
Child Welfare Clinic (CWC) Model:
Developed a three-component counseling system comprising:
- A 10-minute standardized group talk using the “Birth Spacing Group Talk” flipchart during immunization wait times,
- Brief one-to-one counseling during child vaccination using illustrated “Birth Spacing Cards” and
- Streamlined referral system with color-coded cards directing women to on-site family planning units
Postnatal Care (PNC) Model:
Created comprehensive training manuals and job aids for midwives covering:
- Client-centered contraceptive counseling techniques
- Side effect management protocols
- Customized method selection guides for postpartum women
- Integration strategies for routine PNC visits
Both models were supported by:
- Training 47 providers (23 PNC, 24 CWC) through interactive sessions with role-playing simulations
- Developing facility-specific implementation plans accounting for patient flow and staffing and
- Establishing monitoring systems to track counseling quality and referral completion.
Key Findings
While the intervention demonstrated modest knowledge improvements (4/5 metrics increased) and a 12% rise in contraceptive intentions at CWCs, reported modern contraceptive uptake paradoxically declined by 5-13% across sites – a result potentially influenced by survey design flaws yielding baseline figures exceeding regional norms. Implementation quality varied significantly, with PNC sites showing stronger protocol adherence than CWC locations. The program’s ultimate decision against scale-up reflected both operational findings and fundamental reassessment of postpartum family planning’s impact potential given high natural insusceptibility periods.
However, the pilot yielded valuable implementation insights regarding: 1) optimal counseling integration points in routine care, 2) training methodologies for frontline providers, and 3) improved monitoring approaches for future maternal health initiatives in similar contexts. Regional health directorates maintained all capacity building investments, preserving potential for sustained local service quality improvements.