Integration of Postpartum Family Planning in to a Community-Based Maternal and Newborn Health Program in Bangladesh: Evidence on Impact on Contraceptive Use and Optimal Birth Spacing

Session: Impact of Family Planning on Maternal Newborn Health

Presenter: Saifuddin Ahmed, Department of Family and Reproductive Health/International Center for Maternal and Newborn Health, Johns Hopkins Bloomberg School of Public Health
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Background: Promoting contraceptive use immediately after birth is considered an important family planning (FP) programmatic strategy. The integration of FP and maternal and newborn health (MNH) services is expected to provide a “gateway” for reaching women during antenatal care and soon after birth for FP counseling and services. However, few studies examined the effects of MNH-FP program integration in resource-poor settings and the results are mixed.

Methodology: Using a quasi-experimental trial design, this study examined the effect of MNH-FP integration on improvement of postpartum contraceptive use and reduction of short birth intervals < 24 months in 4,504 pregnant women in a rural district of Bangladesh.  Intervention women received a package of integrated MNH and FP interventions and control women received MNH interventions only. Locally recruited CHWs counselled on risks of closely spaced births, timing of return to fertility, benefits of longer birth intervals, promoted use of LAM and modern methods, and distributed oral pills and condoms. Standard FP services from the Ministry of Health and Family Welfare (MOHFW) were available in both the intervention and comparison areas. A team of data collectors, independent of the CHWs, conducted surveys 8 times over a three year period.

Results: Integration of FP with MNH program was not associated with any negative impact on MNH services; rather there was a synergy. There was a 20% increased cumulative probability of modern contraceptive method adoption through 36 months postpartum period, preventing pregnancies that had the highest risk for the women and newborn health. The intervention women experienced a 21% lower probability of shorter birth intervals (95% CI: 11.7% – 30.4%) and 20% lower risk of preterm birth.

Conclusion: MNH programs should consider systematically integrating FP as it would offer women benefits from early and sustained use of FP and reduced risk of short birth intervals.