1. Office of Global Health and HIV (OGHH) Office of Overseas Programming & Training Support (OPATS) Maternal and Newborn Health Training Package Session 3: Healthy Timing and Spacing of Pregnancy

3. Benefits of family planning for maternal and newborn health Family planning:  Saves women’s lives  Saves adolescents’ lives  Saves children’s lives  Reduces deaths from AIDS

4. Healthy timing of pregnancy  Refers to the healthiest ages for pregnancy to occur: when a woman is between 18 and 34 years of age  Pregnancies that occur before the age of 18 and after the age of 34 are higher risk

5. Health risks of teenage pregnancy  The risk of maternal mortality is highest for adolescent girls under 15 years old.  Complications in pregnancy and childbirth are a leading cause of death among adolescent girls in most developing countries.  Babies born to women younger than 18 are more likely to be born pre- term, have low birth weight and have problems during birth that could be fatal.  Behavior: delay first pregnancy until 18 years of age or older.

6. Health risks of high-parity women  Women with 5+ children are 1.5 to 3 times more likely to die from complications of pregnancy and childbirth than women with 2–3 children  Women with 3+ children are more likely to suffer from anemia, require blood transfusion during delivery, and die of bleeding than are women with fewer children

7. Healthy spacing of pregnancy  Spacing refers to the amount of time a woman should wait after a live birth, abortion, or miscarriage before attempting to get pregnant again. – At least 24 months after a live birth (approximately 3 years between births) – At least 6 months after an abortion or miscarriage

8. Unmet need for family planning  More than half of all couples in the developing world now use a modern method of contraception  But, about 222 million women in the developing world who want to avoid a pregnancy are NOT using a modern method of contraception

9. Reasons for unmet need  Poor access to family planning services (especially women in rural areas, youth, and the urban poor)  Poor quality of family planning services and counseling  Poor availability of family planning supplies and limited choices of contraception

10. Barriers related to demand for family planning  Worry about side effects or health concerns  Fear of a partner’s opposition  Social disapproval  Belief that religion does not support family planning

11. (Post adaptation)  Country-specific data and information on unmet needs for family planning and causes.

12. Methods of contraception Oral contraceptive pills Injections (e.g., Depo-Provera) Intrauterine device (IUD) Implants Lactational Amenorrhea Method (LAM) Male/female condom Female & male sterilization Emergency contraception Diaphragm Foam/jelly Modern Methods Periodic abstinence (“natural family planning” or fertility awareness method) Withdrawal Country-specific traditional methods Traditional Methods

13. (Post adaptation)  At this point, take time to share more country-specific information. For example, if countries emphasize family planning as a key HIV prevention strategy, share that information. Briefly describe any country-specific initiatives related to “repositioning” family planning. Include information on local resources such as UNFPA, USAID, MOH, and other programs including IPPF affiliate information.  See http://africahealth2010.fhi360.org/PDF/RFP_English.pdf.http://africahealth2010.fhi360.org/PDF/RFP_English.pdf  Clarify country-specific policies and availability of family planning methods.  Review country-specific information on preferences for particular modern and traditional family planning methods and the rationale underlying these preferences.

14. Family planning counseling and services on the continuum of care

15. Family planning over time  Adolescence and before pregnancy  During pregnancy  Birth  Postnatal care  Motherhood

16. Family planning at different levels  Health facilities level – Family planning counseling and methods provision  Community & outreach level and household level – Community health workers – Social marketing of family planning products – Information, education, social and behavior change programs – Outreach to underserved populations