Helping Egyptian women achieve optimal birth spacing intervals through fostering linkages between family planning and maternal/child health services

This study was made possible by the generous support of the American people through the United States Agency for International Development (USAID) under the terms of Cooperative Agreement Number HRN-A-00-98-00012-00, Subagreement AI05.38A and In-house project 5800 53094. The contents are the responsibility of FRONTIERS and do not necessarily reflect the views of USAID or the United States Government. One major challenge facing policy-makers is how to support women in achieving healthier birth intervals, i.e. a birth to conception interval of at least two years. To respond to this challenge, the Population Council " s USAID-funded Frontiers in Reproductive Health (FRONTIERS) program, in collaboration with the Egyptian Ministry of Health and Population (MOHP) and the NGO " Social Planning, Analysis and Administration Consultants " (SPAAC), conducted an operations research study to measure the acceptability and effectiveness of two birth spacing message models. For Model I (health services model), birth spacing messages were communicated through services by health workers to women during prenatal and postpartum periods. Model II (community awareness model), provided this service plus an awareness raising component that targeted men through training community influentials to communicate messages. The study used an experimental design in six health districts, three from each governorate of Assiut and Sohag in Upper Egypt. One district in each governorate was randomly assigned to implement Model I, Model II or to serve as a control site by providing standard care only. Sources of data for this study included: (1) exit and home interviews with low parity pregnant women at 4 months and 10-11 months postpartum (a total of 1,416 women); (2) structured interviews with physicians, nurses and family planning outreach workers; (3) in-depth interviews with local MOHP managers and supervisors; (4) focus group discussions (FGDs) with community influentials; (5) FGDs with husbands of low parity women; and (6) service statistics on utilization of MCH and family planning services. Providing birth spacing messages to low parity women during antenatal and postpartum care and also to husbands through community awareness activities was feasible and acceptable. Both models proved effective in changing women " s knowledge and attitudes towards birth spacing and in enhancing use of contraception at 10-11 months postpartum, by 48 percent among Model I mothers and 43 percent among Model II mothers, compared with 31 percent among control group mothers. Over the postpartum period, women in the two intervention groups used contraception more consistently than women in …