A model of integration: Postpartum family planning through a community based maternal and newborn program

Background

In Bangladesh, neonatal mortality remains high, and 17% of births occur at intervals less than 24 months. We describe an innovative intervention strategy for an area of rural Bangladesh where over 90% of births occur at home, and demonstrate how promotion of pregnancy spacing and family planning can be effectively integrated into this package for postpartum women.

Intervention

The intervention consists of (i) systems and capacity strengthening by training of the health providers and, (ii) community-based advocacy and behavior change communication that is targeting pregnant and postpartum women and their families. Female community health workers, one per 4000 population, conduct antenatal and postpartum home visits during which they counsel families on newborn care, the lactational amenorrhea method (LAM), transitional methods and on healthy timing and spacing of pregnancy. Community Mobilizers organize advocacy and community meetings with influential persons including religious leaders, their wives; and identify people to serve as role models on LAM.

Evaluation Design

The study has a quasi-experimental design. It follows 4430 pregnant women longitudinally from pregnancy to 36 months postpartum at eight time points, in Sylhet district, Bangladesh

Conclusion

Expected outcomes include increased knowledge and practice of LAM, use of balanced method mix during extended postpartum period and increased pregnancy interval.

These results using data collected during the first one and a half years of the study will describe community knowledge and practices of using LAM and other modern contraceptives and also would reveal the impact of integrating FP component within community-based MNCH program.