Healthy Fertility Study Findings from baseline and postpartum at 3/6/12/18 month surveys October 26,

 Intervention coverage  Contraceptive use, methods, source  Factors influencing non-users’  Integration impact  Summary of results Presentation of findings 2

Intervention Coverage 3

CHW Home Visit Coverage 4

Additional Activities Intervention (n=2118) Comparison (n=2132) Visited by CHW within last two months during pregnancy surveillance Yes79%59% Community mobilization meeting attendance By study participant (Woman) 98%0% By her husband40%0% By her mother-in-law58%0% 5

Exposure to IEC Materials Intervention 3 Months Postpartum 6 Months Postpartum Birth spacing pamphlet 90.6% 94.2% Leaflet on postpartum care 90.2% 94.4% Leaflet on LAM 90.5% 94.5% 6

Contraceptive use, methods, and sources 7

Starts in a Low Performance Area Percent Control Intervention Ever Used Contraceptive Method

Contraceptive Use Rate at 3, 6, 12, and 18 Months Postpartum by Study Arm 9

Statistically significant improvement in the contraceptive use rate in the intervention area over time -- 36% at 3 months to 47% at 18 months postpartum -- 10% to 31% increase the comparison arm over the same period of 3-18 months postpartum High number of new users and a trend towards increased early adoption 10

Probability of Contraceptive Adoption by Study Arm P<

Contraceptive method mix among intervention area users’ 12

Contraceptive method mix among intervention area users’ Overall high adoption of LAM  23% at 3 months and 12% at 6 months Shift in method preference from LAM to pills, condoms, and injectables 13

Contraceptive method mix among intervention area users’ Slight increases in injectables and long-acting methods Rise in sterilization from 1.9% to 3.1% in intervention area Oral contraceptives are the preferred contraceptive at 12 and 18 months 14

Contraceptive method mix at 18 months postpartum among intervention area users’ 15

Contraceptive method mix among control area users’ 16

Contraceptive method mix among control area users’ at 18 months 17

Method Source Among Users at 18 Months InterventionComparison PillCondomInjectablesPillCondomInjectables HFS CHW 80%89%2%0% Pharmacy or shop 15%8%6%60%91%17% Government facility/clinic/ FWA 4%2%50%37%6%77% NGO clinic/depot holder/ field worker 1% 41%2%0%6% Qualified doctor 0% 1% 0% 18

Leading reasons for non-use at 18 months postpartum by study arm InterventionComparison 12 month18 month12 month18 month Husband abroad 43% 44% 13%14% Husband disapproves 13% 20% 17% 28% Wanted to become pregnant 14% 12%15% Postpartum amenorrhea 13% 10% 33%18% Religious prohibition 8% 9% 11%17% No method suitable 6% 17%20% 19

Self Reported Pregnancy Incidence 20

Does integration of FP adversely affect MNH program? 21

CHW Home Visit Coverage Intervention (n=1889) Comparison (n=1838) Pregnancy counseling- 1 92%97% Pregnancy counseling- 2* 86%90% Newborn-1 counseling 74%80% Newborn-3 counseling 72%76% Newborn-6 counseling* 73%75% Newborn-9 counseling 73%77% Newborn-15 counseling 51%50% *Integrated counseling 22

Delivery Care of Index Pregnancy by Study Arm InterventionComparison Home delivery89.5%91.3% Assistance during delivery TBA/TTBA79.0%79.3% Nurse/Midwife/Para medic/FWV 8.6% 9.4% MBBS doctor9.6%6.2% 23

Effect of Integration on MNH Care: Selected Newborn Care practices by Study Arm Intervention (%) Comparison (%) Drying and wrapping of newborn within 5 minutes of delivery Initiation of Breastfeeding within 30 minutes

25 Duration of exclusive breastfeeding by study arm

Summarizing key results  Significant increase in the probability of contraceptive adoption through 18 months postpartum period in the intervention arm  LAM is a feasible and acceptable method of contraception for the first 6 months postpartum  There has been a significant increase in exclusive breastfeeding in the intervention area, particularly for LAM users  HFS activities have led to a decrease in the incidence of pregnancy  Integration of family planning services within a larger MNCH platform is feasible and does not have a negative impact on service coverage 26

THANK YOU 27

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Probability of Contraceptive Adoption by Study Arm Excluding LAM 29

Duration of postpartum amenorrhea by study arm 30

Pill Continuation Probability 31