Photo Credit: Galina Stolarsky   Trained by ACCESS-FP, midwives in maternity hospitals in Tirana, Korca, and Shkodra now provide counseling on postpartum contraception for new mothers to help reduce the risk of an unplanned pregnancy.

Counseling Provides New Mothers with More Choices

With a baby just over a year old in her arms and visibly pregnant, Elina waits in one of Tirana’s busy health clinics with a dozen other women to see her gynecologist.  Just 23 years old, the expectation of her second child produces mixed emotions.

“We did not plan this baby,” said Elina.  “My husband and I just had our son a year ago and we really wanted to wait a couple years before we had another child. I thought that I wouldn’t get pregnant until after I stopped breastfeeding, but I became pregnant five months after the birth of my first child.” 

In Albania, according to the 2004 Reproductive Health Survey, half of women who have one child would like to delay the next birth for two years or longer, and approximately two-thirds of married women do not want more children. The international medical community also recommends healthy spacing of pregnancies of at least two years between the birth of the child and the next pregnancy, to benefit the mother and the baby. But less than 10% of women in Albanian use modern contraception, which became legal only in 1992 after years of the pro-natalist, communist regime. 

Although now legal, modern methods of contraception are slow to make their way into the lives of everyday Albanians.  This is due to several factors including a lack of evidence-based information, the absence of national evidence-based clinical standards, and widespread misconceptions about susceptibility to pregnancy and the risks of contraceptives. One of the most vulnerable groups is postpartum women, because women and providers alike traditionally (and wrongly) believe that breastfeeding alone protects from pregnancy and that fertility returns only with the resumption of a woman’s menstrual cycle. 

But even for women who wanted to know more about modern methods and how to protect themselves from an unplanned pregnancy, until recently there was little information available for them.

In a 2008 assessment conducted by USAID’s ACCESS-FP project in a Tirana maternity hospital, 94% of postpartum women reported being interested in family planning information, but only 4% received it. When contacted 6 months after delivery, only 15% of them were using condoms, but 77% were using a traditional method (withdrawal) and the rest of women were not using any method, thus putting themselves at risk of an unplanned pregnancy.

All that is changing.  Through ACCESS-FP, a program implemented by Jhpiego (an affiliate of Johns Hopkins University), health care providers and mothers are becoming increasingly aware of the ways to prevent an unplanned pregnancy.

Albanian women now receive information on family planning while they are in the maternity hospital during the first days after delivery. Nurses and midwives, trained by the ACCESS-FP project, use every opportunity to counsel new mothers on healthy spacing of pregnancies, including the effective use of the lactation amenorrhea method (LAM), a very reliable contraceptive method based on breastfeeding, and what contraceptive methods are available to postpartum women. This counseling is now being done routinely, as part of their daily responsibilities of staff, along with teaching mothers how to breastfeed and take care of the baby.

Posters about contraception are placed in each room to help initiate discussions with new mothers.  Colorful leaflets provide comprehensive information and reminders about postpartum family planning methods—information every woman can take home to discuss with her husband and refer to when needed.

“The first days after childbirth are very important,” says Norilda, a 24-year old mother nursing her newborn baby girl. “You don’t know many things, you are unsure, and you need the advice of midwives. You listen to everything they say.  I did not use contraceptives before, but now I will be reading more, and will use a [LAM] method not to get pregnant, because I want to take good care of my daughter.”

Through the USAID program, appropriate and comprehensive counseling on family planning is becoming a part of routine postpartum care in Albanian maternity hospitals, helping women make informed decisions about her family size and timing of the next pregnancy.