Revitalizing Family Planning and Reproductive Health

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Revitalizing Family Planning and Reproductive
Health

• Christian Connections for International Health,
  Annual Conference
• Douglas Huber, Management Sciences for health
• 27 May, 2006
• Bishop Claggett Center, Buckeystown, MD
• Adapted from
• Dr. Therese N. S. LESIKEL, Repositioning Family
  Planning in West Africa, WHO/AFRO
• Dr. Issakha Diallo, Revitalizing Family
  Planninng in Africa, Advance Africa

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One of the most critical consequences of the huge
gap between perceived need and use of family
planning in West Africa is short birth
interval and its dramatic health effects for the
mother and child
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Using family planning to achieve longer birth
intervals saves lives
Spacing births even 2 years or more can reduce
infant mortality by 26 (Guinea), up to 45
(Mali) Very few children in West Africa are
spaced at 3 or more years Family planning could
reduce maternal mortality by 20 or more.
(Source Status and trends of FP in Sub Saharan
Africa, USAID. Oct 2002. From DHS)
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In 2003, if women in developing countries had
spaced births approximately 36 months apart, 3
million deaths to children under the age of five
could have been averted, accounting for about 35
of all deaths to children in this age group.
Excluding China
Source Rutstein, S. Johnson K and Conde-Agudelo
A. Systematic literature Review and Meta Analysis
of the Relationship between interpregnancy or
intervals and Infant and Child Mortality. Report
submitted to the CATALYST Consortium, October
2004.
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Evidence of longer birth intervals effects on
health
Conde-Agudelo A., Effect of Birth Spacing on
Maternal and Perinatal Health A Systematic
Review and Meta-Analysis. Rutstein, S. Johnson
Conde-Agudelo A. Systematic Literature Review and
Meta-Analysis of the Relationship between
Interpregnancyor Interbirth Intervals and Infant
and Child Mortality. Reports submitted to
CATALYST Consortium, October 2004, Conde-Agudelo,
A. and Belizan, J.M. Maternal morbidity and
mortality associated with interval Cross
sectional study. British Journal (Clinical
Research Ed.) 321 (7271) 1255-1259. Nov. 18,
2000.
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New evidence about birth intervals effects on
maternal and child mortality and morbidity

• USAID 2004 Birth Spacing Meta-Analysis
• Considered 14 million pregnancy outcomes

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Three to five year birth intervalslowest
mortality risks for children under-five
Rutstein S. Effects of preceding birth intervals
on neonatal, infant and under-five years
mortality and nutritional status in developing
countries evidence from the Demographic and
Health Surveys. Paper forthcoming in the
International Journal of Gynecologyand
Obstetrics, September, 2004.
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Three to five year birth intervalslowest
mortality risks for neonatal mortality
Rutstein S. Effects of preceding birth intervals
on neonatal, infant and under-five years
mortality and nutritional status in developing
countries evidence from the Demographic and
Health Surveys. Paper forthcoming in the
International Journal of Gynecologyand
Obstetrics, September, 2004.
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Unmet need for family planning Increases
Maternal Mortality

• Most maternal deaths are due to
• Complications during delivery and post-partum
• Complications due to unsafe abortions
• Inadequate obstetrical care
• Closely-spaced births (less than 15 months apart)
• Maternal mortality rates in West Africa are
  unacceptably high, Sierra Leone has a MMR of
  2100/100,000 women (PRB, 2002)

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Family Planning can make a difference the case
of Nigeria
In Nigeria, if no births occurred before 36
months of a preceding birth Infant Mortality
Rate would drop 28 Under Five Mortality Rate
would drop 23 Deaths to children under five
years of age would fall by 165,000
annually Fertility Rate would drop 8
Source Shea Rutstein, PhD, Measure/DHS,Macro
International, Inc.
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Tens of thousands of Deaths could be averted
annually if births occurred after longer
intervals
Annual Number of Infant Deaths with Existing
Birth Intervals and Minimum Intervals of 24 and
36 months, Nigeria
Source Shea Rutstein, PhD, Measure/DHS,Macro
International, Inc.
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Few postpartum women want another birth within
two years, yet many do not use family planning
Percent of women who desire another birth within
two years of previous birth
Source Ross, John William Winfrey.
Contraceptive use, intention to use and unmet
need during the extended post partum period.
International family planning perspectives, vol.
27, Number 1, March 2001
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Actions by International Health Agencies

• 46 African Ministers of Health signed resolution
  to reposition family planning
• Opens doors for national advocacy, by faith
  communities and others
• New partners--WHO/AFRO, WAHO, World Bank, UNFPA,
  and others

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Conclusion

• When births are too close-- 1) poor care of
  children, 2 early weaning, 3) increased diarrheal
  disease, 4) growth suffers, 5) greater risk of
  dying
• When women have pregnancies too closeincreased
  pregnancy and delivery complications
• Spacing births more than 3 years reduces risks
  for mothers and children.

Source Shea Rutstein, PhD, Measure/DHS,Macro
International, Inc.
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ConclusionStrategies to space Births
Increase access to good-quality family planning
servicesappropriate range of methods Encourage
faith communities to speak about needs of younger
couples and cultural norms and tradition
beliefs
Source Population Reports, Volume XXX, Number
3, Summer 2002 (11)
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ConclusionStrategies to space Births

• Use antenatal and post partum periods to counsel
  about of birth spacing and contraception
• Provide contraceptive services during well-baby
  and immunization visits
• Support initiatives to strengthen womens
  decision-making power