HEALTHY PREGNANCY SPACING AND TIMING : Understanding the Rationale and the Benefits

Presented at Family Planning Budget Training Workshop June 22 24, 2011

Kabir M. Abdullahi NURHI Kaduna, State Team Leader

Objectives
At the end of the presentation participants would have:
Increased knowledge on the evidence in support of longer birth spacing interval

Identified key benefits of longer birth intervals and the risks associated with shorter birth intervals Identified key messages for birth spacing promotion

What we Mean by Birth Spacing

Kaduna State Relevant Statistics

Issues

2011 Projected Population: 7.15m Neonatal Mortality Ratio: 55 p. 1000 Under 5 Mortality Ratio: 269 p. 1000 Maternal Mortality Rate: 800 p. 100,000 live birth Fertility Rate: 7.3 Contraceptive Prevalence (modern method): 9.6% Unmet Need for Family Planning: 12% Desire to Use: 18%

Findings and Implication for MCH

Policy is silent on pregnancy spacing/timing role in mortality reduction No budget line for family planning Families unaware of risk of annual childbearing/short spacing of births and pregnancy Mortality reduction strategies (free MCH) do not include pregnancy spacing//childbirth spacing Dearth of skilled personnel trained on Birth Spacing Training/counseling materials for birth spacing unavailable Desire for large family size Conspiracy of silence on the benefits of FP/childbirth spacing by religious leaders

Findings and Implication for MCH

Studies show EVIDENCE of longer birth intervals effects on health

For Children
Lower risk of: Child death Infant death Neonatal death Fetal death Stunting and underweight Small for gestational age Low birth weight Preterm birth

For Mother
Lower risk of: Maternal death Puerperal endometritis Premature rupture membranes Anemia Third trimester bleeding

Conde-Agudelo A., Effect of Birth Spacing on Maternal and Perinatal Health: A Systematic Review and Meta-Analysis. Rutstein, S. Johnson & CondeAgudelo 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.

Birth Intervals Effects on Newborn and Child Health 24 months birth intervals, or longer, are associated with lowest risk of stunting and underweight among under-five children LBW is an indirect cause of 60-80% of neonatal deaths Risk of death among under-five children is lower if the preceding birth interval was loner than 24 months
Source: United States Agency for International Development (USAID), Bureau for Global Health, Office of Population and Reproductive Health, Washington, D.C. 20523-3600. December 2002. (WWW.USAID.GOV)

Neonatal Mortality RISK declines with increasing birth-to-birth interval length up 48 59 months

Birth Spacing Saves Childrens Lives

Birth Spacing Saves Mothers Lives

How Much Death Would be Averted?

In Nigeria thousands deaths could be averted annually if births occurred after longer intervals In Nigeria, if no births occurred before 36 months of a preceding birth:
Infant Mortality Rate would drop by 28% Under Five Mortality Rate would drop by 23% Deaths to children under five years of age would fall by165,000 annually Fertility Rate would drop by 8%
Source: Shea Rutstein, PhD, Measure/DHS+,Macro International, Inc.

Consequences of Shorter Birth Interval !!!

When births are too close, families cannot take care of several small children, they are weaned too soon, and they are thus at greater risk of dying; When children are weaned too soon, their growth suffers, they are more likely to suffer from diarrheal disease, and skins infections, and they are thus greater risk of dying When women have too close pregnancies, they have greater risk of pregnancy related and delivery complications Spacing births more than 24 months can reduce the risk of morbidity and mortality for mothers and children.

Overall Benefits of Birth Spacing

Healthy timing and spacing of pregnancy is associated with multiple health and other benefits to mother, neonates and children It is associated with reduced health risks to mother and child

It is a preventive strategy against adverse maternal and infant/child health outcomes.

It is a key strategy for preventing maternal, infant and child morbidity and mortality. It is complementary to all care and treatment strategies for mother and children

WHO Recommendation for Spacing

After a live birth, the recommended interval before attempting the next pregnancy is at least 24 months in order to reduce the risk of adverse maternal, perinatal and infant outcomes,

After a miscarriage or induced abortion, the recommended minimum interval to next pregnancy should be at least six months in order to reduce risks of adverse maternal andperinatal outcomes

Key Messages: Healthy Spacing of Pregnancy

After a live birth: Couples should use an effective family planning (FP) method of their choice continuously for at least two years after a live birth but not more than five years before trying to become pregnant again. After a miscarriage or abortion: Couples should use an effective FP method of their choice continuously for at least six months after a miscarriage or abortion before trying to become pregnant again. For adolescents: Adolescents need to use an effective FP method of their choice continuously until they are 18 years old before trying to become pregnant.
Source: ESD Pocket guide, version 2006

Suggested Strategies to help Couples Space Birth

Increase access to good-quality contraceptive services and full range of methods, Encourage community campaigns that speak about needs of younger couples and cultural norms and tradition beliefs, Use prenatal and post natal periods as crucial times for information and counseling about birth spacing, Discuss with mothers the benefits of maintaining 2 - 3 years for the next child, Support initiative that strengthen the women decision- making power in the household.
Source: Population Reports, Volume XXX, Number 3, Summer 2002 (11)

How Do we Integrate?