Healthy Timing and Spacing of Pregnancy

Welcome to the programmatic area on healthy timing and spacing of pregnancy (HTSP) within MEASURE Evaluation’s Family Planning and Reproductive Health Indicators Database. HTSP is one of the subareas found in the family planning (FP) section of the database. All indicators for this area include a definition, data requirements, data source(s), purpose, issues and—if relevant—gender implications.

  • HTSP is an intervention to help women and couples make an informed decision about the delay of first pregnancy and the spacing or limiting of subsequent pregnancies to achieve the healthiest outcomes for women, newborns, infants and children. HTSP provides an opportunity to highlight FP as a preventive intervention using the framework of healthy mothers, healthy babies, healthy families, and healthy communities. 
  • The HTSP indicators found in this database can be incorporated into key HTSP interventions including advocacy at the policy level, education, and counseling of women and families, and linking of FP services at the service delivery level.
  • Key indicators to monitor and evaluate HTSP can be found in the links at left. 

 

Full Text

Healthy timing and spacing of pregnancy (HTSP) is an intervention to help women and families make an informed decision about the delay of first pregnancy and the spacing or limiting of subsequent pregnancies to achieve the healthiest outcomes for women, newborns, infants and children.  HTSP messages operate within the context of free and informed contraceptive choice, taking into account fertility intentions and desired family size, as well as the social and cultural contexts.

Qualitative studies conducted by USAID in Pakistan, India, Bolivia, and Peru show that women and couples are interested in the healthiest time to become pregnant versus when to give birth. In this way, HTSP differs from previous birth spacing approaches that refer only to the interval after a live birth and when to give birth. HTSP also provides guidance on the healthiest age for the first pregnancy.

Thus, HTSP encompasses a broader concept of the reproductive cycle – starting from healthiest age for the first pregnancy in adolescents, to spacing subsequent pregnancies following a live birth, still birth, miscarriage or abortion – capturing all pregnancy-related intervals in a woman’s reproductive life.

The Rationale

USAID is working in collaboration with WHO and other organizations to integrate HTSP into health and non-health programs. For countries to reduce their burden of disease and reach their Millennium Development Goals, adding HTSP interventions to their strategies and programs should be considered a priority because of significant, multiple health benefits for women and babies.  For instance:

Multiple studies have shown that adverse maternal and perinatal outcomes are related to closely spaced pregnancies. The risks are particularly high for women who become pregnant very soon after a previous pregnancy, miscarriage, or abortion. Thus, through the promotion of HTSP, there is the potential to significantly reduce risks to both mothers and children. HTSP offers:

  • Reduced risks after a live birth
  • Reduced risks after a miscarriage or postabortion
  • Reduced risks for adolescents

 Considerable unmet need and demand for spacing still exist in the younger 15-29 age cohorts as well as in postpartum women. Spacing is the main reason for family planning (FP) demand among women in younger age groups (15-29). Data from developing countries also show that younger, lower parity women have the highest demand and need for spacing births. 

Unmet need for spacing among postpartum women is very high. Among postpartum women who want to space their pregnancy, 60% have an unmet need.

HTSP is an aspect of FP which is associated with healthy fertility and helping women and families make informed decisions about pregnancy spacing and timing to achieve healthy pregnancy outcomes. FP has made great progress in helping women avoid unintended pregnancies. To date, the focus of FP has mostly been on lowered fertility, rather than healthy fertility. Findings from the WHO technical panel support the role of FP in achieving healthy fertility and healthy pregnancy outcomes. 

HTSP is an effective entry point to strengthen and revitalize FP in sensitive settings because it focuses on the mother/child dyad and improved health outcomes for mother and baby. HTSP provides an opportunity to highlight FP as a preventive intervention using the framework of healthy mothers, healthy babies, healthy families and healthy communities. 

HTSP Messages

To achieve HTSP outcomes, three take-home messages have been developed – all to be discussed in a framework of informed FP choice, personal reproductive health goals and fertility intention.

For couples who desire a next pregnancy after a live birth, the messages are:

  • For the health of the mother and baby, wait at least 24 months before trying to become pregnant again.
  • Consider using an FP method of your choice without interruption during that time.

For couples who decide to have a child after a miscarriage or abortion, the messages are:

  • For the health of the mother and baby, wait at least six months before trying to become pregnant again.
  • Consider using an FP method of your choice without interruption during that time.

For adolescents, the messages are:

  • For yours and your baby’s health, wait until you are at least 18 years of age, before trying to become pregnant.
  • Consider using an FP method of your choice without interruption until you are 18 years old.

These messages should be incorporated into key HTSP interventions including advocacy at the policy level; education and counseling of women and families, and links to FP services at the service delivery level; and monitoring and evaluation.

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References:

Post M. Extending Service Delivery Project. HTSP 101: Everything You Want to Know about Healthy Timing and Spacing of Pregnancy. USAID, 2009.  Available at: http://www.esdproj.org/site/DocServer/HTSP_101_Brief_Final_corrected_8.18.09.pdf?docID=2821

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