Population Council Research that makes a difference

Failure to use postpartum contraception and incorrect use of the lactational amenorrhea method (LAM) are key reasons Egyptian women fail to achieve healthy timing and spacing of their pregnancies. To respond to this need, the Population Council’s USAID-funded FRONTIERS program, in collaboration with the Egyptian Ministry of Health (MOH), conducted an operations research study to measure the acceptability and effectiveness of two models of providing birth-spacing messages to low-parity women and their husbands. The study showed that the two models were effective in changing women’s knowledge of and attitudes toward birth spacing and in enhancing use of contraception at 10–11 months postpartum.

Based on the success of that intervention and in response to requests from local officials in the two study governorates, the Population Council is scaling up a modified version of the intervention with funds from the Extending Service Delivery project/USAID. Scaling up is taking place in 48 health facilities in eight districts of Assiut and Sohag governorates. The scale-up is being implemented by the MOH in the two health directorates with technical assistance from the Council, with the ultimate goal of assisting the Government of Egypt in integrating birth-spacing messages within antenatal and postpartum services and helping Egyptian women achieve healthy birth intervals and avoid unplanned/closely spaced pregnancies.

Family planning and maternal and child health (MCH) supervisors in the districts where the project is being scaled up received three days of training of trainers (ToT) on integrating birth spacing and family planning messages into antenatal and postpartum care. Birth-spacing messages are offered to pregnant women during antenatal care and to postpartum women through home visits by the MCH nurse and a family planning outreach worker on days 2, 4, 7, and 21 postpartum. District supervisors are conducting field visits to intervention clinics in order to monitor implementation of the activities. Seminars for husbands are being conducted in the scale-up villages. They are facilitated by a clinic doctor or local religious leader and a district information, education, and communication (IEC) officer.

Monthly home interviews by project monitors are conducted with a random sample of three pregnant and three postpartum women per clinic (i.e., a total of 288 clients per month) to monitor implementation of the intervention. Home interviews in Assiut and Sohag showed that during February 2010, 94 percent of pregnant women in Assiut and 97 percent of pregnant women in Sohag received counseling on birth spacing and postpartum family planning during antenatal care.  Also, 90 percent and 96 percent of postpartum women in Assiut and Sohag, respectively, could name two health benefits of health timing and spacing of pregnancy for infants and newborns.    

Efforts are underway to scale up the intervention into other clinics in Assiut and Sohag, using local funds. The Council and the MOH are exploring mechanisms to enable the project to be scaled up to the national level.

---

Related project: Helping Women Achieve Optimal Birth-spacing Intervals Through Fostering Linkages Between MCH and FP Services