Final Report: Healthy Fertility Study (HFS)

The study is a collaboration between MCHIP, the Bangladesh Ministry of Health and Family Welfare, Shimantik, and Center for Data Processing and Analysis (CDPA). The HFS aims to contribute to local and global learning about effective family planning (FP) programming, particularly in the postpartum period, in an integrated context. The study objectives 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. 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 study has made significant progress in implementing the intervention package, with high coverage of study household counseling visits by community health workers (CHWs) in pregnancy, 29-35 days postpartum, 2-3 months postpartum, and 4-5 months postpartum periods. Data collection for the study involves a team of data collectors conducting a maximum of eight data collection visits for each study participant, including one visit during pregnancy and seven follow-up visits during the postpartum period. The data collection process has been completed for 3 and 6 months postpartum, and follow-up visits at 12 and 18 months postpartum have been completed. Preliminary findings from the draft 12 month postpartum survey indicate that intervention activities were significantly associated with a greater than 20% increase in the probability of adopting contraception in the 12 months following delivery. The probability of contraceptive use was ~10% higher amongst those individuals not using LAM in both study arms. Among women practicing LAM in the intervention area, the duration of amenorrhea was significantly higher than that reported by women in both study arms not practicing LAM. The study has also found that HFS CHWs were the primary source of pills (77%) and condoms (89%) in the intervention area, whereas pharmacies and/or shops were the primary source for pills (59%) and condoms (89%) followed by government health facilities. Injectables were received predominantly from a government facility (52%), NGO (39%) or pharmacy shop (6.5%) in the intervention arm. In the comparison arm, injectables were received overwhelmingly from government health facilities (78%).