International Family Planning Conference, 2013 World Vision: A Christian NGO Builds Support for Family Planning Addis Ababa, November 15, 2013 Adrienne Allison, MA, MPA Technical Advisor FP/RH, World Vision

WV’s Partnership Policy on Reproductive Health, 2006 In 2006, the WV partnership updated and broadened the 1996 Partnership Policy on Family Planning. It states: “WV’s reproductive health programs are based on biblical principles, the best medical knowledge available, and good medical ethics WV employs established best practices for reproductive health WV holds the position that human life begins at conception. WV does not provide, recommends nor support abortion nor methods of family planning that are determined to be abortive Effective reproductive health programs include both men and women WV respects the rights of parents to make their own decisions about family size and spacing without coercion. WV programs offer complete, accurate, unbiased, updated and comprehensive information disseminated in a caring, respectful, empowering culturally and age-appropriate manner.”

World Vision’s Goal : Sustained well-being of children within families and communities “Reproductive Health” was not compelling and programs failed to thrive But, as new data were published quantifying the impact of timing and spacing pregnancies on child and maternal health, WV related them to WV’s goal – the sustained well-being of children within families and communities and showed how healthy timing and spacing of pregnancies increased the likelihood of: Children enjoy good health Children are educated for life Children experience love of God and their neighbors Children are cared for, protected, participating Strategy: 1.Within WV – Actively disseminate evidence-based data that quantifies the impact of timing and spacing pregnancies on child and maternal mortality and nutrition 2.In 37 countries, WV staff

New data spur new values Moving from “family planning” to “reproductive health” to “Healthy Timing and Spacing of Pregnancies” encouraged WV to focus on healthy fertility Internally, the health staff in WV offices in almost 100 countries joined webinars, participated in workshops, and received papers and publications on Health Timing and Spacing of Pregnancies Externally, WV staff began to integrate these same messages into their ongoing MNCH (maternal, newborn child health) programs and MIYCN (maternal infant and young child nutrition) programs to improve program outcomes WV staff and CHWs (community health workers) discussed the data and their implications with religious leaders, other influentials, fathers, mothers and mothers-in-law.

Pregnant WomenChildren 0-24 months 1. Adequate diet 2. Iron/folate supplements 3. Tetanus toxoid immunisation 4. Malaria prevention (IPT) 5. Healthy Timing and Spacing of Pregnancies (HTSP) 6. De-worming 7. Access to antenatal and postnatal care, skilled birth attendance, prevention of mother-to- child transmission of HIV 1. Appropriate breastfeeding 2. Essential Newborn Care 3. Hand washing 4. Appropriate complementary feeding (6-24 months) 5. Adequate iron 6. Vitamin A supplementation 7. Oral Rehydration Therapy & Zinc 8. Care seeking for fever 9. Full immunisation for age 10. Malaria prevention 11. De-worming (+12 months) World Vision’s Global Health & Nutrition Strategy

What is Healthy Timing and Spacing of Pregnancy – HTSP? HTSP includes analyses of 52 Demographic and Health Survey (DHS) data covering 1.12 million births in developing countries from 2000 to 2005 Researchers analyzed the impact of length of the preceding birth interval, maternal age and parity on infant, child and maternal mortality and malnutrition Data show that timing and spacing pregnancies lowers infant, child and maternal mortality, and reduces stunting and wasting Following are examples of the data and messages we use:

Birth-to-Pregnancy Intervals and Relative Risk of Neonatal and Infant Mortality Source: Rutstein, 2008 Shea Rutstein, Ph.D., Measure DHS

1,049,122 births Shea Rutstein, Ph.D., Measure DHS

1,639,000 deaths could be averted every year by proper spacing

Age of MotherParitySpacing

Shea Rutstein, Ph.D., Measure DHS 352,447 births in 52 DHS surveys

Impact of birth-to-pregnancy interval on mortality 1.6 million deaths in children under 5 could be eliminated if all birth-to-pregnancy intervals were 24 to 36 months Pregnancy is the leading cause of death for teenage girls globally Girls age 15 to 19 are twice as likely to die in pregnancy and childbirth as those age 20 – 24 Girls less than 15 years old are 5 times more likely to die Infants of teenage girls are almost twice as likely to die as those born to mothers age 20 – 24. Up to 40% of infants whose mothers’ die after childbirth will likewise die before their first birthday. Save, 2007

MIYCN + HTSP Maternal infant and young child feeding is integrated with FP and HTSP for the first 1,000 days - conception to age 2 Mothers counseled on breastfeeding and future contraceptive use during antenatal checkups Mothers supported in immediate and exclusive breastfeeding for 6 months to assure infant nutrition, and concurrently delay the onset of menses (Lactational Amenorrhea Method) At 6 months, mothers begin complementary feeding (solids + breast milk) for infants, and a modern method of contraception to protect them from another too-soon pregnancy Protection from pregnancy enables mothers to breastfeed until the child is at least 2 years old, reducing the risk of undernutrition and enables mothers to space pregnancies by at least 2 years for healthiest outcomes Undernutrition may result in stunting that leads to impaired health and reduced intellectual capacity that can be passed on to the next generation (Lundgren, Tuverno, Best Practices Res Cli Endocrinal Meta. 2008)

Healthy Timing & Spacing of Pregnancies Babies born less than 2 years apart are more than twice as likely to die before their first birthday, compared to those born 3 to 4 years apart. S. Rutstein, 2005

Healthy Timing & Spacing of Pregnancy (HTSP) Messages 1.Wait until age 18 before trying to become pregnant 2.After a miscarriage or abortion, wait at least 6 months before trying for another pregnancy 3.Wait until your child is at least 2 years old before trying for another pregnancy 4.Limit pregnancies to a mother’s healthiest ages, 18 to 34.

Thank you!

Source: Borda, M. and W. Winfrey. Family Planning Needs during the First Year Postpartum. ACCESS-FP. Unmet Need for FP (HTSP)1 st Year Postpartum 1 st Year PP All Women

Three Levels of Interventions for HTSP integration Family Governmental Systems/structures Community * Source - IMCI approach, proposed by UNICEF, utilized for working at 3 levels: household, community, governmental system/structure

Healthy Timing and Spacing of Pregnancies 2-6 mo postpartum (2-6)-24mo Use Contraception Delivery 6mo 24mo Months postpartum Exclusive breastfeeding up to 6 months Contraception needed to space pregnancies Can become pregnant again >24 To achieve a 36mo birth interval (including breastfeeding), contraception must be used for months postpartum before trying to become pregnant again.

ARC Model - Advocacy

ARC Model – Resource Generation

ARC Model – Community Mobilization