Child Spacing in MCH Programs

Harriet Stanley, PhDHstanley@path.org

Overview

Impact of child spacing on the health of women and children;

FP services in development countries: what we’ve learned

Women’s choices Looking Ahead

Child Spacing

Close spacing and high fertility are a significant determinant of poor health of mothers and infants – and impacts the health and socio-economic well being of families

Mothers

Avoid unsafe abortion; Limit health risks of pregnancy and

childbirth; Limit births to healthiest ages; Limit number of births.

Children

Spacing increases chances of survival significantly;

Healthier birth weights, healthier babies;

Assures babies are adequately breastfed.

Reducing Excess Fertility

Family planning; Delayed marriage; Prolonged breastfeeding; Abortion

Traditional Approaches to Child Spacing

There are many examples of traditional practices that promoted birth spacing:

Women lives with own family; Polygamy; Importance of breastfeeding period.

Changing Trends

In surveys, women report lower desired than actual fertility or that their last birth was unwanted. Even more report that they want no more children. If they do, they want to wait a significant period of time.

Trends

Last 30 years, % couples using contraception from 10% to 50%;

Fertility dropped from average of 6 to 4 children per woman;

FP and socio-economic development both play role to some degree

Family Planning Programs – what we’ve learned

At service delivery level – demand, access, choice of methods, client-centered quality, communication.

At program Admin level – leadership, R&D.

At gov’t policy level – political commitment, financial resources.

Meeting people’s Needs

“Setting targets for contraceptive ‘acceptors’ is not the road to family planning success. Rather, if people

are given the opportunity, they choose family planning when it

meets their needs.”

Field Programs – focus on availability, access and quality

Availability

Field Programs cont’d

Access – understanding the barriers: Distance, time and cost; Gender, caste and class; Economic; Cultural;

Field Programs cont’d

Quality Skilled providers –

at all levels; Safe clinical

practices; Effective

counseling;

Challenges

Meeting remaining unmet need; Reaching young, unmarried women; Increasing men’s involvement; Linking to broader RH services