1. 1 Healthy Fertility Study Lessons Learnt: Application for Program, Policy and Scaling Up Dr. Catharine McKaig Dr. Ahmed Al Kabir

2. Presentation Outline  Summary of program learning  Implications for program and policy  Global applications  Bangladesh scale up 2 Community Mobilization Meeting, Sylhet Photo: A. Nash-Mercado

3. Program Learning 1) FP Adoption  Integration of FP component increased contraceptive use  Maximum effect during first 18 months  Continued program effect through 36 months  Intervention decreased reliance on withdrawal  Increased equity in contraceptive adoption 3

4. Program Learning 2) LAM  LAM contributed to early protection  Non-LAM users also benefited  LAM use contributed to practice of exclusive breastfeeding 4

5. Program learning 3) Pregnancy  Reduced pregnancy incidence  Reduced short birth interval (<24 months) 5

6. Program learning 4) Design  LAM- including EBF criteria  Importance of HH distribution in this setting with this group (mobility)  Pregnancy surveillance as an opportunity for FP  Postpartum women & influentials require messages about pregnancy risk and amenorrhea  Effective integration with MNH- “ “early and new users” 6 When can Asma become pregnant again?

7. Policy Implications  Focusing on postpartum extends benefits  Identifiable group of women with multiple service contacts and opportunities for FP integration  Evidence that FP integration is a MNH best practice; Addition of FP doesn’t affect delivery/coverage for other interventions  LAM should be advocated based on contraceptive and child survival benefits 7

8. Lessons Learnt  HFS demonstrates the feasibility of PPFP integration within a community-based MNH program with the addition of two postpartum household visits and five messages.  The HFS model led to increased >20% cumulative probability of modern method adoption through 36 months postpartum period, preventing pregnancies that have the highest risk for the women and newborn health. 8

9. Lessons Learnt (Cont.)  The promotion of LAM had a positive effect on optimal breastfeeding practices: duration of exclusive breastfeeding was 25% higher at 6 months among LAM users compared to non-LAM users.  The HFS intervention associated with a 21% reduction of probability of shorter birth intervals (95% CI: 11.7% - 30.4%).  Integration of family planning services within a larger MNCH platform does not have a negative impact on services or other outcomes 9

10. Global Takeaways  MNH benefits from systematically integrating FP  Early & sustained FP use  Reduced probability of short birth intervals  MNH benefits from promoting LAM & EBF together  Duration of EBF 10 CHW Household Counseling Session, Sylhet Photo: S. Ahmed

11. Scaling up in Bangladesh  The work plan of DGFP for 2011-2016 has a provision to strengthening postpartum FP under System Strengthening on FP  This HFS model can be scaled up under the operational plan (2011-16) of CCSDP, DGFP. 11 DGFP, Line Directors and Program Managers reviewing HFS intervention and finding to scale up in Sylhet division on August 27, 2013 at DGFP conference room Photo Credit: Hefzur Rahman

12. Scaling up in Bangladesh  Integrated community package should be scaled up  in low performing divisions (Sylhet, Chittagong) of Bangladesh.  to vulnerable populations (refugee populations).  within low performing districts and sub-districts/ upazilas of Bangladesh.  Program should increase emphasis on continuation of contraceptives once initiated  Program should recognize the needs of women whose husband’s travel abroad and develop messages and program activities to address their specific needs 12

13. THANK YOU! 13 CHW Household Visit, Sylhet Photo: S. Ahmed