International Family Planning Conference, 2013

World Vision: A Christian NGO Builds Support for Family Planning

Addis Ababa, November 15, 2013

Adrienne Allison, MA, MPATechnical 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 thriveBut, 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

Strategy:1. Within WV – Actively disseminate evidence-based data that

quantifies the impact of timing and spacing pregnancies on child and maternal mortality and nutrition

2. In 37 countries, WV staff

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.

Pregnant Women Children 0-24 months1. Adequate diet2. Iron/folate supplements3. Tetanus toxoid

immunisation4. Malaria prevention (IPT) 5. Healthy Timing and

Spacing of Pregnancies (HTSP)

6. De-worming7. Access to antenatal and

postnatal care, skilled birth attendance, prevention of mother-to-child transmission of HIV

1. Appropriate breastfeeding2. Essential Newborn Care3. Hand washing4. Appropriate complementary

feeding (6-24 months)5. Adequate iron6. Vitamin A supplementation7. Oral Rehydration Therapy &

Zinc8. Care seeking for fever9. Full immunisation for age10. Malaria prevention11. De-worming (+12 months)

World Vision’s Global Health & Nutrition Strategy

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:

0

0.5

1

1.5

2

2.5

3

3.5

4

<6 6 to 11 12 to 17 18 to 23 24 to 29 30 to 35 36 to 47 48 to 59

Mortality Risk

Birth-to-Pregnancy Interval (months)

InfantNeonatalEarly Neonatal

Birth-to-Pregnancy Intervals and Relative Risk of Neonatal and Infant

Mortality

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

0

1000

2000

3000

4000

5000

6000

7000

8000

9000

Developing Countries

Thou

sand

s of

dea

ths

Existing Intervals

Min. 24 mos.

Min. 36 mos.

797,000 deaths avertedAdditional 842,000 deaths averted

1,639,000 deaths could be averted

every year by proper spacing

Age of Mother Parity Spacing

Percent of Children Alive and Not Undernourished by Duration of Preceding Birth to Conception Interval

75%

71%

63%63%

59%

55%52%

48%

43%45%

40%

45%

50%

55%

60%

65%

70%

75%

80%

<6 6-11 12-17 18-23 24-29 30-35 36-47 ref. 48-59 60-95 96+

Interval in months

Perc

ent o

f chi

ldre

n

Alive and notundernourished

Shea Rutstein, Ph.D., Measure DHS

352,447 births in 52 DHS surveys

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!

0

10

20

30

40

50

60

70

80

B-desh Haiti Kenya Nigeria

1st Year PP

All Women

Source: Borda, M. and W. Winfrey. Family Planning Needs during the First Year Postpartum. ACCESS-FP.

Unmet Need for FP (HTSP)1st Year Postpartum

1st Year PPAll Women

Three Levels of Interventions for HTSP integration

Family

GovernmentalSystems/structures

Community

* Source - IMCI approach, proposed by UNICEF, utilized for working at 3 levels: household,

community, governmental system/structure

Healthy Timing and Spacing of Pregnancies

2-6 mo postpartum (2-6)-24mo Use Contraception

Delivery 6mo 24moMonths postpartum

Exclusive breastfeeding up to 6 months

Contraception needed to space pregnancies Can become

pregnant again

>24

To achieve a 36mo birth interval (including breastfeeding), contraception must be used for 18-22 months postpartum before

trying to become pregnant again.

ARC Model - Advocacy

ARC Model – Resource Generation

ARC Model – Community Mobilization