1. Child Spacing in MCH Programs Harriet Stanley, PhD Hstanley@path.org

2. Overview  Impact of child spacing on the health of women and children;  FP services in development countries: what we’ve learned  Women’s choices  Looking Ahead

3. Child Spacing  Close spacing and high fertility are a significant determinant of poor health of mothers and infants – and impacts the health and socio- economic well being of families

4. Mothers  Avoid unsafe abortion;  Limit health risks of pregnancy and childbirth;  Limit births to healthiest ages;  Limit number of births.

5. Children  Spacing increases chances of survival significantly;  Healthier birth weights, healthier babies;  Assures babies are adequately breastfed.

6. Reducing Excess Fertility  Family planning;  Delayed marriage;  Prolonged breastfeeding;  Abortion

7. Traditional Approaches to Child Spacing  There are many examples of traditional practices that promoted birth spacing:  Women lives with own family;  Polygamy;  Importance of breastfeeding period.

8. Changing Trends  In surveys, women report lower desired than actual fertility or that their last birth was unwanted. Even more report that they want no more children. If they do, they want to wait a significant period of time.

9. Trends  Last 30 years, % couples using contraception from 10% to 50%;  Fertility dropped from average of 6 to 4 children per woman;  FP and socio-economic development both play role to some degree

10. Family Planning Programs – what we’ve learned  At service delivery level – demand, access, choice of methods, client- centered quality, communication.  At program Admin level – leadership, R&D.  At gov’t policy level – political commitment, financial resources.

11. Meeting people’s Needs “Setting targets for contraceptive ‘acceptors’ is not the road to family planning success. Rather, if people are given the opportunity, they choose family planning when it meets their needs.”

12. Field Programs – focus on availability, access and quality  Availability

13. Field Programs cont’d  Access – understanding the barriers:  Distance, time and cost;  Gender, caste and class;  Economic;  Cultural;

14. Field Programs cont’d  Quality  Skilled providers – at all levels;  Safe clinical practices;  Effective counseling;

15. Challenges  Meeting remaining unmet need;  Reaching young, unmarried women;  Increasing men’s involvement;  Linking to broader RH services