1 Healthy Fertility Study: Results Saifuddin Ahmed Associate Professor Johns Hopkins University, USA September 26, 2013

Evaluation framework for results presentation 2 Process/output indicators Outcome indicators Impact indicators Pregnancy intervals (birth- to-pregnancy) Birth intervals (birth-to-birth ) Neonatal/infant/ch ild mortality Exclusive BF and LAM use CPR Contraceptive choice Contraceptive adoption Contraceptive continuation Coverage of CHW home visits Participation and attendance at HFS community meetings HFS Intervention Impact Evaluation Results translation Policy Advocacy Scale-up Research: next?

Contraceptive Prevalence Rate was higher in the intervention arm at each visit round 3

Long term methods use rates were higher in the intervention arm 4

Contraceptive cumulative adoption probability was higher in the intervention arm [with and without LAM] 5

Leading reasons reported for not using a contraceptive method Intervention N=519 Comparison N= 864 Husband abroad49%16% Wanted to become pregnant 39% Husband disapproves37%42% Religious prohibition14%23% Health concerns11%16% 6

Inequity in contraceptive use was reduced by intervention 7

Impact on lengthening pregnancy and birth intervals  Birth-to-pregnancy intervals  Birth-to-birth intervals 8

Birth to pregnancy interval was higher in the intervention arm after the delivery of the index child 9 Hazards ratio: 0.79; 95% CI:

Risk of shorter birth interval (birth-to- birth) was also lower in the intervention arm 10 The hazards of shorter birth intervals reduced by 21% (95% CI: 11.7% %).

Impact on adverse birth outcomes  Among subsequent births, preterm births were lower in the intervention arm (20% vs 24%)  Adjusted odds of preterm birth outcomes were 20% lower in the intervention area, compared to the control area  (OR: 0.80 [95% CI: ]). 11

In summary… 12 In the intervention arm: Contraceptive acceptance rate was significantly higher LAM at 3 months postpartum was practiced by ~25% women, compared to only few in the control arm The modern contraceptive prevalence rates (CPR) were consistently higher Inequity in contraceptive use was reduced

Continued…  Short birth intervals and birth-to-pregnancy intervals were significantly lower  Intervention is likely reduce preterm births in subsequent pregnancies 13