MCHIP-FP focuses on the health benefits of family planning (FP) for mothers and children. FP integration within maternal, newborn and child health (MNCH) is a key strategy for reducing maternal, infant and child mortality and morbidity through the prevention of unintended pregnancies and the promotion of healthy pregnancy spacing.

Preventing unintended pregnancies: Research has demonstrated that more than 90% of women during their first year postpartum either want to delay the next pregnancy for at least two years or avoid future pregnancies all together.¹  Preventing unintended pregnancies is an important strategy for reducing maternal mortality, as by preventing pregnancies, exposure to obstetric risk is also reduced. An estimated one fourth (25%) of maternal mortality could be prevented through preventing these pregnancies.

Promoting healthy pregnancy spacing:  Research findings demonstrate improved perinatal outcomes for infants born 36–59 months after a preceding birth. Experts made recommendations to the World Health Organization (WHO) to advise an interval of at least 24 months before couples attempt to become pregnant (birth-to-pregnancy interval) in order to reduce the risk of adverse maternal, perinatal and infant outcomes.²  Yet, many pregnancies occur during the first and second year postpartum. The following table presents information from Demographic and Health Surveys on the pregnancy intervals for births in the past five years for three countries—Bangladesh, Kenya and Liberia.

Table 1: Percentage of Births in Last Five Years Conceived by Interval Postpartum
Conceived by:	Bangladesh (2007)	Kenya (2008)	Liberia (2007)
Less than 6 months	4%	4%	4%
6-11 months	6%	11%	8%
12-23 months	22%	35%	29%

In these three economically and socially diverse countries, a similar pattern of pregnancies within the first and second year postpartum emerges. Within the first year postpartum, between 10-14% of births were conceived; within the second year, between 22-35% were conceived. These short intervals place both mothers and infants at risk.

MCHIP-FP includes four key components to more effectively meet the FP needs of women within MNCH services:

1) Increasing awareness about pregnancy risk: Many postpartum women are unaware that they are at any risk of pregnancy and they wait for their menses to return before seeking FP. Similarly, health care workers may be uninformed about fertility return and the need for contraception during the extended postpartum period (through the first year postpartum). Proactive counseling is important to inform women of both the pregnancy risks and ways to safely avoid unintended pregnancies.

2) Systematically offering information and services: Pregnancy and child care are the most common times for health worker contact. Indeed, many women may have few other contacts with health care providers; therefore, the opportunity to integrate FP with other MNCH services should be maximized. Systematically reaching postpartum women has the potential to provide FP information and services to more than 90% of women of reproductive age in many high fertility settings.

3) Considering contraceptive method based on timing postpartum and breastfeeding status: Women with small children have unique needs for contraceptive information and services. For example, the lacatational amenorrhea method (LAM) is a counseling-based, contraceptive method that can only be used by postpartum women. There are special method considerations for women according to their period postpartum and their breastfeeding status.   

4) Implementing strategies for effective integration of FP within other MNCH services: While policies often support the integration of FP with maternal and child health care, implementation is often lacking. MCHIP effectively integrates FP into antenatal care, delivery care, postpartum care, as well as immunization and nutrition services. In these examples, messages and services are tailored to correspond with and support the other services as well as proactively provide information and services.  MNCH services can also serve as a platform to reach women with FP information and services.

In addition, MCHIP-FP supports several important areas of work and learning. These include: postpartum FP (PPFP); LAM and transition; postpartum IUCD (PPIUCD); and community-based PPFP. MCHIP-FP also co-leads several working groups focused on learning about effective approaches to integration, including the FP/Immunization Working Group, the FP/Maternal, Infant and Young Child Nutrition (MIYCN) Working Group, and the PPIUCD Working Group. For more information about any of these groups, contact Elizabeth Sasser at esasser@mchip.net.

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¹ Ross JA, Winfrey WL, Contraceptive Use, Intention to Use and Unmet Need During the Extended Postpartum Period. International Family Planning Perspectives, 2001, 27 (1):20-27.
 
² Report of a WHO Technical Consultation on Birth Spacing Geneva, Switzerland, 13–15 June 2005.