Knowledge, attitude and practices of skilled birth attendants towards immediate postpartum family planning services

Provision of contraceptive services at the time of delivery is called immediate postpartum family planning (PPFP). Technical advisory group comprising of international experts has identified provision of immediate PPFP as one of the High Impact Practices . It can help in addressing the public health concern of high maternal, newborn and infant mortality. In Pakistan, PPFP uptake is reported only as 22% with 64% unmet need for FP in first year postpartum period leaving majority of women vulnerable to an unwanted pregnancy. The best opportunity for increasing the spacing between births is when a woman is in postpartum period, hence integrating FP services as a core component of maternity services is essential. In adoption of PPFP, Health Service Providers (HSPs) can be one major influencing factor and can strongly affect the clients\u27 behavior in attaining FP services. However, to maximize the role of service providers, it is important to understand the viewpoint of the providers and their concerns. The aim of this study was to evaluate HSPs\u27 knowledge, attitude and practice regarding immediate PPFP. Method: It was a descriptive, cross-sectional study done in ten selected public secondary and tertiary care hospitals in Karachi, Pakistan which have round the clock maternity care facilities. Study participants were accredited skilled birth attendants (doctors and nurse/midwives/LHVs). Interviews were completed on 237 SBAs on a specially designed questionnaire. Analysis of data was done by Statistical Package of Social Sciences (SPSS) versionl9 . Descriptive analysis for demographic information and practices of SBAs was done in the form of frequencies and percentages. Results: Of the total sample, 59% were Doctors and 41% were Mid-level providers. 78% of the SBAs had received FP Training whereas nearly quarter of SBAs (22%) were not trained for these services. Appropriate knowledge and attitude of participants was assessed by assigning scores. According to our cutoff value almost equal percentage of Doctors and Mid-level providers were knowledgeable about PPFP. The analysis also shows that 56% of Doctors and 35% of Mid-level providers were supportive towards immediate PPFP. Majority of SBAs considered provision of PPFP services their responsibility and expressed willingness to get trained for these services. However, one third of the Doctors and nearly half of the Mid-level providers mentioned providing these services as time consuming. Nearly 30% of these SBAs have the misconception that religion prohibits FP practices. Data revealed that 72% SBAs are presently providing these services and 28% SBAs are not offering immediate PPFP to their clients. Out of the SBAs who were not providing these services the main reasons were time constraint and fear of medical complications. Barriers to provision of immediate PPFP were lack of knowledge and skills. It is interesting to note that 30% of Midlevel providers were not permitted by Head of Departments to provide these services thus an opportunity of task sharing is missed. Conclusion: The findings of the study help to conclude that Government and other stakeholders need to work on knowledge enhancement and behavior change of all types of HSPs towards family planning in general and PPFP in particular. This will increase contraceptive uptake which is a proven strategy for addressing high maternal and neonatal mortality issues in Pakistan. Key Words: Immediate postpartum family planning, Health service providers, knowledge, attitude, practices