Since her marriage nine years ago, Munni Manjari has given birth to six children. All but one has survived. She is just 25 years old and lives in the Sylhet area of northeast Bangladesh. When receiving maternal and newborn health care services from her local community health worker, Munni begged for some family planning options. But the health worker was neither trained nor equipped to provide such options to her. Munni’s repeated pregnancies have left her anemic, suffering from chest pains and generally weak. Her recurrent fatigue keeps her from working several days a week. With limited means, she and her husband, Kripa, can barely provide for their children, who range in age from four months to nine years old.
Like Munni, the women of Sylhet face an uncertain future because health services are scarce and poorly equipped. A group of Bangladeshi and U.S. health care professionals, Baltimore researchers and local community health workers are coming together to change that. They have joined together to educate women, men and families on the benefits of healthy birth spacing and to provide information on family planning options.
More than 2,200 mothers are participating in the Healthy Fertility Study, a collaboration of the Bangladesh Ministry of Health and Family Welfare, Jhpiego, two local nongovernmental organizations (NGOs)—Shimantik and the Center for Data Processing and Analysis—and the Johns Hopkins Bloomberg School of Public Health.
Previously supported by the ACCESS-FP Program, with funding through the U.S. Agency for International Development (USAID) from 2007 to 2010, the study is now supported by USAID’s Maternal and Child Health Integrated Program (MCHIP), which is led by Jhpiego, and Johns Hopkins public health researchers.
The study is already making a difference in the lives of the women participants.
The area of Sylhet has the highest fertility rate in the country—women there have about four children, compared to an average of about three in the five other divisions in the country. The maternal mortality ratio (MMR) is highest in Sylhet (471 per 100,000 live births, compared to the national average of 322), and the infant mortality rate is twice what it is elsewhere in the country, according to country health data.
But results from the Healthy Fertility Study so far show that women and their families are getting the message that pregnancies spaced too closely after a live birth or miscarriage carry very high risks for the mother and her newborn. Three years into the project, the use of family planning in the area is up—36 percent of women reported using contraception as compared to 18 percent in the comparison area at six months postpartum.
A key aspect of the project is providing community-based postpartum family planning along with maternal and newborn health services to women. This integration of services maximizes the benefits of the contact between the community health worker and the woman.
Community health workers—who are typically young, unmarried women with a tenth grade education—are trained to visit homes in their communities to identify pregnant women and educate women enrolled in the study about maternal and newborn health. They also provide information about postpartum family planning, supply oral contraceptive pills and condoms based upon the women’s fertility intentions, and make referrals to government and NGO health facilities for other contraceptive methods.
One effective method that new mothers can use is the Lactational Amenorrhea Method, in which breastfeeding women follow specific criteria in order to avoid pregnancy during the initial six months after a birth. After that period, women need to use other modern contraceptive methods to avoid unplanned pregnancies.
The recent results from the Healthy Fertility Study found exclusive breastfeeding rates were higher, at 38 percent as compared to 28 percent at three months postpartum. In addition, 94 to 95 percent of women in Sylhet said they had seen communications materials developed for the project and 87 percent said they attended a community meeting related to it.
“The Healthy Fertility Study is important because it is using innovative strategies that are helping Bangladeshi women avoid unplanned pregnancies,” said Catharine McKaig, a family planning specialist with MCHIP. “The study is helping women, men, families and communities understand that modern contraceptive methods can be used to ensure that pregnancies occur at healthy times, and avoided at unhealthy times.
“Findings from this study will influence how family planning is integrated in community-based maternal and newborn health care programming elsewhere in the world,” McKaig said.