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Improving Access to Family Through PNC and Child Welfare Clinic

Year of Implementation: 2023

Background

Access to postnatal care (PNC) and child welfare clinics (CWCs) presents a critical opportunity to reach postpartum women with essential family planning information and services. In Ghana’s northern regions, contraceptive uptake remains among the lowest nationally, with rates of 17.4 percent in the Northern Region and 19.2 percent in the Savannah Region. Yet, evidence shows that over 90 percent of mothers engage with the health system through PNC and CWC services, making these platforms strategic entry points for integrated family planning interventions.

This programme was designed to address persistent gaps in postpartum family planning by embedding counselling and referral services within routine maternal and child health visits. Emerging evidence indicated that integrating family planning counselling into postpartum care could reduce maternal mortality by up to 30 percent, reinforcing the need for targeted, context-specific interventions within these service delivery points.

Strategy​

The Maternal Health Initiative, in partnership with Savana Signatures, implemented a dual-track pilot programme across six health facilities in the Northern and Savannah Regions, focusing on both Child Welfare Clinics and Postnatal Care services:

Child Welfare Clinic (CWC) Model:
A three-component counselling approach was developed and implemented, including:

  • 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
  • A streamlined referral system with color-coded cards directing women to on-site family planning units

Postnatal Care (PNC) Model:

Comprehensive training manuals and job aids were developed for midwives, covering:

  • Client-centered contraceptive counseling techniques
  • Side effect management protocols
  • Postpartum-appropriate contraceptive method selection, and
  • Practical strategies for integrating counselling into 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.
  • Establishing monitoring systems to track counseling quality and referral completion.

Key Highlights

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.