Annual Performance Report: October’2012 - September’2013 Maternal and Child Health Integrated Program Bangladesh Healthy Fertility Study

The study aims to contribute to local and global learning about effective family planning (FP) programming, particularly in the postpartum period, in an integrated context. The HFS commenced in 2007 and was previously supported by ACCESS-FP. In December 2010, HFS transitioned from ACCESS-FP to MCHIP for technical oversight and program support. The design of HFS was a collaborative effort between JHBSPH, ACCESS-FP, USAID/Washington, and USAID/Bangladesh to respond to the poor family planning (FP) indicators in Sylhet division and the need for improved integration of FP and maternal and newborn health (MNH) services. The objectives of the study are four-fold: to develop and test an integrated FP/MNH service delivery approach; to assess the strengths and limitations of integrating family planning into 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 the benefits of healthy fertility practices, and contraceptive prevalence and method mix at different points during the extended postpartum period; and to assess the impact of the intervention on pregnancy spacing and its outcomes. During the reporting period of October 1, 2012 to September 30, 2013, the study achieved high coverage of study household counseling visits by community health workers (CHWs) during pregnancy, 29-35 days postpartum, 2-3 months postpartum, and 4-5 months postpartum periods to deliver the intervention package. CHWs conducted 1755 community mobilization meetings with 3,876 pregnant and postpartum women, mothers-in-laws, and female family members and 3,449 husbands, fathers-in-laws, and male family members. Sixty-two ward-level advocacy meetings were held with influential community and religious leaders to garner support and educate on key study messages. The couple-years protection (CYP) of this reporting period was 503.39. The study team provided training on USAID family planning policy to project field staff and GOB staff in the study intervention unions. Data collection for the sub-study of cost-effectiveness analysis was completed. The study team also oriented DGFP about HFS best practices to scale up. The study's findings were shared with USAID's Dhaka Mission office. Key findings of the postpartum 30 months survey report were: HFS activities were associated with a 26% increase in contraceptive uptake in the intervention arm from baseline (18%) to 30-months postpartum (43.9%); in comparison area, it was a 16% increase from baseline (21.1%) to 30-months postpartum (37.2%). Husband abroad was the main reason for not using any method in the intervention arm (43%), and husband disapproval was the main reason in the control area (39%). The probability of becoming pregnant by 30 months was significantly low in the intervention arm compared to the control arm (36.5% in the intervention arm vs. 44.8% in the control arm; p<0.001). The study's lessons learned were utilized by other projects in Bangladesh, including MaMoni, Mayer Hashi, and the Extended Service Delivery (ESD) program. Globally, Jhpiego used HFS training curriculum and IEC materials in Afghanistan and Nigeria, and a team from Health Science Academy of Pakistan visited HFS site to collect training and IEC materials to scale up a similar program in Pakistan. The study's data collection was completed, and final analysis is ongoing. A team of data collectors, independent of the CHWs and community mobilizers, conducted a maximum of eight data collection visits for each study participant. These included one visit during pregnancy and seven follow-up visits during the postpartum period: 3, 6, 12, 18, 24, 30, and 36 months. Integrated FP/MNCH training was provided to comparison area's field staff in January 2013. A data analysis workshop was held at Johns Hopkins Bloomberg School of Public Health on February 11-20, 2013, with the objective of linking and cleaning the longitudinal data sets, reviewing draft manuscripts, and finalizing them. A dissemination meeting of the Healthy Fertility Study took place on September 26, 2013, at the Lakeshore Hotel on Gulshan-2, Dhaka, to share findings from the study with a wider audience.