International Family Planning Conference, 2013
World Vision: A Christian NGO Builds
Support for Family Planning
Addis Ababa, November 15, 2013
Adrienne Allison, MA, MPA
Technical Advisor FP/RH, World Vision
WV’s Partnership Policy on
Reproductive Health, 2006
• In 2006, the WV partnership updated and broadened the
1996 Partnership Policy on Family Planning. It states:
• “WV’s reproductive health programs are based on biblical principles,
the best medical knowledge available, and good medical ethics
• WV employs established best practices for reproductive health
• WV holds the position that human life begins at conception. WV does
not provide, recommends nor support abortion nor methods of family
planning that are determined to be abortive
• Effective reproductive health programs include both men and women
• WV respects the rights of parents to make their own decisions about
family size and spacing without coercion.
• WV programs offer complete, accurate, unbiased, updated and
comprehensive information disseminated in a caring, respectful,
empowering culturally and age-appropriate manner.”
World Vision’s Goal:
Sustained well-being of children
within families and communities
“Reproductive Health” was not compelling and programs failed
to thrive
But, as new data were published quantifying the impact of timing
and spacing pregnancies on child and maternal health, WV
related them to WV’s goal – the sustained well-being of
children within families and communities and showed how
healthy timing and spacing of pregnancies increased the
likelihood of:
• Children enjoy good health
• Children are educated for life
• Children experience love of God and their neighbors
• Children are cared for, protected, participating
New data spur new values
• Moving from “family planning” to “reproductive health” to “Healthy
Timing and Spacing of Pregnancies” encouraged WV to focus on
healthy fertility
• Internally, the health staff in WV offices in almost 100 countries
joined webinars, participated in workshops, and received papers and
publications on Health Timing and Spacing of Pregnancies
• Externally, WV staff began to integrate these same messages into their
ongoing MNCH (maternal, newborn child health) programs and
MIYCN (maternal infant and young child nutrition) programs to
improve program outcomes
• WV staff and CHWs (community health workers) discussed the data
and their implications with religious leaders, other influentials, fathers,
mothers and mothers-in-law.
World Vision’s Global Health & Nutrition
Strategy
Pregnant Women
1. Adequate diet
2. Iron/folate supplements
3. Tetanus toxoid
immunisation
4. Malaria prevention (IPT)
5. Healthy Timing and
Spacing of
Pregnancies (HTSP)
6. De-worming
7. Access to antenatal and
postnatal care, skilled
birth attendance,
prevention of mother-tochild transmission of
HIV
Children 0-24 months
1. Appropriate breastfeeding
2. Essential Newborn Care
3. Hand washing
4. Appropriate complementary
feeding (6-24 months)
5. Adequate iron
6. Vitamin A supplementation
7. Oral Rehydration Therapy &
Zinc
8. Care seeking for fever
9. Full immunisation for age
10. Malaria prevention
11. De-worming (+12 months)
What is Healthy Timing and
Spacing of Pregnancy – HTSP?
• HTSP includes analyses of 52 Demographic and Health Survey
(DHS) data covering 1.12 million births in developing
countries from 2000 to 2005
• Researchers analyzed the impact of length of the preceding
birth interval, maternal age and parity on infant, child and
maternal mortality and malnutrition
• Data show that timing and spacing pregnancies lowers infant,
child and maternal mortality, and reduces stunting and wasting
• Following are examples of the data and messages we use:
Birth-to-Pregnancy Intervals and
Relative Risk of Neonatal and Infant Mortality
Mortality Risk
4
3.5
3
Infant
Neonatal
2.5
Early Neonatal
2
1.5
1
0.5
0
<6
6 to 11
12 to 17 18 to 23 24 to 29 30 to 35 36 to 47 48 to 59
Birth-to-Pregnancy Interval (months)
Source: Rutstein, 2008
Shea Rutstein, Ph.D., Measure DHS
1,049,122 births
Shea Rutstein, Ph.D., Measure DHS
Annual Number of Under Five Deaths
with Existing Birth to Conception Intervals
and with Minimum Intervals of 24 and 36 months, 2012
9000
8000
797,000 deaths averted
Additional 842,000 deaths
averted
7000
Thousands of deaths
6000
5000
4000
Existing Intervals
3000
Min. 24 mos.
Min. 36 mos.
1,639,000 deaths could
be averted every year
by proper spacing
2000
1000
0
Developing Countries
Age of Mother
Parity
Spacing
Percent of Children Alive and Not Undernourished by Duration of Preceding
Birth to Conception Interval
80%
75%
75%
70%
Percent of children
71%
352,447 births in 52
DHS surveys
63%
65%
63%
59%
60%
55%
52%
55%
48%
50%
Alive and not
undernourished
45%
43%
45%
40%
<6
6-11
12-17
18-23
24-29
30-35
Interval in months
Shea Rutstein, Ph.D., Measure DHS
36-47 ref.
48-59
60-95
96+
Impact of birth-to-pregnancy interval on
mortality
•
•
•
•
•
•
1.6 million deaths in children under 5 could be eliminated
if all birth-to-pregnancy intervals were 24 to 36 months
Pregnancy is the leading cause of death for teenage girls
globally
Girls age 15 to 19 are twice as likely to die in pregnancy
and childbirth as those age 20 – 24
Girls less than 15 years old are 5 times more likely to die
Infants of teenage girls are almost twice as likely to die as
those born to mothers age 20 – 24.
Up to 40% of infants whose mothers’ die after childbirth
will likewise die before their first birthday.
Save, 2007
MIYCN + HTSP
Maternal infant and young child feeding is integrated with FP and
HTSP for the first 1,000 days - conception to age 2
• Mothers counseled on breastfeeding and future contraceptive use during
antenatal checkups
• Mothers supported in immediate and exclusive breastfeeding for 6 months
to assure infant nutrition, and concurrently delay the onset of menses
(Lactational Amenorrhea Method)
• At 6 months, mothers begin complementary feeding (solids + breast milk)
for infants, and a modern method of contraception to protect them from
another too-soon pregnancy
• Protection from pregnancy enables mothers to breastfeed until the child is
at least 2 years old, reducing the risk of undernutrition and enables mothers
to space pregnancies by at least 2 years for healthiest outcomes
• Undernutrition may result in stunting that leads to impaired health and
reduced intellectual capacity that can be passed on to the next generation
(Lundgren, Tuverno, Best Practices Res Cli Endocrinal Meta. 2008)
Healthy Timing & Spacing of
Pregnancies
• Babies born less than
2 years apart are more
than twice as likely to
die before their first
birthday, compared to
those born 3 to 4 years
apart.
S. Rutstein, 2005
Healthy Timing & Spacing of Pregnancy
(HTSP) Messages
1. Wait until age 18 before trying to become pregnant
2. After a miscarriage or abortion, wait at least 6 months
before trying for another pregnancy
3. Wait until your child is at least 2 years old before trying
for another pregnancy
4. Limit pregnancies to a mother’s healthiest ages, 18 to 34.
Thank you!
Unmet Need for FP (HTSP)1st Year Postpartum
80
70
1st Year PP
60
All Wome
50
1st Year PP
40
All Women
30
20
10
0
B-desh
Haiti
Kenya
Nigeria
Source: Borda, M. and W. Winfrey. Family Planning Needs during the First Year Postpartum. ACCESS-FP.
Three Levels of Interventions for HTSP integration
Family
Community
Governmental
Systems/structures
* Source - IMCI approach, proposed by
UNICEF, utilized for working at 3 levels:
household, community, governmental
system/structure
Healthy Timing and Spacing of Pregnancies
To achieve a 36mo birth interval (including breastfeeding),
contraception must be used for 18-22 months postpartum before
trying to become pregnant again.
Exclusive
breastfeeding up to 6
months
2-6 mo
postpartum
Delivery
Contraception needed
to space pregnancies
Can become
pregnant again
(2-6)-24mo Use Contraception
6mo
Months postpartum
24mo
>24
ARC Model - Advocacy
ARC Model – Resource Generation
ARC Model – Community Mobilization