Integrated family-planning, maternal, newborn and child health services in a low-resource area of rural Bangladesh

Background: In the study area of Sylhet, Bangladesh, 90% deliveries occur at home, 26% births occur at intervals less than 24 months, contraceptive prevalence rate (CPR) was 31% and unmet need for family planning (FP) was 26%. Intervention: The Community Health Workers (CHW), one per 4000 population, conducted antenatal and postpartum counseling on maternal, neonatal and child health (MNCH) care in both intervention and comparison areas; pregnancy spacing and FP counseling were integrated in intervention area only. Evaluation Design: Using a quasi-experimental design a cohort of 4504 pregnant women – 2247 in intervention and 2257 in comparison arms were followed from December 2007 to June 2011. Quantitative data were collected from the consented cohort longitudinally from pregnancy to 18 months postpartum at five time points. Results: Counseling coverage by CHWs during pregnancy (99% vs. 99%; p>0.1) and within first week of delivery (86% vs. 89%; p>0.1) were similar in both arms. CPR at three months (36% vs. 11%; p<0.01), six months (37% vs. 18%; p<0.01), 12 months (42% vs. 27%; p<0.01) and 18 months (47% vs. 34%; p<0.01) postpartum were significantly higher in intervention arm with significant changes in the method mix over time. Exclusive breastfeeding at three (58% vs. 47%; p<0.01) and five months postpartum (40% vs. 25%; p<0.01) were higher in intervention arm. Conclusion: FP messages were well integrated with MNCH counseling. More women used contraceptives during 18 months postpartum period, preventing pregnancies that have the highest risk for the mother and newborn.