Healthy Fertility Study

The Integrated Family Planning/ Maternal and Neonatal Health Intervention is designed to develop and test an integrated Family Planning/ Maternal and Neonatal Health (FP/ MNH) service delivery approach in the Bangladesh setting building on the existing Projahnmo Study. Intervention activities include behavior change communication on healthy timing and spacing of pregnancy, couples counseling, social networking and expression of contraceptive options for postpartum women with an emphasis on first time and adolescent mothers.

 

The Healthy Fertility Study (HFS), conducted in eight unions with about 200,000 population of Sylhet District in Bangladesh, is funded by the United States Agency for International Development (USAID). The study began in 2007 as a partnership of the Bangladesh Ministry of Health and Family Welfare (MoHFW), the Bangladeshi nongovernmental organization Shimantik, the Center for Data Processing and Analysis, ACCESS-FP, and the Johns Hopkins Bloomberg School of Public Health (JHU). In December 2010, the study transitioned from ACCESS-FP to the USAID-funded Maternal and Child Health Integrated Program (MCHIP). The study setting of Sylhet District has the highest rates of maternal and newborn mortality and the lowest rates of contraceptive use in Bangladesh. The study integrates postpartum family planning within a community-based maternal and newborn health (MNH) program, which has demonstrated results in reducing newborn mortality. The study follows 2,247 pregnant women in four intervention unions and 2,257 women in four control unions from pregnancy to three years after delivery. Households in the control unions receive antenatal and postpartum home visits focused on maternal and newborn health, while those in the intervention unions receive the same MNH-focused home visits plus family planning (FP) counseling, distribution of contraceptives, and community mobilization activities.

 

HFS OBJECTIVES

The objectives of the study are four-fold:

  • To develop and test an integrated FP/MNH service delivery approach in the Bangladesh setting
  • To assess the strengths and limitations of integrating FP with an ongoing community-based MNH care program
  • To assess the impact of the intervention package on exposure to key intervention-related messages, knowledge of contraceptive methods and benefits of healthy fertility practices, and contraceptive prevalence and method mix at different points during the extended postpartum period
  • To assess the impact of the intervention on pregnancy spacing outcomes.

 

The results will be used to inform MNH programs, particularly in South Asia, on integrating FP/MNH services, addressing contraceptive unmet need in the first year postpartum and enabling contraceptive use through the second year postpartum.

Community-Based Distribution of Methods Added to Study Design:

In the original study design, CHWs provided family planning counseling based on women’s fertility intentions -  whether and when women would like to have another child, or if they would prefer to end childbearing but did not distribute contraceptive methods. There was demand among women for contraceptives but they had difficulty accessing them from health facilities.

 

After receiving approval from the JHU Institutional Review Board in July 2009 to amend the study protocol, the HFS team began training CHWs to distribute combined hormonal contraceptive pills and condoms, in accordance with Bangladeshi government protocols for in-home provision of contraceptives by community-based workers. Beginning March 2011, CHWs also dispensed follow-up doses of injectables contraceptive, following a training conducted by HFS using the Government of Bangladesh training manuals and protocols.

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