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Repositioning family planning in the reduction of maternal mortality

MBABANE, Swaziland – In August 2016, Swaziland officially launched a strategic and sustainable training intervention, aimed at repositioning family planning (FP) as one of the core strategies for the prevention of and reduction of maternal mortality in the country.

The six week family planning course, was launched by the Ministry of Health in partnership with the Southern Africa Nazarene University (SANU) and UNFPA, with financial support from the UK Department for International Development (DFID), under the Prevention of Maternal Deaths in East and Southern Africa (PreMDESA) project. The PreMDESA project is a two-year project whose main objectives are to increase the availability of robust evidence and proven innovations relating to SRH; improve the awareness of, access to and uptake of family planning and sexual and reproductive health services across 10 countries in the East and Southern Africa (ESA), with a focus on women and adolescent girls.

A brainchild of the Ministry of Health, SANU and UNFPA, the comprehensive competency based FP Certificate Course offers five thematic modules, namely: 1/FP services and health systems strengthening 2/Integrated FP services for diverse groups 3/Adolescent sexual and reproductive health and rights and FP  4/ Client health assessment & FP and 5/ Practicum/clinical attachment. Delivered in six weeks, the FP Certificate Course significantly expands the scope of the FP module currently offered by SANU to trainee nurses. It comprises of both theory and practice, with two weeks intensive theory and four weeks practical application at one of five (5) high volume and quality practice sites identified countrywide, namely King Sobhuza II Clinic, Mbabane FLAS Clinic, Manzini FLAS Clinic, Raleigh FItkin Memorial Hospital and Mbabane Public Health Unit.

The FP course is open to nurses and nurse midwives keen on strengthening their knowledge and practice on family planning and sexual and reproductive health and rights, particularly adolescent and youth friendly sexual and reproductive health service providers. Whilst the course comprehensively covers the provision of all modern family planning methods, strengthening the capacity for the provision of long-acting reversible contraceptive (LARC) is a priority focus during the practical phase, which recorded a high uptake, with a total of 247 of these long term methods - (53) Jadelle and (162) Implanon NXT insertion and (32) IUCDs) during the 4 days of practicum that during the training.  

By the end of the year two trainings had been implemented with a total of 154 nurse midwives participants, and practicals are ongoing at the identified practice sites. In early 2017, all participants will be convened for a feedback session and thereafter officially attain their certificates. With an additional year of research on a pertinent area in family planning, participants have the opportunity to upgrade their FP certificate course to an accredited post graduate qualification.

Participants interviewed appreciated the strong mentorship component that is part and parcel of the FP course, noting that the on-hands supervision and mentoring they received from a core team of trainers from the Ministry of Health and SANU significantly complemented the theory phase. They also highlighted how the course has helped them to fully appreciate the centrality of family planning within the whole sexual and reproductive health and rights spectrum and why it was critical that FP be integrated at all levels of health care provision.

Most of the participants were both excited and astounded by the Marie Stopes Impact (MSI) calculator, a pre-programmed calculator used to estimate how different FP methods are contributing to, for example, the number of maternal deaths averted, unwanted pregnancies prevented, unsafe abortions averted, etc. Trainees were highly motivated by seeing the difference they were making in the lives of their clients expressed in numeric value. For example, being able to estimate that that the number of long term methods offered to clients during the practical trainings averted 8 maternal deaths in the country, left them with a sense of accomplishment.

Repositioning FP through the launch held on 18th August this year has also improved the prominence of FP services as reported by one of the service providers from the Mbabane Public Health Unit.   According to this midwife ever since the launch of FP “Choices Not Chance” Campaign through a breakfast meeting, followed by an expo of FP planning methods at the Mbabane City Mall, showing  the different FP methods provided in health facilities, the  numbers of clients seeking  FP services has increased immensely.  As such, in 2017, similar FP expos will be held around other busy malls and shopping areas in the country.