Effects of Hybrid Family Planning Counseling on Postpartum Maternal Health

Postpartum family planning is an approach that aims to encourage women to have at least 24 months between pregnancies, starting within the first 6-24 hours after delivery. Within this scope, providing appropriate contraceptive methods within six weeks of delivery, even if the woman is breastfeeding or amenorrhea, and providing couples with counseling on sexual health issues are among the basic practices.

A pregnancy immediately after delivery increases the risk of pregnancy complications, shortens the duration of breastfeeding, and jeopardizes maternal and child health. While the World Health Organization (WHO) recommends that the time between two pregnancies should be at least 24 months for the physiological and psychosocial health of the mother in the postpartum period, the American College of Obstetrics and Gynecology (ACOG) recommends that this period should be 18 months.

Family planning; It encompasses all techniques and practices aimed at helping couples have children of their own free will, at the time and in the number they desire, determining the interval between pregnancies, and preventing unwanted pregnancies. Because the exact timing of resuming sexual activity in the postpartum period and the duration of fertility in breastfeeding women are not precisely known, the most appropriate time for contraceptive method counseling is the antenatal period. If the mother has not made a decision about contraceptive methods during this period, the choice of contraceptive method must be determined before discharge. Therefore, midwives play an important role in pre-pregnancy and post-natal contraceptive counseling and care

Postpartum family planning counseling aligns directly with the United Nations Sustainable Development Goals (SDGs) by helping women avoid unwanted or closely spaced pregnancies in the postpartum period, ensuring a minimum of 24 months between pregnancies, and enabling couples to consciously choose birth control methods that align with their reproductive preferences. Specifically, SDG 2 (End Hunger) and SDG 3 (Healthy Individuals) aim to promote exclusive breastfeeding for the first six months and continued breastfeeding with complementary foods until the age of two, thereby reducing maternal mortality and morbidity, preventing infant and child deaths, and ensuring universal access to reproductive health services. Research indicates that effective family planning services can reduce maternal mortality by approximately 30%. As stated in a summary of the results on the effects of family planning on nutrition, "malnutrition, including stunting, low weight, weakness, and vitamin deficiencies, contributes to almost half of all childhood deaths. This means that approximately 3.1 million children under the age of 5 die each year from malnutrition-related causes.

In addition, postpartum family planning contributes to SDG 5 (Gender Equality) by supporting women's right to make decisions about their fertility. Furthermore, planning and regulating the intervals between pregnancies aligns with SDG 1 (Poverty Reduction) by easing the economic burden on families, SDG 4 (Quality Education) by supporting girls' education through the prevention of early and unplanned pregnancies, and SDG 8 (Decent Work and Economic Growth) by increasing women's participation in the workforce. Therefore, postpartum family planning counseling is not only It plays a strategic role not only in terms of maternal and child health, but also in terms of social development, gender equality, and economic sustainability.

Across Turkey, 11.5% of women have unmet family planning needs, with 3.9% needing to space out births and 7.6% needing to terminate pregnancies. Furthermore, 3.9% of women in Turkey have an unmet need for modern methods of contraception. The need for family planning among married women doubled in the five years following 2013. Considering the number of married women and the level of need in 2018, approximately 600,000 women needed family planning to space out births, and 1 million women needed it to terminate pregnancies. The use of contraceptive methods, particularly modern methods, has steadily increased in Turkey. As a result of this increase, the share of women with unmet family planning needs decreased from 15% in 1993 to approximately one-third (6%) in 2013. However, this situation has recently changed; the needs gap revealed by the 2018 Turkish National Health Survey (TNSA) points to levels as high as those approximately 20 years ago. Unmet family planning needs are not unique to women with many children. The unmet need is higher among women with two or fewer births compared to other groups. The disruptions in the provision of family planning services and the demand for healthcare services due to the Covid-19 pandemic, as well as the postpartum period, indicate a high level of unmet family planning needs among women. Since the need for family planning services continues under all circumstances, uninterrupted access is essential. During pandemics and natural disasters, women faced difficulties accessing healthcare facilities, disruptions in pregnancy and postpartum follow-ups, and delays in seeking help for risky situations. During this period, women also did not have adequate access to preventive healthcare services for maternal and child health. This situation highlighted the need for different counseling methods to ensure uninterrupted access to counseling for women, and the necessity of providing telehealth services.

Therefore, family planning counseling services for postpartum contraception can be provided through various methods during antenatal care, before discharge after delivery, during postpartum follow-ups, and/or during infant monitoring. Midwives, who are in constant contact with women, provide couples with qualified family planning counseling using their equipment and knowledge, helping them choose an appropriate method and use it correctly. Midwives who establish good communication with women after delivery identify women's unmet family planning needs and provide the necessary support.

The project has unique value for a sustainable future in terms of its impact on maternal health in particular, and family and community health in general. Ensuring that every mother and couple has access to uninterrupted family planning services is a fundamental human right essential for a healthy sexual life and the future of pregnancies. Another unique value is that it is a longitudinal study that uses innovative methods and provides early information at the national level to quickly compensate for the lost momentum in family planning, especially during pandemics and natural disasters. Counseling will begin face-to-face during pregnancy and then continue in a hybrid format. The continuity of counseling will ensure that the mother has access to the necessary information on family planning on the right platform. Another unique value of this study is that it will provide data for comparing innovative counseling methods with traditional methods. Thus, it will help to improve or regulate future initiatives. In line with this purpose, the objectives are:

• Development of a hybrid counseling model in family planning counseling,
• Evaluation of the effectiveness of innovative methods in hybrid family planning counseling,
• Determination of the effects of hybrid family planning counseling in the postpartum period on the time between pregnancies,
• Maternal mortality and morbidity risks,
• Maternal psychosocial well-being,
• Determination of mothers' attitudes towards family planning,
• Determination of the effect on women's quality of sexual life,
• Evaluation of the advantages of telehealth-based counseling in terms of accessibility and sustainability.