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LERIBE DISTRICT, Lesotho – After delivering her fifth child, ‘Mathabo*, 33, and her husband decided to start using contraceptives a day after the birth, to avoid an unplanned pregnancy. While still in hospital, she had Implanon, a contraceptive implant, inserted.

I will not have to miss work to go for family planning services, because the implant will last three years.

In four districts of Lesotho, hospitals are now offering long-term family planning immediately after childbirth, to allow women to better plan and space their pregnancies. © UNFPA Lesotho

“My husband asked me to find a suitable method of family planning and this is it. I will now be able to raise my children well, without fear of falling pregnant, and will not have to miss work to go for family planning services, because the implant will last three years,” she said.

She delivered her baby at Motebang Hospital in Leribe District during the introduction of immediate postpartum family planning by the Ministry of Health, with the support of UNFPA, the United Nations sexual and reproductive health agency.

Like ‘Mathabo, women who work in garment factories in Lesotho often lose wages for the days they miss work, due to a 'no work, no pay' policy at the factories. Attending health clinics for family planning services means a financial penalty they can barely afford.

“I am going to encourage others to use the implant as it is long term, and also not listen to those who give them false information,” ‘Mathabo said.

Long-term contraceptives save time and money

Thato* chose to have Implanon inserted after she gave birth at Motebang hospital. She was pleased that she would save money by making fewer visits to the clinic for family planning services.

I was using another method of family planning, but it ran out of stock. I fell pregnant.

“I was using another method of family planning, but because it had run out of stock, I stayed without any contraceptives for six months. That is when I fell pregnant,” she said.

UNFPA supports Lesotho with the introduction of postpartum family planning, in the initiation and use of family planning services immediately after childbirth and within the first 12 months following childbirth. The goal is to reduce maternal and infant morbidity and mortality by preventing unplanned and unwanted pregnancies, and to reduce unmet need for family planning among post-partum women.

The intention is to strengthen implementation of family planning and improve family planning indicators, to create more opportunities for uptake of family planning methods before women leave the health facility, and to sharpen service providers’ skills and competences on family planning, said Motsoanku ‘Mefane, Sexual and Reproductive Health Manager at the Ministry of Health.

“We want to offer them the family planning services while they are still at the health facility after child birth, because they may face many different challenges that may [prevent] them from getting back to the facility for family planning after they leave,” she said.

Increasing contraceptive use

This initiative to offer modern contraception services as part of care provided during childbirth is expected to increase contraceptive use, as well as to reduce unintended and closely spaced pregnancies. It will also be advantageous for adolescents and young people. It was implemented in Qacha’s Nek and Mokhotlong last year, and in Butha-Buthe and Leribe districts in August this year.

According to ‘Makhauta Litaolana, a nurse working at the Adolescent Health Corner at Motebang hospital, the introduction of postpartum family planning will help reduce unintended pregnancies, which often lead to illegal abortions and the associated health risks, including fatalities. Recent data obtained from one hospital, covering the first quarter of 2019, 2020 and 2022, showed that the percentage of obstetric and gynaecological admissions due to abortion were highest among adolescent girls aged 10 to14, at 36 per cent.

During an orientation session on postpartum family planning, health workers at Butha-Buthe and Leribe hospitals received refresher training on modern contraceptives, to enhance their knowledge and skills. One of the aims of postpartum family planning is to promote long-term and less-used methods of family planning, such as intra-uterine contraceptive devices (IUCDs), to increase uptake.

*Names changed to protect privacy.