Academic journal article International Perspectives on Sexual and Reproductive Health

Postpartum Family Planning during Sociopolitical Transition: Findings from an Integrated Community-Based Program in Egypt

Academic journal article International Perspectives on Sexual and Reproductive Health

Postpartum Family Planning during Sociopolitical Transition: Findings from an Integrated Community-Based Program in Egypt

Article excerpt

CONTEXT: Limited information exists on postpartum family planning and implementation of integrated reproductive and maternal and child health programs in countries experiencing sociopolitical transition.

METHODS: A quasi-experimental evaluation of an integrated reproductive and maternal and child health program implemented in selected sites in Upper and Lower Egypt was conducted between 2012 and 2014. Preintervention and postintervention household surveys were conducted among 12,454 women in intervention sites and nonintervention comparison sites who at survey had a child younger than 24 months. Bivariate and multivariate analyses estimated the intervention's effects on postpartum family planning-related outcomes, including contraceptive use, knowledge of optimal birthspacing, reproductive intentions and decision making about contraceptive use.

RESULTS: In Upper Egypt, modern contraceptive use decreased over the study period in both intervention and comparison sites (by six and 15 percentage points, respectively), and in Lower Egypt, contraceptive use remained unchanged in intervention sites and decreased slightly (by three points) in comparison sites; in both regions, the intervention was positively associated with the difference in differences between groups (odds ratios, 1.5 for Upper Egypt and 1.3 for Lower Egypt). The intervention appears to have had a positive effect on knowledge of optimal birthspacing in Upper Egypt, on wanting to delay the next pregnancy in Lower Egypt, and on pregnancy risk and joint decision making in both regions.

DISCUSSION: Study findings demonstrate the feasibility and effectiveness of an integrated reproductive and maternal and child health program implemented in a changing sociopolitical context. Revitalized efforts to bolster family planning within the country are needed to avert further losses and spark a return to positive trends.

International Family Planning Perspectives, 2016, 42(2):57-69.

Postpartum family planning aims to help women who have recently given birth select a contraceptive method that they want to use, voluntarily initiate its use and continue use for two years or longer, depending on the reproductive intentions of the woman or couple. (1) Family planning following childbirth is important not only to help women and couples achieve their reproductive intentions, but also to achieve broader maternal and child health outcomes. Pregnancies spaced fewer than 18-24 months apart have been associated with an increased risk of preterm birth; low birth weight; fetal, early neonatal and infant death; and adverse maternal health outcomes. (2) In addition, short interpregnancy intervals have been positively associated with childhood stunting and underweight. (3) Programs have successfully integrated family planning into maternal and child health services, (4,5) and community-based approaches for integrating postpartum family planning into broader health activities have been successful in improving postpartum contraceptive uptake without negatively affecting maternal and child health service provision. (5,6)

National demographic data from Egypt show that many reproductive and maternal and child health outcomes for the country improved between 1990 and 2011; (7,8) however, challenges remained, including stagnating neonatal mortality rates and an increase in stunting among children younger than five, from 23% in 2005 to 29% in 2008, the latest data available at the time the intervention was designed. To address these challenges and build on previous donor investments, the United States Agency for International Development (USAID) funded the Maternal and Child Health Integrated Program to implement the SMART project in selected sites in Upper and Lower Egypt. (*) The project was designed to address the increase in child malnutrition rates by introducing an integrated, community-based reproductive and maternal and child health intervention package. …

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