During the month of May, IMPACT will be highlighting USAID’s work in Global Health. This week we are focused on family planning. 

In too many places around the world, women lack the access to contraception or the decision-making ability to seek services.

Mother in Ethiopia. Photo Credit: Jhpiego

Eighty million unintended pregnancies were estimated to have occurred in developing countries last year. Of these, 63 million occurred among the 222 million women with an unmet need for modern contraception.[1]And in sub-Saharan Africa, one in four women in is unable to decide when and how many children she will have.

The importance of healthy timing and spacing of pregnancies cannot be underestimated. According to the World Health Organization, short birth-to-pregnancy intervals—the time between the date of a live birth and the start of the next pregnancy—greatly affect maternal, newborn, and child health and mortality outcomes. In low-resource settings, preventing another pregnancy by using family planning and waiting to get pregnant again for 36 months can reduce under-five child mortality by 25%.  For neonates in the developing world, this number is even greater—findings indicate that mortality is reduced by approximately 40% for preceding birth intervals of 3 years or more, compared with intervals of less than 2 years.[2]

The likelihood of miscarriages and stillbirths are also much higher for extremely short birth-to-pregnancy intervals. Women who become pregnant 15 to 75 months after a preceding pregnancy are less likely to miscarry or have a stillbirth baby than those with shorter or longer inter-pregnancy intervals.1

Family planning can help women ensure that pregnancy occurs at the healthiest times of their lives. Research shows that positive health outcomes for both mothers and newborns occur when pregnancy happens:

  • 24 months after a live birth (an almost three-year birth-to-birth interval);
  • 6 months after an induced abortion or miscarriage;
  • To women who have had fewer than four live births; and
  • To women between the ages of 18 and 34.

Family planning, including healthy timing and spacing of births, has been recognized as one of the most cost-effective global health interventions. For every $1 spent on family planning, $6 are saved on other interventions. And with a better-spaced family, there are more opportunities for members to grow, remain healthy, and be better educated.

Here at USAID’s flagship Maternal and Child Health Integrated Program (MCHIP), we are working around the world to save and improve lives through increased use and understanding of family planning. In India, for instance, the Program has worked with the Ministry of Health to help prevent nearly 100,000 unintended pregnancies during the extended postpartum period through our work with the postpartum IUCD.  This is just one example of our work in more than 50 countries, but is illustrative of our efforts to scale up results to reach as many women as possible.

And in Africa, where the PPIUD has been slower to gain acceptance, we’re seeing signs of hope. At a regional PPIUD meeting co-hosted by MCHIP last month in Zambia, 60 enthusiastic champions from professional societies, service delivery, INGOs, donors and governments representing 10 countries[3]convened to share their successes and challenges implementing PPIUD programs. But while these international and regional experts will surely help to advance integration of PPIUCDs into maternal health services in their respective contexts, we must multiply this number by a factor of 10—or even 100—to reach all the women who need PPFP to space their pregnancies at the safest intervals. Given the lack of understanding of return to fertility after a birth or miscarriage in much of Africa, as well as elsewhere, coupled with early return to sexual activity after delivery and short periods of amenorrhea, the role of PPFP/PPIUCD is critical to healthy timing and spacing of pregnancies. Raising awareness to dispel myths and misconceptions among clients and service providers is also key to improving PPIUCD uptake.

In our own lives, many of us have had the luxury to determine when and if we will have children. We cannot forget the millions of women in developing countries who do not have this same freedom—and who desire more time before becoming pregnant again, facing the risk of death with every pregnancy. Healthy pregnancy spacing is a cost-effective intervention that can reduce both maternal and childhood mortality and excessive population growth. Investing in women’s reproductive health and autonomy improves not only the health of the individual, but also the welfare of the whole family and, ultimately, the larger society. This investment is modest in relation to the dramatic returns it yields.

[1] UNFPA World Population Report, 2012

[2] Setty-Venugopal V, Upadhyay UD. Birth spacing: three to five saves lives. Baltimore: Johns Hopkins University, Population Information Program, 2002.

[3]Ethiopia, Kenya, Liberia, Malawi, Mozambique, Rwanda, Tanzania, Uganda, Zambia and Zimbabwe