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Study Context

Impact of Integrating Family Planning within a Community-Based Maternal and Neonatal Health Program in Rural Bangladesh Salahuddin Ahmed 1 & 2 , Jaime Mungia 2 , Catharine McKaig 2 , Saifuddin Ahmed 1 , Amnesty LeFevre 1 , Peter Winch 1 , Ahmed Al-Kabir 3 , and Abdullah Baqui 1

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Study Context

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  1. Impact of Integrating Family Planning within a Community-Based Maternal and Neonatal Health Program in Rural BangladeshSalahuddinAhmed1 & 2, Jaime Mungia2, Catharine McKaig2, Saifuddin Ahmed1, Amnesty LeFevre1, Peter Winch1, Ahmed Al-Kabir3, and Abdullah Baqui1 1Johns Hopkins School of Public Health; 2Jhpiego; 3Shimantik

  2. Study Context TFR by Divisions, Bangladesh, 2004 Selected FP indicators in Sylhet, BDHS 2007 2.6 4.2 2.9 2.8 2.9 3.7

  3. Integrated model of PPFP & MNH Evolution of MNCH packages Designed a community-based maternal and newborn care intervention package and evaluated the effectiveness of the package using a cluster randomized design A home care package which involved CHW antenatal and postnatal home visits and management of sick newborn reduced NMR by 34% (Baqui et al., Lancet, 2008) Postpartum FP counseling and contraceptive distribution Newborn care

  4. Study Objectives • To develop and test an integrated Family Planning, Maternal and Neonatal Health (FP/MNH) service delivery approach • To assess the strengths and limitations of integrating FP into an ongoing community-based MNH care program • To assess the impact of the intervention package on contraceptive knowledge and practices including LAM during the extended postpartum period • To assess the impact of the intervention package on pregnancy spacing

  5. Study Design Study sites: eight unions in two sub-districts in Sylhet district, Bangladesh Non-Random Allocation Comparison unions: four Enrolled women: 2257 Intervention unions: four Enrolled women: 2247 Enrollment of women during <8 months of pregnancy Comparison clusters: MNH ONLY during ANC and Postpartum visit Intervention clusters: MNH plus FP during ANC and Postpartum visit Follow the cohort through pregnancy to 36 months postpartum

  6. Intervention Delivery Strategy Service Delivery: Home visits by CHWs Counsel in antenatal and postpartum periods Conduct pregnancy surveillance and provide contraceptives • Messages on LAM and transition, return to fertility, healthy spacing, contraceptive methods • Conduct visits to all households every two months to identify new MWRA and pregnant women • Pills, condoms, and follow up doses of injectables • Refer for other methods Community mobilization: Conduct meetings with husbands, mothers-in-law and community leaders to raise awareness about PPFP messages

  7. Results

  8. Starts in a Low Performance Area Ever Used Contraceptive Method Intervention 18.0 Control 21.1 0 10 20 30 40 50 60 70 80 90 100 Percent

  9. Contraceptive Use Rate at 3, 6, 12, and 18 Months Postpartum by Study Arm

  10. Contraceptive Use Rate at 3, 6, 12, and 18 Months Postpartum by Study Arm • Statistically significant improvement in the contraceptive use rate in the intervention area during the high risk period of first 18 months after delivery • -- 18% ever user before the index pregnancy to 47% at 18 months postpartum • -- 21% ever user before the index pregnancy to 34% at 18 months postpartum • High number of new users and a trend towards increased early adoption

  11. Probability of Contraceptive Adoption by Study Arm P<.001

  12. Self Reported Pregnancy Incidence

  13. Does integration of FP adversely affect MNH program?

  14. CHW Home Visit Coverage *Integrated counseling

  15. Effect of Integration on MNH Care: Selected Newborn Care practices by Study Arm

  16. Duration of Exclusive Breastfeeding by Study Arm

  17. Lessons Learned HFS demonstrates The feasibility of integration of FP within a community-based MNH program. The effectiveness of the model in increasing modern method use. No notable negative effect on the delivery of MNH services. The promotion of LAM had a positive effect on the duration of exclusive breastfeeding.

  18. Shimantik and CDPA Government of Bangladesh ACCESS-FP /MCHIP JHSPH Study Partners Funded by USAID

  19. THANK YOU

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