2. Healthy Timing and Spacing of
Pregnancies
Objectives
• By the end of this presentation
participants will be able to
1. Define spacing intervals
2. Define the recommended optimal pregnancy
spacing intervals
3. Describe the effects of pregnancy spacing on
morbidity, mortality and nutrition
3. What is Postpartum Family Planning
• Postpartum family planning (PPFP) is any
family planning service or method
provided immediately after birth up till
during one year after birth.
• Post-abortion family planning (PAFP) is a
similar service offered to women
immediately after an abortion/miscarriage.
4. 0
0.4
0.8
1.2
1.6
2
2.4
2.8
3.2
3.6
<6 6 to 11 12 to 17 18 to 23 24 to 29 30 to 35 36 to 47 48 to 59
Pregnancy Interval (months)
Risk (odds ratio)
Miscarriage
Low Birth Weight
Maternal Death
Pre-term Birth
Sources: Conde-Agudelo 2005 and DaVanzo et al 2007
Birth to Pregnancy Intervals and
Relative Risk of Adverse Maternal, Perinatal and
Pregnancy Outcomes
5. What Is HTSP?
Healthy
Timing and
Spacing of
Pregnancy
Delaying pregnancy until age 18
Healthy pregnancy spacing
(after live
birth/miscarriage/induced
abortion)
Interventions to help women
and families:
-Make informed decisions about
delay/spacing
-Achieve healthiest
maternal/newborn outcomes
6. DEMAND FOR HTSP
• Large generation of adolescents
• Main FP demand for <29 age group is for
spacing methods
• High percentages of births occur after too-
short intervals
• Even higher percentages of young women
with short birth intervals also desire longer
birth intervals
• Only 3–5% of postpartum women want
another child within 2 years
• Significant service delivery gaps
Ross and Winfrey, 2001;Jansen, 2004/5; Rutsein, 2005;
7. Birth Interval:
Selected Asian Countries
Percentage of Asian Women Aged 20–29 Giving
Birth in <36 Months after Last Birth
Source: DHS Surveys
0
10
20
30
40
50
60
70
80
68.4
75 76.2
68 67.2
80
61
Percent
of
women
having
birth
intervals
less
than
three
years
20-29 yrs
8. Perinatal Outcomes
Birth to pregnancy (BTP) interval of <18 months is
associated with increased risk of:
• Maternal mortality
• Induced abortion
• Miscarriage
• Pre-term birth
• Small size for gestational age
• Low birth weight
Sources: Conde-Agudelo, A et al. Effect of birth spacing on maternal health: A systematic review, American
Journal of Obstetrics and Gynecology, 2006, DaVanzo, J, Hale L, Razzaque A, Rahman M, Effects of
interpregnancy interval and outcome of the preceding pregnancy on pregnancy outcomes in Matlab,
Bangladesh, BJOG: An International Journal of Obstetrics and Gynaecology, 2007.
Conde-Agudelo, A, Belizan, JM. Maternal morbidity and mortality associated with interpregnancy interval:
cross sectional study. Br Med J, 2000, 321(7271): 1255-9.
9. Perinatal Outcomes (cont’d)
• BTP interval of >59 months is associated with
increased risk of:
• Pre-eclampsia
• Abortion/miscarriage
• Pregnancy interval of <6 months is associated with
increased risk of:
• Premature rupture of membranes, maternal
anemia
• Pre-term birth, low birth weight, small for
gestational age
Source: Conde-Agudelo,A et al. “Effect of the interpregnancy interval after an abortion on maternal and
perinatal health in Latin America,” InternationalJournal of Gynecology and Obstetrics,Vol. 89,
Supplement No. 1,April 2005.
11. Birth Interval - Recommendations
• Recommendation for spacing after a live birth:
• Recommended minimum interval before
attempting the next pregnancy is at least 24
months in order to reduce the risk of adverse
maternal, perinatal and infant outcomes.
• Recommendation for spacing after miscarriage or
induced abortion:
• Recommended minimum interval to next pregnancy
should be at least 6 months in order to reduce risks
of adverse maternal and perinatal outcomes
• First Pregnancy should not be before the age of 18
years as it results in maternal and neonatal
complications
Source:World HealthOrganization, 2006 Report of aWHOTechnicalConsultation on BirthSpacing
12. Very High Risk
and
Slightly Higher
Perception
of Risk
Higher Risk
and
Low Perception
of Risk
Lower Risk
and
Low Perception
of Risk
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
0-3 4-6 7-9 10-12
Sexually active Return to menses Exclusively breastfdg
Risk of Unplanned Pregnancy
Source: ACCESS-FP Analysis of NFHS 2006
13. Return to Fertility
• Non breastfeeding:
• As early as 3 weeks postpartum – 21 days
postpartum
• Breastfeeding
• Using LAM accurately:
• some time after 6 months – variable
• Breastfeeding without using LAM:
• possibly even before 6 months, but again, variable.
• average is 45 days
• 5 – 10% of breastfeeding women get pregnant in first
year PP
• : Fertility returns before menses returns!
14. Return to sexual activity
• Physiologically women can resume intercourse
when the perineum is fully healed
• But she should do so when she is ready
• Typically, sexual activity resumes before a
woman is on a effective FP method
• Therefore, the woman is at risk of pregnancy
15. Postpartum Family Planning?
• Postpartum family planning (PPFP) is the
prevention of unintended and closely spaced
pregnancies through the first 12 months
following childbirth.
• Not only do pregnancies during this period hold
the greatest risk for mother and baby, the first
12 months after childbirth also present the
greatest opportunities in terms of number of
contacts with health care services.
16. PPFP Importance
• According to an analysis of Demographic and
Health Survey data from 27 countries, 65% of
women who are 0–12 months postpartum want
to avoid a pregnancy in the next 12 months but
are not using contraception. This is unmet need.
• PPFP can avert more than 30% of maternal
deaths and 10% of child mortality if couples
spaced their pregnancies more than two years
apart.
21. The Problem
35% Contraceptive prevalence rate for all methods
(modern and traditional)
24% Contraceptive prevalence rate for modern
methods
34% Births occurring within 24 months of last delivery
22% Postpartum women using a family planning
method in first year after delivery
64% Unmet need for family planning in the first year
after delivery
23. For more information, please visit
www.mcsprogram.org
This presentation was made possible by the generous support of the American people through
the United States Agency for International Development (USAID), under the terms of the
Cooperative Agreement AID-OAA-A-14-00028. The contents are the responsibility of the
authors and do not necessarily reflect the views of USAID or the United States Government.
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