Repositioning Family Planning in West Africa Repositionnement de la Planification Familiale en Afrique de l’Ouest Sponsored by: U.S. Agency for International Development (USAID), World Health Organization (WHO), Action for West Africa Region Project - Reproductive Health (AWARE-RH), Advance Africa, the POLICY Project Dr. Therese N. S. LESIKEL Regional Adviser in Reproductive Health Training & Family Planning Division of Family & Reproductive Health (WHO/AFRO) Spacing Births to save lives and preserve families: an overlooked strategic opportunity

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

Infants are more likely to survive if the previous birth interval is at least 3 years. Very few children in West Africa are spaced at a birth interval of 3 or more years. Using family planning to achieve longer birth intervals saves lives

New evidence about birth intervals’ effects on maternal and child mortality and morbidity USAID 2004 Birth Spacing Meta-Analysis Considered 14 million pregnancy outcomes

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 In 2003, if women in developing countries (excluding China) 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.

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): Nov. 18, Evidence of longer birth intervals effects on health

Family Planning for longer birth interval can reduce the neonatal, infant, under five and maternal morbidity and mortality Examples from few selected countries

Source: Shea Rutstein, PhD, Measure/DHS+,Macro International, Inc, 2005 Tens of thousands of deaths could be averted annually in Mali if births occurred after longer intervals

In Mali, if no births occurred before 36 months of a preceding birth: Infant Mortality Rate would drop 31% Under Five Mortality Rate would drop 32% Deaths to children under five years of age would fall by 45, 000 annually Mali

Source: Shea Rutstein, PhD, Measure/DHS+,Macro International, Inc. In Nigeria, if no births occurred before 36 months of a preceding birth: Infant Mortality Rate would drop 24% Under Five Mortality Rate would drop 15% Deaths to children under five years of age would fall by 96,200 annually Nigeria

In Benin, if no births occurred before 36 months of a preceding birth: Infant Mortality Rate would drop 18% Under Five Mortality Rate would drop 15% Deaths to children under five years of age would fall by 8,100 annually Benin

In Côte d’Ivoire, if no births occurred before 36 months of a preceding birth: Infant Mortality Rate would drop 20% Under Five Mortality Rate would drop 31% Deaths to children under five years of age would fall by 33,200 annually Côte d’Ivoire

In Ghana, if no births occurred before 36 months of a preceding birth: Infant Mortality Rate would drop 27% Under Five Mortality Rate would drop 23% Deaths to children under five years of age would fall by 21,700 annually Ghana

In Senegal, if no births occurred before 36 months of a preceding birth: Infant Mortality Rate would drop 21% Under Five Mortality Rate would drop 13% Deaths to children under five years of age would fall by 10,000 annually Senegal

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 Percent of women who desire another birth within two years of previous birth Few post–partum women want another birth within two years, yet many do not use family planning

Source: Most recent DHS survey Percent of women with birth intervals less than 3 years Large percentages of too closely spaced births occur among women ages 20-29

Source: Shea Rutstein, PhD, Measure/DHS+,Macro International, Inc. More Lost Benefits due to Current Short Birth Intervals Avoiding short birth intervals would lower both fertility, maternal, infant and child mortality by additional substantial amounts West African countries’ fertility would drop by half a child if no intervals were shorter than 36 months The fertility rate would drop 8-10%, or about half a million births per year.

CountryNumber of years between DHS surveys % Reduction between first and last survey Mali8% has increased Nigeria94 Senegal117 Source: Setty-Venugopal, V. and Upadhyay, U.D., three to Five Saves Lives, Population Report Summer 2002 Percentage of Married Women of Reproductive Age Reporting Birth Intervals Under 3 Years, Multiple Surveys, * Data show minimal change in birth interval trends

When births are too close, families cannot take care of several small children, they are weaned too soon, and they are thus at greater risk of dying; When women have too close pregnancies, they have greater risk of pregnancy related and delivery complications Spacing births more than 3 years can reduce the risk of morbidity and mortality for mothers and children. Conclusion: Consequences of shorter birth interval Source: Shea Rutstein, PhD, Measure/DHS+,Macro International, Inc.

Source: Population Reports, Volume XXX, Number 3, Summer 2002 (11) Conclusion: Strategies to space Births Increase access to good-quality contraceptive services with full range of contraceptive methods, Encourage community based programs that speak about needs of younger couples – and cultural norms and tradition beliefs, Use prenatal and post natal periods as crucial times for information and counseling about birth spacing the birth of next child, Discuss with mothers during well-baby and immunization visits the benefits of using FP for 3-5 years before the next child, Support initiative that strengthen the women decision-making power