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. 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
- 2. 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
- 3. What do the data tell us?
- 4. 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:
- 5. 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
- 6. 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.
- 7. Risk of Under-Five Mortality is Lower Among Children Born about Three Years After a Preceding Birth
- 8. 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
- 9. 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.
- 10. 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.
- 11. 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.
- 12. 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.
- 13. 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.
- 14. 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.
- 15. Adolescents have more very closely spaced pregnancies than other age groups Nigeria Mozambique Malawi Source: Demographic and Health Surveys
- 16. 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
- 17. 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
- 18. Programming interventions to help women achieve healthy maternal and child outcomes
- 19. 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
- 20. FP/MNCH: “Smart” Integration of FP with MNCH/N Services FANC •FP Counseling EmOC PAC •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
- 21. 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 –
- 22. 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
- 23. 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
- 24. Postabortion Care compared with EmOC • Uterine evacuation • Uterine evacuation • Family Planning• Family Planning Postabortion Care Emergency Obstetric Care only
- 25. FAMILY PLANNING ANC-FP messages- Immediate Post Partum Family Planning 0-48 hours Postpartum FP 6 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 P M T C T P E D I A T R I C C A R E PPFP integrated with MNCH services HIV Opportunities?
- 26. Continuum of Points of Contact for Postpartum Family Planning (PPFP)
- 27. Postpartum Contraceptive Options Timing of Method Initiation and Breastfeeding Considerations
- 28. International Support for PPFP http://www.mchip.net/ppfp http://www.k4health.org/toolkits/ppfp
- 29. • 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. PhotobyR.Mowli/EngenderHealth PhotobyStaff/EngenderHealth Here’s the “health payoff” if FP choice and access are increased!
Notes de l'éditeur
- We are delighted to have this opportunity to talk with you about family planning’s role in maternal and child health and its contribution to Ending Preventable Child and Maternal Deaths: USAID’s contribution to A PROMISE RENEWED , a country-led endeavor with leadership and support from UNICEF and USAID.
- Family planning contributes to child and maternal health by enabling women to choose if and when to become pregnant and thus: -- preventing unintended pregnancies and reducing unmet need for contraception -- helps couples achieve their desired family size -- helping women to use family planning to ensure that pregnancies occur at the healthiest times of women’s lives -- that is: After age 18 and before age 34 At least 24 months after a live birth (about three years between births) Six months after a miscarriage or induced abortion And by preventing many children per woman. (this is awkward. I would use the family size language above)
- Sexually active women of reproductive age in developing countries experience high rates of unintended pregnancy. Nearly 90 percent of the estimated 208 million pregnancies in 2008 occurred in the developing world, according to the Guttmacher Institute. Globally, 86 million pregnancies were unintended; of these, 41 million ended in abortions 33 million in unplanned birth and 11 million in miscarriage. Roughly as many women with unintended pregnancies obtain induced abortions as give birth to a child they had not planned for. The majority of these induced abortions take place in non-medical settings under unsafe conditions. 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 208 million pregnancies 86 m unintended pregnancies 41-44 m abortions 33m unplanned births 11m miscarriages ~50% ~38% ~13%
- This graph shows that maternal mortality is lower among women who become pregnant before age 34. It is important to keep in mind that APR now includes a focus on maternal mortality. The analysis presented in the graph is still underway, and will be shared with us when it is completed. The findings strengthen the rationale for countries to invest in LARCs and LAPMs in the context of a broad method mix to help prevent maternal deaths in the higher age groups, and for programs to help this group of women understand the advantages of LARCs and LAPMs. As far as we know, this is the first comprehensive analysis of advanced maternal age and maternal mortality. This graph shows that maternal mortality is lower when women have fewer children. As far was we know, this is the first comprehensive analysis of the relationship between the number of children and maternal death. These findings also strengthen the rationale for countries investing in LARCs and LAPMs to save women’s lives. This analysis is still underway and will be shared when it is completed. Maternal mortality ratio (maternal deaths per 100,000 live births). FP prevents unintended pregnancy, one of the underlying causes of maternal mortality. [Insert % of pregnancies that are unplanned worldwide?] Postpartum FP and postabortion FP offer important opportunities for more effective linkages with other efforts to end preventable maternal deaths. Challenges to cohesive prioritization of efforts include: insufficient funding and staffing, plus organizational divisions between maternal health and family planning – both in USAID and in the healty facilities and health systems we support What is within our manageable interest to overcome? Within USAID, we can build on our current efforts to become better integrated in our approach to strengthen postpartum FP and postabortion FP
- This graph shows that the risk of under-five mortality is lower among children born about three years after a preceding birth. The graph clearly shows almost three times the risk of child mortality when the pregnancy occurs after a short interval of 6 months or less (see the far left side of the horizontal axis) compared to longer and healthier intervals of about three years or more. SPEAKER CAN STOP HERE Additional information if needed: This slide presents pooled data from 52 Demographic and Health Surveys. The vertical axis presents the adjusted relative risk (adjusted for about 16 socio-economic variables and relative to the risk at 36-47 months) of under-five mortality. The horizontal axis presents birth to pregnancy intervals in months. The analysis was prepared by Shea Rutstein, Technical Director at IFC Macro. The under-five mortality rate is defined as: the number of children who die by the age of five, per 1000 live births per year.
- Family planning contributes to child and maternal health by enabling women to choose if and when to become pregnant and thus: -- preventing unintended pregnancies and reducing unmet need for contraception -- helps couples achieve their desired family size -- helping women to use family planning to ensure that pregnancies occur at the healthiest times of women’s lives -- that is: After age 18 and before age 34 At least 24 months after a live birth (about three years between births) Six months after a miscarriage or induced abortion Shea Rutstein, Technical Director at IFC Macro, analyzed 52 Demographic and Health Surveys. He estimated that if all birth to pregnancy intervals were increased to three years, approximately 1.6 million under-five deaths could be prevented annually . Finally, researchers at Johns Hopkins and the Gates Foundation (Saiffudin Ahmed and Amy Tsui) presented their findings on family planning’s contribution to maternal health in The Lancet in June of 2012. They concluded that, in one year, family planning prevented more than 272,000 maternal deaths, a 44 percent reduction. And if all FP needs were met, an additional 104,000 maternal deaths could be prevented annually. In the next few slides we present some data that show that pregnancies occurring at healthy times of women’s lives contribute to healthier outcomes for the woman and her children. Family planning use can help ensure that pregnancies occur at the healthiest times. In this slide, we present data gathered by WHO that show that perinatal mortality is lower among babies born when the woman is between the ages of 20-29, compared to when she is an adolescent* Family planning can help ensure that women’s pregnancies occur after age 20 and in this way it helps prevent perinatal mortality. SPEAKER CAN STOP HERE. (Additional information if needed is included below.) The slide shows perintatal mortality rates at ages 20-29 and under age 20 in six countries. Data from additional countries are available. The horizontal axis presents perinatal mortality rates – the number of perinatal deaths per 1000 live births.* In each country, as shown on the vertical axis, perinatal mortality is higher when the woman is under age 20, compared to when she is ages 20-29. *The perinatal mortality rate is defined as the number of fetal and infant deaths, including stillbirth, from 28 weeks of gestation to the end of the neonatal period of 4 weeks after the birth, per 1000 live births, in a given period and a specific geographic region. This graph shows that the risk of undernutrition -- meaning child stunting and underweight -- is lower among children born about three years after a preceding birth. The World Food Programme defines underweight as being dangerously thin, and stunting as being too short for one’s age (moved from below). The graph clearly shows significantly higher risk when the pregnancy occurs after a short interval of 6 months or less (see the far left side of the horizontal axis) compared to intervals of about three years or longer. SPEAKER CAN STOP HERE Additional information if needed: This slide presents pooled data from 52 Demographic and Health Surveys. The vertical axis presents the adjusted relative risk (adjusted for about 16 socio-economic variables) of stunting and underweight. The horizontal axis presents birth to pregnancy intervals in months. The analysis was prepared by Shea Rutstein, Technical Director at --.
- FP/MNCH: The goal of FP/MNCH is to meet the need of postpartum and postabortion women by integrating FP into the services that they use and reaching them at every point of contact. Focused Antenatal Care (FANC) + FP counseling Emergency Obstetric Care (EmOC) for PAC + FP counseling and methods Birth and Essential Newborn Care (0-48 hours) + LAM, PPIUD, male/female sterilization, and any methods for non-breastfeeding women Postnatal Care, Immunization & Nutrition (through 1 st year) + LAM & transition, all FP methods after 6 weeks Child health services & Nutrition (through 2-5 years) + all FP methods with a focus on continuation
- Avant de commencer la discussion sur les Résultats de la Recherche, nous devons nous demander pourquoi la planification familiale est tellement importante dans les soins après avortement ? C’est le Counseling et les services de planification familiale qui distinguent les soins après avortement des services obstétricaux d’urgence. Evacuation utérine + planification familiale = soins après avortement Evacuation utérine sans planification familiale= uniquement soins obstétricaux d’urgence. La planification familiale est nécessaire quelle que soit la méthode d’évacuation utérine utilisée, D&C ou AMIU
- This slide portrays the programming streams as they exist. Dotted lines indicate that services are more theoretical than existing. In FP emphasis is placed on integrating FP messages in ANC, then immediate PPFP for long acting and permanent methods as available, with the greatest emphasis on the six week postpartum visit. In maternal health, more emphasis is placed on skilled delivery care and the immediate postpartum period. In neonatal and child health, emphasis is placed on immediate and later postnatal as well as the immunization schedule.