Reaching Women Who Experience High Parity and Advanced Maternal Age Pregnancies

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Using Family Planning to Address Drivers of Mortality: Reaching Women Who Experience High Parity and Advanced Maternal Age Pregnancies

Maureen Norton, Ph.D. and Jane Ebot, Ph.D. United States Agency for International Development Global Maternal Newborn Health Conference Mexico City, Mexico Oct 18-21, 2015

FAMILY PLANNING SAVES LIVES

• In one year, family planning prevented more than 272,000 maternal deaths, a 44% reduction

• If all needs for family planning were met, an addition 104,00 maternal deaths could be prevented annually

Source: Ahmed S, Quingfeng L, Tsui, A, (2012). Maternal deaths averted by contraceptive use: an analysis of 172 countries. The Lancet, 380(9837):111-125.

11/24/15 2 HEALTHY TIMES FOR A PREGNANCY OVER THE REPRODUCTIVE LIFE COURSE

• For best maternal outcomes, healthiest times for a pregnancy are:

• Age: After 18 and before 34

• Parity: Four or less than four children

Family planning can ensure that pregnancies occur at the healthiest times of a woman’s life.

11/24/15 3 Over 50%

Stover J and Ross J. BMC Public Health, 2013(Suppl3):S4 High Parity: Percent birth order 4+ pregnancies - all women 15-49 years - USAID 24 priority countries 60 57

51 50 49 49 50 48 48 45 44 44 43 42 40 40 38 37 37

29 30 26 Percept 20 20 17 13 10

Source: DHS Surveys Note: No available data for Afghanistan, South Sudan, India. Advanced Maternal Age: Percent Advanced Maternal Age Pregnancies > age 34 – USAID 24 Priority Countries 20 18 17 18 17 17 16 16 16 15 15 15 15 15 14 14 13 13 14 13 12 12 11 10 Percent 8 7 6 4 4 4 2 0

Source: DHS Surveys Note: No available data for Afghanistan, South Sudan, India HIGH PARITY PREGNANCIES AND MATERNAL MORTALITY

• Maternal mortality is lower among women who have fewer than 4 children

7 ADVANCED MATERNAL AGE AND MATERNAL MORTALITY

• Maternal mortality is lower among women who become pregnant before age 34

11/24/15 8 ADVANCED MATERNAL AGE AND NEWBORN OUTCOMES

• Advanced maternal age is associated with approximately 30% increased risk of preterm birth Association between maternal age and preterm delivery (OR, 95% CI)*

1.8 1.6 1.4 1.2 1 0.8

Odds Ratio 0.6 0.4 0.2 0 <19 25-29 30-34 >35 Maternal age, years Note: * Reference category is 20-24 years; Adjusted for sex, SES factors, maternal height, breastfeeding duration and parity

Source: Fall et al. (2015). Association between maternal age at childbirth and child and adult outcomes in the offspring: a prospective study in five low-income and middle-income countries (COHORTS collaboration). The Lancet 3: e366-377. 9 TRENDS IN PERCENT OF MARRIED WOMEN 35-49 USING IMPLANTS OR IUD Use of implants or IUD by advanced maternal aged women is very low in most countries

IUDs Implants

18 1.3 16

14 15.4 12 19.5 10 9.4 8 16.5 0.4 0.2 1.1 6 3.9 11.1 12 7.3 4 7.1 8.6 2.4 6.8 7.4 5.1 6 5.8 5.3 2 0.3 3.7 3.1 4.3 0.6 2.6 1.5 1.8 1.3 1.2 0 0.3 0.8 0.4 0.2 0.4 2006 2006 2011 2008 2013 2008 2013 2010 2010 2006 2011 2013 2014 1997 2012-13 2012-13 2007-08 2012-13 2004-05 2006-07 Mali Nepal Nigeria Pakistan Philippines Rwanda Senegal Tanzania Uganda Yemen TRENDS IN PERCENT OF MARRIED WOMEN 35-49 USING IMPLANTS OR IUD, CONTINUED Use of implants or IUD by advanced maternal aged women is very low in most countries IUDs Implants 18

16 5.9 14

12 4.8 10

9.7 3 6 11.7 1.3 8.8 4 4.8 2.5 0.9 4.3 4.7 2 4.6 4.1 2.7 1.6 0.6 2.8 3.3 2.4 1.9 1.4 0.8 1.3 1.4 1.2 1 0 2007 2011 2007 2013-14 2005 2011 2003 2008 1998-99 2005-06 2003 2008-09 2007 2013 2003-04 2008-09 Bangladesh DRC Ethiopia Ghana India Kenya Liberia Madagascar NEW USAID MATERIALS FOR HIGH PARITY AND ADVANCED MATERNAL AGE WOMEN 1. Counseling and assessment guide 2. Program managers guide 3. Info-graphic 4. Guide for research 5. Guide for radio journalists 6. Poster 7. Client brochure KEY RECOMMENDATIONS

• Counsel women and families on complications and risks associated with AMA and HP pregnancies and prevention role of FP • Use HTSP I-Kit Materials -- will be ready in early 2016 • Obtain from HC3 and test and adapt them in country • Advocate with public health officials to train providers • Mobilize women’s groups, community groups, district health teams, religious leaders • Train journalists • Share brochures with couples • Review availability of modern contraceptives at health posts and work to increase availability i.e. no stock outs

Thank you!