Transcript Slide 1

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
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
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)
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.
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 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.
New evidence about birth intervals’
effects on maternal and child mortality
and morbidity
USAID 2004 Birth Spacing Meta-Analysis
Considered 14 million pregnancy
outcomes
Three to five year birth intervals=lowest
mortality risks for children under-five
Adj Relative Odd ratio
Uner Five Mortality by Birth Interval 17 DHS Surveys
3.5
3
2.5
2
1.5
1
0.5
0
2.98
1.88
1.53
1.25
1.00 1.03
0.8
0.79 0.81
<18 18-23 24-29 30-35 36-41 42-47 48-53 54-59 60+
Ref
BI in months
Three to five year birth intervals=lowest
mortality risks for neonatal mortality
Adj Relative Odd ratio
Neonatal Mortality by BIRTH Interval 17 DHS Surveys
3
2.65
2.5
2
1.6
1.22
1.5
1.17
1.00
1.06
0.96
0.96
36-41
Ref
42-47
48-53
54-59
1.12
1
0.5
0
<18
18-23
24-29
30-35
BI in months
60+
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)
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.
Few post–partum 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
9.30%
Percent of Women
5.10%
3.70%
Mali
Seneagl
Ghana
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
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
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 close—
increased 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.
Conclusion
Strategies to space Births
Increase access to good-quality family
planning services—appropriate 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)
Conclusion
Strategies 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
women’s decision-making power