Family Planning’s Role in Improving Maternal & Child

Health and Well-Being

Patricia MacDonald RN, MPH

Core Group Spring Conference

April 22-25, 2013

Baltimore, MD

Family Planning Improves Maternal and Child Health and Well-being by:

Preventing unintended pregnancy and abortion Helping couples achieve their desired family size Reducing unmet need for contraception

And by helping ensure that pregnancy occurs at the healthiest times of a woman’s life:

After age 18 and before age 34 At least 24 months after a live birth About 6 months after an abortion or miscarriage At birth orders below 5

Desired FP Outcomes for Improved Maternal and Child Health

What do the data tell us?

208 million pregnancies

86 m unintended pregnancies

41-44 m abortions

33m unplanned births

11m miscarriages

~49%

~38%

~13%

Of These…

Maternal deaths

Of These…

~9-13%

Unintended Pregnancies Lead To:

Maternal Mortality is Lower among Women who Become Pregnant

Before Age 34

Maternal Mortality is Lower among Women who

Have Fewer Children

Family Planning Supports Improved Maternal Health

Proportion of Births That Are Fifth Order or Higher in Sub-Saharan Africa

The proportion of births of fifth order or higher in SSA ranges from 22.8 percent in Ghana to 43.3 percent in Uganda.

Risk of Under-Five Mortality is Lower Among Children Born about Three Years After a Preceding Birth

Perinatal Mortality is Lower among Babies Born to Women Ages 20-29 vs Those Born to

Adolescents

Risk of Undernutrition is Lower Among Children Born

about Three Years After a Preceding Birth

Healthy Pregnancy Timing and Spacing Contributes to Improved Child Survival

Percentage of Births by Number of Months Since Preceding Birth - Sub-Saharan Africa

Source: Demographic and Health Surveys for given years.

Between 40 to 65 percent of births are spaced less than 36 months apart. Between 4 to 14 percent of births are spaced more than 68 months apart.

Percentage of Births by Number of Months Since Preceding Birth - Asia and Haiti

Source: Demographic and Health Surveys for given years. Pakistan is ever-married only. Data are unavailable for Afghanistan and Yemen.

Between 35 and 57 percent of births are spaced less than 36 months apart. Between 5 to 15 percent of births are spaced more than 68 months apart.

Percentage of Women Aged 15–19 Who Are Mothers or Pregnant With Their First Child

-Sub-Saharan Africa-

Source: STATcompiler – most recent Demographic and Health Surveys, Malawi 2010.

Between 5.7 percent of 15-19 year olds in Rwanda to 41 percent in Mozambique are mothers or pregnant with their first child.

Percentage of Adolescents Aged 15–19 Who Are Mothers or Pregnant With Their First Child

in Asia and Haiti

Source: STATcompiler – most recent Demographic and Health Surveys. Information is not available for Afghanistan, Yemen and India (UP). Note: Bangladesh sample is ever-married women.

Between 9.1 percent of 15-19 year olds in Pakistan to 32.7 percent in Bangladesh are mothers or are pregnant with their first child.

Percentage of Births by Number of Months Since Preceding Birth Among Young Women

Aged 15–19 Sub-Saharan Africa

Source: Demographic and Health Surveys for given years.

The majority of young women aged 15-19 space their births fewer than 36 months apart, from 72.1 percent in Malawi to 90.7 percent in Kenya.

Percentage of Births by Number of Months Since Preceding Birth Among Young Women

Aged 15–19 Asia and Haiti

Source: Demographic and Health Surveys for given years. Pakistan is ever-married only. Data are unavailable for Afghanistan and Yemen.

The majority of young women aged 15-19 space their births less than 36 months apart, from 71.7 percent in Nepal to 93 percent in Pakistan.

Adolescents have more very closely spaced pregnancies than other age groups

Nigeria

Mozambique

Malawi

Source: Demographic and Health Surveys

Source: Most recent DHS; data for all women. Secondary analysis by EngenderHealth & Futures Institute (The RESPOND Project), 2012

Total demand, unmet need and method use among all women with demand to space

70%

60%

50%

40%

30%

20%

10%

0%

Traditional method use to space

No method use, or Unmet need to space

Height of bar = Total demand for FP to space

Other modern method use (resupply method) to space

Long-acting reversible method (IUD or implant) to space + = Unmet need for modern FP to space

70%

60%

50%

40%

30%

20%

10%

0%

Total demand, unmet need and method use among all women with demand to limit

Source: Most recent DHS; data for all women. Secondary analysis by EngenderHealth & Futures Institute (The RESPOND Project), 2012.

Using traditional method to limit

Using no method to limit

Height of bar = Total demand for FP to limit

Other modern method use (resupply method) to limit

Using one of the four LAPMs to limit+ = Unmet need for modern FP to limit

Programming interventions

to help women achieve healthy

maternal and child outcomes

Reaching Girls and Young Women – Before they Become Pregnant

• Keeping Girls in School – helps delay the age of first

pregnancy

• Providing Youth –Friendly Care, integrated into a

range of existing community services, reaches youth

with FP/RH information and services

• Expanding access to emergency contraception – helps

prevent unintended pregnancy and abortion

• Promoting good nutrition – helps improve maternal

and newborn health when pregnancy does occur

FP/MNCH: “Smart” Integration of FP with MNCH/N Services

FANC

•FP Counseling

EmOCPAC

•All FP Methods

Delivery & NB Care(0-48 hours)

•LAM •PPIUD•Female Sterilization•Vasectomy•Hormonal methods for non-breastfeeding women

PNC, Immunization & Nutrition

(through 1 year)

•LAM & Transition•All FP Methods (after 6 weeks)

Child Health Services

& Nutrition(through 2-5 years)

•All FP Methods

Initiation

Continuation

Reaching women with FP counseling and services:

PPFP/PA-FP Indicators, Documentation, Evaluation of Integration

First Time Parents activities address RH goals and FP needs

1. Fertility intentions of young married women around second

and subsequent pregnancies and their ability to act on their

intentions through the lens of the individual,

couple/extended family, and community at large

2. Quality of FP/RH care offered to the young married

women/couple when they seek FP services and counseling

3. Interventions targeting spacing for second and subsequent

pregnancies among young married women

– REPRODUCTIVE LIFE PLAN –

Determinants of Spacing Second and Subsequent Pregnancies among First Time Parents

Demand Side•Individual Factors-Cognitive abilities-Autonomy-Mobility -Education•Household Factors-Relationship with spouse-Relationship with in-laws•Community-Culture and gender norms•State-National laws, policies and regulations

Supply Side•FP/RH service delivery system

-Accessibility, availability and coverage-High performing health workers and quality of counseling and services-Supportive policies and systems

Increase birth to

pregnancy interval >

24 months

First Time Parents activities also address integrated maternal, newborn and child care

1. Maternal care, hygiene and nutrition during pregnancy,

childbirth, postpartum and between pregnancies

2. Knowledge and skills to breastfeed and care for the

newborn through infancy and early childhood, including

feeding practices, immunizations, stimulation for learning

3. Prevention of gender based violence, utilization of health

services for prevention services and treatment of illnesses

Postabortion Care compared with EmOC

• Uterine evacuation • Uterine evacuation

• Family Planning• Family Planning

Postabortion Care Emergency Obstetric Care only

FAMILY PLANNING

ANC-FP messages-

Immediate Post Partum Family Planning

0-48 hours

Postpartum FP6 wk visit

Extended Postpartum FP

6 weeks to 12 months

Inter-partum FP

Up to 24 months or longer

Birth Preparedness

ANC

Delivery care

3-6 days

1-6 weeks

POSTPARTUM

Immunization EBF 4-6wks

Immunization EBF 8 wks

Immunization EBF 12 wks

Child feeding 6 mo

Immunization-Measles

9 mo

TT Immunization

Neonatal care 6-12 hrs

Later postnatal

3-6 days

Immediate postpartum

6-12 hrs

MATERNAL HEALTH NEONATAL & CHILD HEALTH

PMTCT

PEDIATRIC

CARE

PPFP integrated with MNCH services

HIV

Opportunities?

Continuum of Points of Contact for Postpartum Family Planning (PPFP)

Postpartum Contraceptive Options Timing of Method Initiation and Breastfeeding Considerations

International Support for PPFP

http://www.mchip.net/ppfp

http://www.k4health.org/toolkits/ppfp

• 222 million women in the developing world have an unmet need for FP

• Meeting this need would prevent 54 million unintended pregnancies

– 26,000,000 fewer abortions

– ~ 80,000 fewer maternal deaths

– 2,400,000 fewer serious morbidities

– 1,100,000 fewer infant deaths

– >300,000 fewer children lose mother

• Many other family, societal and national benefits. P

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Here’s the “health payoff” if FP choice and access are increased!

Thank You!

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