Family Planning’s Rolein Improving Maternal & ChildHealth and Well-BeingPatricia MacDonald RN, MPHCore Group Spring Confer...
Family Planning Improves Maternal and ChildHealth and Well-being by: Preventing unintended pregnancy and abortion Helpin...
What do the data tell us?
208 million pregnancies86 m unintended pregnancies41-44 m abortions33m unplanned births11m miscarriages~49%~38%~13%Of Thes...
Maternal Mortality isLower among Womenwho Become PregnantBefore Age 34Maternal Mortality isLower among Women whoHave Fewer...
Proportion of Births That Are Fifth Orderor Higher in Sub-Saharan AfricaThe proportion of births of fifth order or higher ...
Risk of Under-Five Mortality is Lower Among ChildrenBorn about Three Years After a Preceding Birth
Perinatal Mortality is Loweramong Babies Born to WomenAges 20-29 vs Those Born toAdolescentsRisk of Undernutrition isLower...
Percentage of Births by Number of MonthsSince Preceding Birth - Sub-Saharan AfricaSource: Demographic and Health Surveys f...
Percentage of Births by Number of MonthsSince Preceding Birth - Asia and HaitiSource: Demographic and Health Surveys for g...
Percentage of Women Aged 15–19 Who AreMothers or Pregnant With Their First Child-Sub-Saharan Africa-Source: STATcompiler –...
Percentage of Adolescents Aged 15–19 Who AreMothers or Pregnant With Their First Childin Asia and HaitiSource: STATcompile...
Percentage of Births by Number of MonthsSince Preceding Birth Among Young WomenAged 15–19 Sub-Saharan AfricaSource: Demogr...
Percentage of Births by Number of MonthsSince Preceding Birth Among Young WomenAged 15–19 Asia and HaitiSource: Demographi...
Adolescents have more very closelyspaced pregnancies than other age groupsNigeriaMozambiqueMalawiSource: Demographic and H...
Source: Most recent DHS; data for all women. Secondary analysisby EngenderHealth & Futures Institute (The RESPOND Project)...
70%60%50%40%30%20%10%0%Total demand, unmet need and method useamong all women with demand to limitSource: Most recent DHS;...
Programming interventionsto help women achieve healthymaternal and child outcomes
Reaching Girls and Young Women –Before they Become Pregnant• Keeping Girls in School – helps delay the age of firstpregnan...
FP/MNCH: “Smart” Integrationof FP with MNCH/N ServicesFANC•FP CounselingEmOCPAC•All FPMethodsDelivery & NB Care(0-48 hours...
First Time Parents activities addressRH goals and FP needs1. Fertility intentions of young married women around secondand ...
Determinants of Spacing Second and SubsequentPregnancies among First Time ParentsDemand Side•Individual Factors-Cognitive ...
First Time Parents activities also addressintegrated maternal, newborn and child care1. Maternal care, hygiene and nutriti...
Postabortion Carecompared with EmOC• Uterine evacuation • Uterine evacuation• Family Planning• Family PlanningPostabortion...
FAMILY PLANNINGANC-FP messages-Immediate Post Partum FamilyPlanning0-48 hoursPostpartum FP6 wk visitExtended Postpartum FP...
Continuum of Points of Contactfor Postpartum Family Planning (PPFP)
Postpartum Contraceptive OptionsTiming of Method Initiation and Breastfeeding Considerations
International Support for PPFPhttp://www.mchip.net/ppfphttp://www.k4health.org/toolkits/ppfp
• 222 million women in the developingworld have an unmet need for FP• Meeting this need would prevent 54million unintended...
Thank You!PhotobyC.Svingen/EngenderHealth
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Family Planning's Role in Improving Maternal and Child Health_Patricia MacDonald_4.23.13

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Family Planning's Role in Improving Maternal and Child Health_Patricia MacDonald_4.23.13

  1. 1. Family Planning’s Rolein Improving Maternal & ChildHealth and Well-BeingPatricia MacDonald RN, MPHCore Group Spring ConferenceApril 22-25, 2013Baltimore, MD
  2. 2. Family Planning Improves Maternal and ChildHealth and Well-being by: Preventing unintended pregnancy and abortion Helping couples achieve their desired family size Reducing unmet need for contraceptionAnd by helping ensure that pregnancy occurs at thehealthiest 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 5Desired FP Outcomes forImproved Maternal and Child Health
  3. 3. What do the data tell us?
  4. 4. 208 million pregnancies86 m unintended pregnancies41-44 m abortions33m unplanned births11m miscarriages~49%~38%~13%Of These…MaternaldeathsOf These…~9-13%Unintended Pregnancies Lead To:
  5. 5. Maternal Mortality isLower among Womenwho Become PregnantBefore Age 34Maternal Mortality isLower among Women whoHave Fewer ChildrenFamily Planning SupportsImproved Maternal Health
  6. 6. Proportion of Births That Are Fifth Orderor Higher in Sub-Saharan AfricaThe proportion of births of fifth order or higher in SSAranges from 22.8 percent in Ghana to 43.3 percent in Uganda.
  7. 7. Risk of Under-Five Mortality is Lower Among ChildrenBorn about Three Years After a Preceding Birth
  8. 8. Perinatal Mortality is Loweramong Babies Born to WomenAges 20-29 vs Those Born toAdolescentsRisk of Undernutrition isLower Among Children Bornabout Three Years After aPreceding BirthHealthy Pregnancy Timing and SpacingContributes to Improved Child Survival
  9. 9. Percentage of Births by Number of MonthsSince Preceding Birth - Sub-Saharan AfricaSource: 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.
  10. 10. Percentage of Births by Number of MonthsSince Preceding Birth - Asia and HaitiSource: 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.
  11. 11. Percentage of Women Aged 15–19 Who AreMothers 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 aremothers or pregnant with their first child.
  12. 12. Percentage of Adolescents Aged 15–19 Who AreMothers or Pregnant With Their First Childin Asia and HaitiSource: STATcompiler – most recent Demographic and Health Surveys. Information is not available for Afghanistan, Yemen and India (UP). Note: Bangladesh sample isever-married women.Between 9.1 percent of 15-19 year olds in Pakistan to 32.7 percent in Bangladeshare mothers or are pregnant with their first child.
  13. 13. Percentage of Births by Number of MonthsSince Preceding Birth Among Young WomenAged 15–19 Sub-Saharan AfricaSource: 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.
  14. 14. Percentage of Births by Number of MonthsSince Preceding Birth Among Young WomenAged 15–19 Asia and HaitiSource: 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 36months apart, from 71.7 percent in Nepal to 93 percent in Pakistan.
  15. 15. Adolescents have more very closelyspaced pregnancies than other age groupsNigeriaMozambiqueMalawiSource: Demographic and Health Surveys
  16. 16. Source: Most recent DHS; data for all women. Secondary analysisby EngenderHealth & Futures Institute (The RESPOND Project), 2012Total demand, unmet need and method useamong all women with demand to space70%60%50%40%30%20%10%0%Traditional method use to spaceNo method use, or Unmet need to spaceHeight of bar = Total demand for FP to spaceOther modern method use (resupply method) to spaceLong-acting reversible method (IUD or implant) to space+ = Unmet need for modern FP to space
  17. 17. 70%60%50%40%30%20%10%0%Total demand, unmet need and method useamong all women with demand to limitSource: Most recent DHS; data for all women. Secondary analysis byEngenderHealth & Futures Institute (The RESPOND Project), 2012.Using traditional method to limitUsing no method to limitHeight of bar = Total demand for FP to limitOther modern method use (resupply method) to limitUsing one of the four LAPMs to limit+ = Unmet need for modern FP to limit
  18. 18. Programming interventionsto help women achieve healthymaternal and child outcomes
  19. 19. Reaching Girls and Young Women –Before they Become Pregnant• Keeping Girls in School – helps delay the age of firstpregnancy• Providing Youth –Friendly Care, integrated into arange of existing community services, reaches youthwith FP/RH information and services• Expanding access to emergency contraception –helps prevent unintended pregnancy and abortion• Promoting good nutrition – helps improve maternaland newborn health when pregnancy does occur
  20. 20. FP/MNCH: “Smart” Integrationof FP with MNCH/N ServicesFANC•FP CounselingEmOCPAC•All FPMethodsDelivery & NB Care(0-48 hours)•LAM•PPIUD•Female Sterilization•Vasectomy•Hormonal methods fornon-breastfeedingwomenPNC, Immunization& Nutrition(through 1 year)•LAM & Transition•All FP Methods(after 6 weeks)Child HealthServices& Nutrition(through 2-5 years)•All FP MethodsInitiationContinuationReaching women with FP counseling and services:PPFP/PA-FP Indicators, Documentation, Evaluation of Integration
  21. 21. First Time Parents activities addressRH goals and FP needs1. Fertility intentions of young married women around secondand subsequent pregnancies and their ability to act on theirintentions through the lens of the individual,couple/extended family, and community at large2. Quality of FP/RH care offered to the young marriedwomen/couple when they seek FP services and counseling3. Interventions targeting spacing for second and subsequentpregnancies among young married women– REPRODUCTIVE LIFE PLAN –
  22. 22. Determinants of Spacing Second and SubsequentPregnancies among First Time ParentsDemand 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 andregulationsSupply Side•FP/RH service deliverysystem-Accessibility, availabilityand coverage-High performing healthworkers and quality ofcounseling and services-Supportive policies andsystemsIncreasebirth topregnancyinterval >24 months
  23. 23. First Time Parents activities also addressintegrated maternal, newborn and child care1. Maternal care, hygiene and nutrition during pregnancy,childbirth, postpartum and between pregnancies2. Knowledge and skills to breastfeed and care for thenewborn through infancy and early childhood, includingfeeding practices, immunizations, stimulation for learning3. Prevention of gender based violence, utilization of healthservices for prevention services and treatment of illnesses
  24. 24. Postabortion Carecompared with EmOC• Uterine evacuation • Uterine evacuation• Family Planning• Family PlanningPostabortion Care Emergency ObstetricCare only
  25. 25. FAMILY PLANNINGANC-FP messages-Immediate Post Partum FamilyPlanning0-48 hoursPostpartum FP6 wk visitExtended Postpartum FP6 weeks to 12 monthsInter-partum FPUp to 24 months or longerBirth PreparednessANCDelivery care3-6 days1-6 weeksPOSTPARTUMImmunization EBF 4-6wksImmunization EBF 8 wksImmunization EBF 12 wksChild feeding 6 moImmunization-Measles9 moTT ImmunizationNeonatal care 6-12 hrsLater postnatal3-6 daysImmediate postpartum6-12 hrsMATERNAL HEALTH NEONATAL & CHILDHEALTHPMTCTPEDIATRICCAREPPFP integrated with MNCH servicesHIVOpportunities?
  26. 26. Continuum of Points of Contactfor Postpartum Family Planning (PPFP)
  27. 27. Postpartum Contraceptive OptionsTiming of Method Initiation and Breastfeeding Considerations
  28. 28. International Support for PPFPhttp://www.mchip.net/ppfphttp://www.k4health.org/toolkits/ppfp
  29. 29. • 222 million women in the developingworld have an unmet need for FP• Meeting this need would prevent 54million 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 andnational benefits.PhotobyR.Mowli/EngenderHealthPhotobyStaff/EngenderHealthHere’s the “health payoff”if FP choice and access are increased!
  30. 30. Thank You!PhotobyC.Svingen/EngenderHealth

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