The Effect of Integrating Family Planning with a Maternal and Newborn Health Program on Postpartum Contraceptive Use and Optimal Birth Spacing in Rural Bangladesh.
Meeting postpartum contraceptive need remains a major challenge in developing countries, where the majority of women deliver at home. Using a quasi-experimental trial design, we examine the effect of integrating family planning (FP) with a community-based maternal and newborn health (MNH) program on improving postpartum contraceptive use and reducing short birth intervals <24 months. In this two-arm trial, community health workers (CHWs) provided integrated FP counseling and services during home visits along with their outreach MNH activities in the intervention arm, but provided only MNH services in the control arm. The contraceptive prevalence rate (CPR) in the intervention arm was 15 percent higher than in the control arm at 12 months, and the difference in CPRs remained statistically significant throughout the 24 months of observation. The short birth interval of less than 24 months was significantly lower in the intervention arm. The study demonstrates that it is feasible and effective to integrate FP services into a community-based MNH care program for improving postpartum contraceptive use and lengthening birth intervals.
Associate Professor, Department of Population, Family and Reproductive Health, Bloomberg School of Public Health, Johns Hopkins University, 615 North Wolfe Street #E4642, Baltimore, MD 21205. sahmed@jhsph.edu.
Saifuddin
S
Ahmed
Research Coordinator, Johns Hopkins University-Bangladesh/Projahnmo Study Group, Dhaka, Bangladesh.
Salahuddin
S
Ahmed
Coordinator, Johns Hopkins University-Bangladesh/Projahnmo Study Group, Dhaka, Bangladesh.
Catharine
C
McKaig
Country Director, Jhpiego, Baltimore, MD.
Nazma
N
Begum
Senior Program Officer, Jhpiego, Baltimore, MD.
Jaime
J
Mungia
Senior Technical Advisor, Office of Population and Reproductive Health, United States Agency for International Development, Washington, DC.
Maureen
M
Norton
Professor, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
Abdullah H
AH
Baqui
D000328:Adult; D001459:Bangladesh; D001721:Birth Intervals / Q000523:psychology / Q000706:statistics & numerical data; D003267:Contraception / Q000379:methods / Q000706:statistics & numerical data; D003268:Contraception Behavior; D019033:Delivery of Health Care, Integrated; D005193:Family Planning Services / Q000379:methods / Q000592:standards; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006301:Health Services Needs and Demand; D006801:Humans; D000068104:Infant Health; D007231:Infant, Newborn; D008297:Male; D008427:Maternal Health Services / Q000592:standards; D011181:Postnatal Care / Q000379:methods / Q000592:standards; D049590:Postpartum Period / Q000523:psychology; D011247:Pregnancy; D012424:Rural Population; D012736:Sex Education / Q000379:methods / Q000592:standards