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

Presented at

Family Planning Budget Training Workshop

June 22 24, 2011

Kabir M. AbdullahiNURHI Kaduna, State Team Leader

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Objectives

At the end of the presentation participantswould 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

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What we Mean by Birth Spacing

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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%

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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/shortspacing of births and pregnancy

Mortality reduction strategies (free MCH) do not includepregnancy spacing//childbirth spacing

Dearth of skilled personnel trained on Birth Spacing

Training/counseling materials for birth spacingunavailable

Desire for large family size

Conspiracy of silence on the benefits of FP/childbirthspacing by religious leaders

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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 & Conde-

Agudelo A. Systematic Literature Review and Meta-Analysis of the Relationship between Interpregnancyor Interbirth Intervals and Infant and ChildMortality. Reports submitted to CATALYST Consortium, October 2004, Conde-Agudelo, A. and Belizan, J.M. Maternal morbidity and mortalityassociated with interval: Cross sectional study. British Journal (Clinical Research Ed.) 321 (7271): 1255-1259. Nov. 18, 2000.

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Birth Intervals Effects on Newborn and

Child Health

24 months birth intervals, or longer, areassociated with lowest risk of stunting andunderweight among under-five children

LBW is an indirect cause of 60-80% ofneonatal deaths

Risk of death among under-five children is

lower if the preceding birth interval was lonerthan 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)

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Neonatal Mortality RISK declines withincreasing birth-to-birth interval length up

48 59 months

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Birth Spacing SavesChildrens Lives

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Birth Spacing Saves Mothers Lives

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How Much Death Would beAverted?

In Nigeria thousands deaths could be avertedannually if births occurred after longerintervals

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 fallby165,000 annually

Fertility Rate would drop by 8%

Source: Shea Rutstein, PhD, Measure/DHS+,Macro International, Inc.

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Consequences of Shorter BirthInterval !!!

When births are too close, families cannot take care ofseveral small children, they are weaned too soon, andthey are thus at greater risk of dying;

When children are weaned too soon, their growth

suffers, they are more likely to suffer from diarrhealdisease, and skins infections, and they are thus greaterrisk of dying

When women have too close pregnancies, they have

greater risk of pregnancy related and deliverycomplications

Spacing births more than 24 months can reduce the riskof morbidity and mortality for mothers and children.

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Overall Benefits of Birth Spacing

Healthy timing and spacing of pregnancy isassociated with multiple health and other benefitsto mother, neonates and children

It is associated with reduced health risks to mother

and child

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

It is a key strategy for preventing maternal, infantand child morbidity and mortality.

It is complementary to all care and treatmentstrategies for mother and children

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WHO Recommendation for Spacing

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

After a miscarriage or induced abortion, the

recommended minimum interval to next pregnancyshould be at least six months in order to reducerisks of adverse maternal andperinatal outcomes

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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 yearsafter a live birth but not more than five years before trying tobecome pregnant again.

After a miscarriage or abortion:

Couples should use an effective FP method of their choicecontinuously 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 theirchoice continuously until they are 18 years old before trying

to become pregnant. Source: ESD Pocket guide, version 2006

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Suggested Strategies to helpCouples Space Birth

Increase access to good-quality contraceptiveservices and full range of methods,

Encourage community campaigns that speakabout needs of younger couples and cultural

norms and tradition beliefs,

Use prenatal and post natal periods as crucialtimes for information and counseling about birthspacing,

Discuss with mothers the benefits of maintaining 2- 3 years for the next child,

Support initiative that strengthen the womendecision- making power in the household.

Source: Population Reports, Volume XXX, Number 3, Summer 2002 (11)

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How Do we Integrate?

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