Objective: This is a formative study aiming to identify the main barriers to the provision and uptake of quality postpartum family planning (PPFP) services at the supply, access, demand and policy levels in Burkina Faso. Design and Methods: A combination of three methods was used: a review of relevant literature, policy and clinical guidelines; observations of client-provider interactions in government-run primary health care centres in and around the city of Bobo-Dioulasso; and semi-structured interviews with stakeholders and key informants, including service providers and users. Results: At the supply level, this study reveals that there are substantial shortfalls in the availability of quality postpartum family planning (PPFP). Individual counselling and the quality of information provided are often inadequate and occasions to advise women on family planning are wasted, resulting in low uptake of contraception during routine postnatal care. Providers appear to have an ambivalent and largely resigned attitude towards the possibility of enabling women to make informed choices, and towards the potential involvement of men. Services offer a limited range of methods due to a variety of factors including the lack of competent staff, stock issues, and provider biases. Furthermore, legal barriers are in place which prevent the majority of maternity staff from providing long-acting reversible contraception (LARC). The accessibility of services is limited by geographical and cost barriers. Cultural traditions and practices and high desired family size place limits on the demand for modern contraception, which is not well understood or acceptable to many people. Notable policy gaps exist in relation to user fees and to authorising maternity staff to provide LARC, and some national clinical guidelines are in need of improvement. However, most of the difficulties observed in the provision of PPFP services are in fact due to the failure to translate largely sound policies and guidelines into practice. Conclusions: This study contributes to identifying priority areas and makes recommendations for improvement in order to respond to unmet need for family planning in the postpartum. Furthermore, it suggests that there may be a margin for the expansion of demand, and that improving quality of care could play a role in this.
Daniele, M. Postpartum family planning in Burkina Faso. (2014) 36 pp. [STEP-UP Research Report]