The international postpartum family planning program: eight years of experience

The International Postpartum Program was begun in 1966 in order to demonstrate the feasibility of providing efficient and effective family planning services in the context of the obstetrical care provided by hospitals. The project included 138 institutions in 21 countries. Over an eight-year period, 1.14 million women were recruited, representing 33 acceptors per 100 obstetrical/abortion patients in these hospitals. Relying primarily on modern methods of contraception, the pill, the IUD, and sterilization, the program provided about 124 years of contraceptive protection for each 100 obstetrical/abortion patients, or somewhat more than four years' protection per acceptor. Predischarge insertion of IUDs was found to be safe and effective. In all countries, the program acceptors experienced important changes in fertility over and above the effects of aging. The demonstration showed that basing a program on activities in the obstetrical wards permits a rapid buildup of services, without great cost for construction. Whether using specially trained additional staff to provide family planning education and information or relying on the existing staff, hospitals were able to recruit a substantial proportion of women on the maternity wards as acceptors. Cost per acceptor averaged about US$5.00 during the eight-year period--considerably below the cost per acceptor in the majority of national programs. Such economy arose because acceptance ratios for the International Postpartum Program were higher than ratios for national programs where the target population is more dispersed, and because only direct costs for the services needed to be considered. The idea of uniting family planning information and services with the maternity services of hospitals has been seized upon and replicated outside the International Postpartum Program. The governments of India, Pakistan, Indonesia, Colombia, Thailand, and the Philippines, among others, now operate such systems. Postpartum programs still do not reach substantial segments of the urban population in the developing world, but the expansion of such services is continuing. Also, adaptations of maternity-centered family planning programs are now being tested in rural areas in the world, where most children are born.