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Optimal Birth Spacing Interval

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One Solution Avoid 'Too close together' through an Optimal Birth Spacing Interval ... Young Women Have Births That Are 'Too Close Together' Developing Countries ... – PowerPoint PPT presentation

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Title: Optimal Birth Spacing Interval


1
Optimal Birth Spacing Interval
2
Keys to Reducing Maternal and Child Mortality
  • The Problem
  • Births are risky when they are
  • Too many
  • Too close together
  • Or when they occur among women who are
  • Too young
  • Too old
  • One SolutionAvoid Too close together through
    an Optimal Birth Spacing Interval

3
Objectives
  • Understand the new research findings
  • Understand the scope of the problem
  • Understand what programs can do

4
What Is Optimal Birth Spacing?
  • The length of time needed between births to
    minimize the risks for adverse health
    outcomesnew research indicates this is three
    years or longer.
  • A fundamental, but often underemphasized, part of
    family planning/reproductive health.
  • A way to address family planning that does not
    interfere with many cultural norms.

5
Significant Health Benefits
  • For Children
  • Lower risk for
  • Stunted and underweight child
  • Small for gestational age
  • Low birth weight
  • Preterm birth
  • Child death
  • Infant death
  • Neonatal death
  • Fetal death
  • For Mothers
  • Lower risk for
  • Malnutrition from overlap of pregnancy and
    breastfeeding
  • Puerperal endometritis
  • Premature rupture of membranes
  • Anemia
  • Third trimester bleeding
  • Maternal death

6
Benefits of Optimal Birth Spacing
  • Contributes to preserving the health and
    fertility of women and their overall quality of
    life
  • Contributes to improving childrens lives by
    increasing their access to adequate food,
    clothing, housing, and educational opportunities
  • Decreases a womans work burden
  • Provides a cost-effective means of improving
    health and quality-of-life compared with other
    investments

7
New Research
  • Child morbidity, mortality, and nutrition
    (developing countries)
  • Child morbidity and mortality (developed country
    USA)
  • Maternal morbidity and mortality (developing
    countries)

8
New Research
  • What is new about this research?
  • Controls for many important variables
  • Allows for comparison between developing and
    developed settings
  • Large sample sizes
  • Few studies look at impact of birth spacing on
    maternal health

9
Intervals Associated with Lowest Mortality Risk
for Children Developing Countries
Source Rutstein, S. 2003.
10
Intervals Associated with Lower Mortality Risk
for InfantsAsian Countries
Adjusted Odds Ratio
Source Rutstein, S. 2002.
11
Longer Intervals Lead to Improved Child Nutrition
Developing Countries
Source Rutstein, S. 2003.
12
Intervals Associated with Lowest Maternal
Morbidity and MortalityLatin America
Source Conde-Agudelo, A. and J. Belizan. 2000.
13
Rates of Adverse Perinatal Outcomes According to
Inter-Pregnancy Interval After a Miscarriage
14
Birth Spacing Longer than Five Years Is
Associated with Risk for Maternal MorbidityLatin
America
Source Conde-Agudelo, A. 2002.
15
Potential Public Health ImpactChildren
  • Derivation of deaths averted based on
  • Adjusted Odds Ratios derived from the Demographic
    and Health Surveys (DHS) regression equations
  • Mortality rates from DHS
  • Projected number of births in given year using
    projection of women 15-49 from UN population
  • No projections available for maternal healtharea
    for further research.

Source Rutstein, S. 2003.
16
Annual Number of Deaths Among Children Under Age
5 with Existing Birth Intervals and Minimum
Intervals of 24 and 36 MonthsDeveloping Countries
1,931,000 deaths averted
Additional 945,000 deaths averted
Source Rutstein, S. 2003.
17
Optimal Birth SpacingRelevance for Developed
Countries
  • Research from developed country two studies by
    the Centers for Disease Control and Prevention
    (CDC-P) in Michigan and Utah
  • Similar methodologies variables between CDC-P and
    CLAP studies
  • Offers an opportunity to compare effect of the
    birth interval on children in different settings
  • No data comparing effect on maternal healthan
    area for future research

18
A Comparison Optimal Birth Spacing in Developed
and Developing Countries
Source Conde-Agudelo, A. 2002. Zhu, B.P. et al.
2001. Zhu, B.P. et al. 1999.
19
Scope of the Problem
  • Many women, especially young women, in developing
    countries are having births too close together.
  • Many women want longer birth intervals than they
    are achieving.
  • Birth spacing decisions are complex.
  • Few tools exist (e.g., job aids, counseling
    manuals) that would help providers educate
    clients on the benefits of optimal birth spacing.

20
Issue Many Young Women Have Births That Are Too
Close Together Developing Countries
70
70
68
66
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64
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61
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59
58
58
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56
49
48
36
Source Venugopal, V. and Setty Upadhyay, V.D.
2002.
21
Issue Many Young Women Have Births That Are Too
Close Together Latin American Countries
Source Venugopal, V. and Setty Upadhyay, V.D.
2002.
22
Issue Many Young Women Have Births That Are Too
Close Together continued
  • Problem
  • In Latin America, an average of 90 of women
    ages 15-19 and 68 of women ages 20-29 have birth
    intervals of less than three years.
  • Programmatic Strategy
  • Focus Optimal Birth Spacing education on young,
    low parity women, newly married and engaged
    couples

23
Issue Many Women Want Longer Birth Intervals
Than They Are Achieving
Of postpartum women, only 3 want birth within 2
years, yet only 40, on average, are actually
using a family planning method.
Source Ross, John A. and William Winfrey. 2001.
24
Issue Many Women Want Longer Birth Intervals
Than They Are Achieving continued
  • Problem
  • Only 3 of postpartum women want a new baby
    within two years, yet only 40 on average are
    actually using a family planning method for birth
    spacing.
  • Programmatic Strategy
  • Integrate Optimal Birth Spacing information and
    services into existing programs and identify
    missed opportunities.

25
Issue Birth Spacing Decisions Are Complex
  • Focus group discussions from Peru, Bolivia,
    India, Pakistan, and Egypt show
  • Beliefs in favor of Optimal Birth Spacing
  • Concern for health of mother and baby
  • Economic considerations
  • Barriers to Optimal Birth Spacing
  • Gender inequity
  • Cultural expectations and norms as expressed by
    mothers-in-law and community leaders
  • Erroneous beliefs about modern contraception

Source CATALYST Consortium. 2003.
26
Issue Birth Spacing Decisions Are Complex
continued
  • Problem
  • There are few programs that emphasize the
    benefits of birth spacing and few communication
    campaigns on birth spacing.
  • Programmatic Strategy
  • Create culturally appropriate communication
    campaigns on Optimal Birth Spacing.

27
Communication Campaigns
  • Media Campaigns
  • -Radio
  • -Television
  • -Newspaper
  • -Posters

28
Issue Great Variation in the Messages Women
Receive from Providers
  • Problem
  • Many providers did not know about the benefits
    of birth spacing, nor did they communicate this
    to clients.
  • Programmatic Strategy
  • Create user-friendly and culturally appropriate
    job aids to make the message easy to communicate
    to clients.

29
Optimal Birth Spacing Counseling Recommendations
  • Women and Couples should be counseled
  • About the health and economic benefits of spacing
    their children
  • Waiting three years from the birth of the last
    child before getting pregnant

30
The Message
  • Mothers should wait for their youngest child to
    turn three years old before their next pregnancy.

31
Summary
  • Women and men have the right to know that Optimal
    Birth Spacing is associated with
  • Lower risk for perinatal, neonatal, infant
    mortality
  • Lower risk for poor nutritional outcomes
  • Lower risk for maternal morbidity and mortality.
  • There are simple programmatic strategies that can
    help women achieve the birth intervals that they
    desire and that can contribute to healthy
    outcomes for themselves and their children.

32
Resources
  • CATALYST Consortium
  • OBSI Training Guide for Counselors
  • Cue Cards
  • Fact Sheet
  • Pathfinder
  • Family Planning Counseling Manual with OBSI
    content
  • JHU Center for Communication Programs
  • Population Report
  • MACRO
  • Recommendations on how NGOs and PVOs can
    integrate OBSI into programs
  • USAID
  • Guidance document

33
For More Information
  • 1201 Connecticut Avenue, N.W.
  • Suites 500/501
  • Washington, D.C. 20036
  • 202-775-1977
  • info_at_rhcatalyst.org
  • www.rhcatalyst.org
  • 1615 Thames Street
  • Baltimore, MD 21231
  • 410-537-1800
  • info_at_jhpiego.net
  • www.reproline.jhu.edu
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