Photograph of high-parity woman in West Africa with her six children, used to discuss AMA and HP pregnancy in the study’s focus groups. © 2014 Dieneba Ouedraogo. All rights reserved.

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.