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Poverty and InequalitySexual and Reproductive HealthFamily, Maternal & Child HealthMethodology

Impact of integrating a postpartum family planning program into a community-based maternal and newborn health program on birth spacing and preterm birth in rural Bangladesh

TitleImpact of integrating a postpartum family planning program into a community-based maternal and newborn health program on birth spacing and preterm birth in rural Bangladesh
Publication TypeJournal Article
Year of Publication2018
AuthorsBaqui, AH, Ahmed, S, Begum, N, Khanam, R, Mohan, D, Harrison, M, Al Kabir, A, McKaig, C, Brandes, N, Norton, M, Ahmed, S
JournalJ Glob Health
Volume8
Pagination020406
Date PublishedDec
ISBN Number2047-2978
Accession Number30023053
KeywordsAdolescent, Adult, Bangladesh, Birth Intervals/*statistics & numerical data, Family Planning Services/*organization & administration, Feasibility Studies, Female, Humans, Infant, Newborn, Maternal-Child Health Services/*organization & administration, Postnatal Care/*organization & administration, Pregnancy, Premature Birth/*prevention & control, Program Evaluation, Rural Health Services/*organization & administration, Rural Population/*statistics & numerical data, Time Factors, Young Adult
Abstract

Background: Short birth intervals are associated with an increased risk of adverse perinatal outcomes. However, reduction of rates of short birth intervals is challenging in low-resource settings where majority of the women deliver at home with limited access to family planning services immediately after delivery. This study examines the feasibility of integrating a post-partum family planning intervention package within a community-based maternal and newborn health intervention package, and evaluates the impact of integration on reduction of rates of short birth intervals and preterm births. Methods: In a quasi-experimental trial design, unions with an average population of about 25 000 and a first level health facility were allocated to an intervention arm (n = 4) to receive integrated post-partum family planning and maternal and newborn health (PPFP-MNH) interventions, or to a control arm (n = 4) to receive the MNH interventions only. Trained community health workers were the primary outreach service providers in both study arms. The primary outcomes of interest were birth spacing and preterm births. We also examined if there were any unintended consequences of integration. Results: At baseline, short birth intervals of less than 24 months and preterm birth rates were similar among women in the intervention and control arms. Integrating PPFP into the MNH intervention package did not negatively influence maternal and neonatal outcomes; during the intervention period, there was no difference in community health workers' home visit coverage or neonatal care practices between the two study arms. Compared to the control arm, women in the intervention arm had a 19% lower risk of short birth interval (adjusted relative risk (RR) = 0.81, 95% confidence interval (CI) = 0.69-0.95) and 21% lower risk of preterm birth (adjusted RR = 0.79; 95% CI = 0.63-0.99). Conclusions: Study findings demonstrate the feasibility and effectiveness of integrating PPFP interventions into a community based MNH intervention package. Thus, MNH programs should consider systematically integrating PPFP as a service component to improve pregnancy spacing and reduce the risk of preterm birth.

PMCID

PMC6036944 form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare no conflict of interest.