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

Projahnmo Study Group in Bangladesh

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Number of pages1
JournalJournal of Global Health
Volume8
Issue number2
DOIs
StatePublished - Dec 1 2018

Fingerprint

Birth Intervals
Bangladesh
Premature Birth
Family Planning Services
Postpartum Period
Confidence Intervals
House Calls
Birth Rate
Health Facilities
Feasibility Studies
Health Status
Infant Health
Maternal Health
Research Design
Mothers
Pregnancy
Population

ASJC Scopus subject areas

  • Medicine(all)

Cite this

@article{c4b1ee5da7f44eaf8275badfbd7c6927,
title = "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",
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.",
author = "{Projahnmo Study Group in Bangladesh} and Abdullah Baqui and Salahuddin Ahmed and Nazma Begum and Rasheda Khanam and Diwakar Mohan and Meagan Harrison and {Al Kabir}, Ahmed and Catharine McKaig and Neal Brandes and Maureen Norton and Saifuddin Ahmed",
year = "2018",
month = "12",
day = "1",
doi = "10.7189/jogh.08.020406",
language = "English (US)",
volume = "8",
journal = "Journal of Global Health",
issn = "2047-2978",
publisher = "Edinburgh University Global Health Society",
number = "2",

}

TY - JOUR

T1 - 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

AU - Projahnmo Study Group in Bangladesh

AU - Baqui, Abdullah

AU - Ahmed, Salahuddin

AU - Begum, Nazma

AU - Khanam, Rasheda

AU - Mohan, Diwakar

AU - Harrison, Meagan

AU - Al Kabir, Ahmed

AU - McKaig, Catharine

AU - Brandes, Neal

AU - Norton, Maureen

AU - Ahmed, Saifuddin

PY - 2018/12/1

Y1 - 2018/12/1

N2 - 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.

AB - 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.

UR - http://www.scopus.com/inward/record.url?scp=85050299380&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85050299380&partnerID=8YFLogxK

U2 - 10.7189/jogh.08.020406

DO - 10.7189/jogh.08.020406

M3 - Article

C2 - 30023053

AN - SCOPUS:85050299380

VL - 8

JO - Journal of Global Health

JF - Journal of Global Health

SN - 2047-2978

IS - 2

ER -