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Filling the Void: Addressing AMA and HP Pregnancy Through Research and Social and Behavior Change Communication
Pregnancies among women of advanced maternal age (AMA, 35 years or older) or among women of high parity (HP, having had five or more births) are linked to maternal and infant mortality. To better understand the context in which AMA and HP pregnancies occur, the USAID-funded Health Communication Capacity Collaborative (HC3) project conducted qualitative research on the perception and determinants of such pregnancies in rural and urban locations of two USAID family planning (FP) priority countries – Niger and Togo. HC3 supplemented this research with secondary analyses of DHS data and data from a 2014 Niger study referred to here as the AMA/HP Niger Women’s Insights Research.
The study showed that urban locations had less restrictive cultural norms preventing FP method use compared to rural locations, and urban Togolese participants demonstrated more knowledge about AMA and HP pregnancy risks than Nigerian participants as a whole. We found that AMA and HP pregnancies were generally seen as part of the reproductive norms in situations where fertility rates remain exceptionally high, such as in Niger. However, pregnancy risks, such as loss of the mother or child’s life, were key fears among men and women in both countries. The study provided important insights needed to address AMA/HP pregnancies through culturally appropriate health communication interventions.
HC3 used these findings to create an Implementation Kit (I-Kit) for FP and maternal and child health program managers. While the I-Kit provides guidance on addressing AMA and HP through social and behavior change communication in Niger and Togo specifically, the resource is designed to be adapted for use in the broader Sub-Saharan Africa region. The I-Kit includes ready-to-use health communication tools for engaging women, decision-makers, communities, healthcare providers, journalists and others. In 2016 and 2017, one organization each in Niger and Togo piloted the I-Kit, integrating selected I-Kit tools into their unique programs and documenting their experiences. Both organizations credit the I-Kit with expanding the scope of topics their programs now address to include AMA and HP pregnancy, and provided concrete suggestions for adapting the materials according to activity and intended audience.
Download Health Communication Capacity Collaborative (HC3)'s full text of the study.
A total market approach (TMA) to family planning harnesses the resources of the entire range of health care providers—public, private (nonprofit and for-profit commercial), and donor—to ensure that all people who want family planning products and services can access them, regardless of their ability to pay. K4Health's new topic page on TMA highlights key messages,the latest essential evidence and tools, eLearning courses, and connects you to projects implementing a total market approach in family planning.
The Total Market Approach topic page includes:
- Overview: of the topic including key messages;
- Take a Course: relevant Global Health eLearning courses;
- Access Tools: several resources to standardize how countries assess their need and readiness for a TMA.;
- Review the Evidence: POPLINE searches on various sub-topics; key documents such as USAID High-Impact Practices in Family Planning Briefs;
- Illustrate and Advocate: Images from Photoshare, videos, and other multimedia resources;
- Share and Connect: Blogs; projects implementing TMA in FP
Economic Empowerment: A Potential Pathway for Women and Girls to Gain Control Over Their Sexual and Reproductive Health
Economic empowerment is the ability to make and act on decisions that involve the control over and allocation of financial resources. Women’s influence over financial decisions is associated with increased use of preventive health services by children and women, including use of modern contraceptive methods.
Thus, interventions that aim to increase the economic power of women and girls may improve reproductive health behaviors, including sustained use of modern contraception, particularly when linked with investments that directly address reproductive health and family planning and/or gender norms.
This brief summarizes the current evidence on interventions used by family planning programs that sought to improve women’s or girls’ economic empowerment and that measured key family planning outcomes. The interventions cluster in three primary focus areas:
- Vocational Training
- Cash transfers