Professional Documents
Culture Documents
TFR
Birth Intervals <24 months <36 months
2.7
3.7
2.3
3.1
15% 37%
26% 57%
12% 32%
2
19% 47%
Newborn care
Study Objectives
To design and develop integrated community-based PPFP and MNH program and evaluate the intervention package:
Feasibility and effectiveness-
exposure to key messages contraceptive prevalence, method mix at different postpartum points optimum birth interval adverse pregnancy outcome
Study Design
Study sites: eight unions in two sub-districts in Sylhet district, Bangladesh
Non-Random Allocation Intervention unions: four Enrolled women: 2247 Comparison unions: four Enrolled women: 2257
Enrollment of women during <8 months of pregnancy Intervention clusters: MNH plus FP during ANC and Postpartum visit Comparison clusters: MNH ONLY during ANC and Postpartum visit
Training Orientation
Household level through Community Health Workers (CHW) Community level through Community Mobilizers Facility level through Service Providers
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Messages
ANC Newborn Care, EBF Return to fertility LAM and transition, EBF HTSP FP methods Visit to facility
During pregnancy
Day 6 postpartum
Conduct advocacy meetings with community leaders, religious leaders, teachers and their wives Facilitate targeted male/female group meetings Conduct one-to-one visits to develop role models on LAM
Provide postnatal care Counsel about PPFP methods including LAM Provide FP methods
Womens age1
Womens education (in years of schooling)1 Husbands education1 Parity1
26.5 (24.9-28.1)
4.5 (4.0-5.0) 4.1(3.2-5.0) 2.2 (2.0-2.3) 2135 (95.0) 112 (5.0) 18.0%
26.6 (25.7-27.5)
4.1(3.4-4.8) 4.0 (3.0-5.0) 2.2 (1.9-2.5) 2080(92.2) 177(7.8) 21.1%
0.753
0.026 0.783 0.653
Religion
Muslim Hindu/other Ever contraceptive use before the index pregnancy
1 Data
0.270 0.022
Contraceptive Prevalence Rate was Higher in the Intervention Arm at Each Visit Round
50% 45% 40% 35% 30% 25% 20% 15% 10% 5% 0%
3 months 6 months 12 months 18 months 24 months 30 months 36 months
47%
46%
42% 36%
37% 34% 27% 18% 11% 35%
44% 37%
45% 39%
Intervention
Comparison
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Contraceptive Prevalence Rate was Higher in the Intervention Arm at Each Visit Round
50% 45% 40% 35% 30% 27% 47% 46%
42% 36%
37% 34% 35%
44% 37%
45% 39%
25% Statistically significant improvement in the contraceptive use rate in the intervention area 18% 20% during the high risk period of first 24 months after delivery 15% -- 18% ever user before the index pregnancy to 46% at 24 months postpartum 11% -21% ever user before the index pregnancy to 35% at 24 months postpartum 10% 5% number of new users and a trend towards increased early adoption High 0%
3 months 6 months 12 months 18 months 24 months 30 months 36 months
Intervention
Comparison
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45% 40%
35% 30% 25% 20% 15% 10% 5% 0% Intervention Intervention Intervention Intervention Intervention Intervention Comparison Comparison Comparison Comparison Comparison Comparison Intervention Comparison
3 months LAM
12 months Injectables
24 months Sterilization
30 months
36 months
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Contraceptive Cumulative Adoption Probability Was Higher in The Intervention Arm [with and without LAM]
1.00 1.00
LAM excluded
0.75
Probability
0.50
0.25
0.00
0.00
0.25
0.50
0.75
P <0.001
P <0.001
14
15
12
30
36
Intervention
Wilcoxon P = 0.001
16
Effect of Integration on MNH Care: Selected Newborn Care practices by Study Arm
Intervention (%) 50.4 Comparison (%) 44.1
Drying and wrapping of newborn within 10 minutes of delivery Initiation of Breastfeeding within 30 minutes
56.6
46.8
17
0.00
0.25
0.50
0.75
Lessons Learned
1. Feasibility of integration of PPFP within a community-based MNH program 2. Effectiveness of the model in increasing modern method use during extended postpartum period 3. No notable negative effect on the delivery of MNH services. 4. The promotion of LAM had a positive effect on duration of exclusive breastfeeding. 5. Pregnancy spacing and its health benefits accepted in religiously conservative settings
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THANK YOU
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