Skip to main content

Main menu

  • Content
    • Current Issue
    • Advance Access
    • Archive
    • Supplements
      • The Challenge Initiative Platform
      • Call for Abstracts
      • The Responsive Feedback Approach
    • Topic Collections
  • For Authors
    • Instructions for Authors
    • Submit Manuscript
    • Publish a Supplement
    • Promote Your Article
    • Resources for Writing Journal Articles
  • About
    • About GHSP
    • Editorial Team
    • Advisory Board
    • FAQs
    • Instructions for Reviewers
  • Webinars
    • Local Voices Webinar
    • Connecting Creators and Users of Knowledge
    • Publishing About Programs in GHSP
  • Other Useful Sites
    • GH eLearning
    • GHJournal Search

User menu

  • My Alerts

Search

  • Advanced search
Global Health: Science and Practice
  • Other Useful Sites
    • GH eLearning
    • GHJournal Search
  • My Alerts

Global Health: Science and Practice

Dedicated to what works in global health programs

Advanced Search

  • Content
    • Current Issue
    • Advance Access
    • Archive
    • Supplements
    • Topic Collections
  • For Authors
    • Instructions for Authors
    • Submit Manuscript
    • Publish a Supplement
    • Promote Your Article
    • Resources for Writing Journal Articles
  • About
    • About GHSP
    • Editorial Team
    • Advisory Board
    • FAQs
    • Instructions for Reviewers
  • Webinars
    • Local Voices Webinar
    • Connecting Creators and Users of Knowledge
    • Publishing About Programs in GHSP
  • Alerts
  • Visit GHSP on Facebook
  • Follow GHSP on Twitter
  • RSS
  • Find GHSP on LinkedIn
Methodology
Open Access

Operations research to add postpartum family planning to maternal and neonatal health to improve birth spacing in Sylhet District, Bangladesh

Salahuddin Ahmed, Maureen Norton, Emma Williams, Saifuddin Ahmed, Rasheduzzaman Shah, Nazma Begum, Jaime Mungia, Amnesty Lefevre, Ahmed Al-Kabir, Peter J Winch, Catharine McKaig and Abdullah H Baqui
Global Health: Science and Practice August 2013, 1(2):262-276; https://doi.org/10.9745/GHSP-D-13-00002
Salahuddin Ahmed
aJohns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
bJhpiego, Baltimore, MD, USA
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Maureen Norton
cU.S. Agency for International Development, Washington, DC, USA
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Emma Williams
aJohns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Saifuddin Ahmed
aJohns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Rasheduzzaman Shah
aJohns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Nazma Begum
aJohns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Jaime Mungia
bJhpiego, Baltimore, MD, USA
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Amnesty Lefevre
aJohns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Ahmed Al-Kabir
dResearch, Training and Management (RTM) International, Dhaka, Bangladesh
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Peter J Winch
aJohns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Catharine McKaig
bJhpiego, Baltimore, MD, USA
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Abdullah H Baqui
aJohns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • For correspondence: abaqui@jhsph.edu
PreviousNext
  • Article
  • Figures & Tables
  • Supplements
  • Info & Metrics
  • Comments
  • PDF
Loading

Figures & Tables

Figures

  • Tables
  • Additional Files
  • Figure1
    • Download figure
    • Open in new tab
    • Download powerpoint

    The Healthy Fertility Study used successful LAM users, designated as “LAM Ambassadors,” to promote LAM to other pregnant and postpartum women in their communities.

  • Figure
    • Download figure
    • Open in new tab
    • Download powerpoint
    Figure

    Timeline: Implementation of Healthy Fertility Study

    Abbreviations: HFS, Healthy Fertility Study; PP, postpartum.

  • Figure3
    • Download figure
    • Open in new tab
    • Download powerpoint

    During the Healthy Fertility Study, community mobilizers met with religious leaders during advocacy meetings.

  • Figure4
    • Download figure
    • Open in new tab
    • Download powerpoint

    Community health workers provided doorstep delivery of oral contraceptive pills and other modern methods to women in their communities.

Tables

  • Figures
  • Additional Files
    • View popup
    Table 1. Postpartum Family Planning Communication Messages, by Timing of CHW Visits
    CHW Visits Within Existing MNH VisitsNew CHW Visits
    Communication MessagesDuring PregnancyOn Day 6 PostpartumBetween Days 29–35 PostpartumBetween Months 2–3 PostpartumBetween Months 4–5 Postpartum
    Benefits of longer birth intervals, risks of shorter birth intervals✓✓✓✓✓
    Essential newborn care, including exclusive breastfeeding✓✓✓
    LAM, promotion of 6 months of exclusive breastfeeding✓✓✓✓✓
    Timing of return to fertility, signs indicating return to fertility✓✓✓
    Transition from LAM to another modern contraceptive method✓✓✓
    Discussion of contraceptive methods, potential side effects, strategies to minimize side effects✓✓✓
    Referral to health facility for contraceptive methods, if needed✓✓✓
    • Abbreviations: CHW, community health worker; LAM, Lactational Amenorrhea Method; MNH, maternal and neonatal health.

    • View popup
    Table 2. Baseline Characteristics of Enrolled Study Participants (N = 4,570)
    Study Group
    CharacteristicIntervention
    (n = 2,280)
    Comparison
    (n = 2,290)
    P value
    Age, mean (95% CI), y26.5 (25.4–27.6)26.6 (26.0–27.3).86
    Years of schooling, mean (95% CI)
     Women4.5 (4.1–4.8)4.1 (3.6–4.5).11
     Husbands4.0 (3.4–4.6)4.0 (3.2–4.7).88
    Religion
     Muslim94.5%91.4%.40
     Hindu/other5.5%8.6%
    Parity, mean (95% CI)2.2 (2.0–2.3)2.2 (1.9–2.3).74
    Economic Status, %
     Poorest18.622.6.10
     Poor16.822.8
     Middle19.520.2
     Rich22.617.2
     Richest22.517.3
    Ever used contraception, %18.021.1.51
    Fertility desires, %
     Wants more children59.755.7.36
     Wants no more26.032.4
     Undecided/up to God14.311.9
    • Abbreviations: CI, confidence interval.

    • P values are adjusted for clustering effects. P values ≤ .05 were considered statistically significant.

    • View popup
    Table 3. Coverage Rates of Community Health Worker (CHW) Visits
    Study Group
    Timing of CHW VisitIntervention
    (n = 2,183)
    Comparison
    (n = 2,216)
    P value
    During pregnancy99.4%99.6%.42
    Within 3 months postpartum95.6%93.0%.21
    Within first week postpartum89.8%96.4%.007
    Mean number of visits4.23.5.001
    • P values ≤ .05 were considered statistically significant.

    • During pregnancy, denominator is all women with complete information.

    • During the postpartum period, denominator is all women with a surviving infant at 3 months postpartum.

Additional Files

  • Figures
  • Tables
  • GHSP-D-13-00002 Supplementary Material

    The Healthy Fertility Study in Bangladesh used 4 communication materials to educate women, their families, and communities about postpartum family planning, birth spacing, and the Lactational Amenorrhea Method (LAM). Readers are free to use or adapt these materials in their own programs.

    Files in this Data Supplement:

    • Postpartum care leaflet - Ahmed, et al. doi: 10.9745/GHSP-D-13-00002 A pictorial description of postpartum services and potential postpartum complications, and the importance of visiting a health center at the sign of any complication. The leaflet also emphasizes visiting a health center for a postpartum physical check-up, for immunization of the baby, and to choose a contraceptive method.
    • Exclusive breastfeeding and birth spacing leaflet - Ahmed, et al. doi: 10.9745/GHSP-D-13-00002 Describes exclusive breastfeeding, the benefits of birth-to-pregnancy spacing of at least 24 months, the citation from the Quran about breastfeeding, and visiting a health facility for consultations.
    • LAM leaflet - Ahmed, et al. doi: 10.9745/GHSP-D-13-00002 A pictorial listing of LAM criteria and when to transition, and the importance of timely transition, to another modern method when LAM is no longer effective.
    • Return to fertility leaflet - Ahmed, et al. doi: 10.9745/GHSP-D-13-00002 Describes the story of a woman named Asma; the story discusses the short time period before fertility returns after delivery, and variations in return to fertility from woman to woman, including messages describing the risk of becoming pregnant prior to the return of menses and as soon as 1 month postpartum if the baby is not breastfed, as well as the benefits of birth-to-pregnancy spacing of at least 24 months. The story was received well by women in the study, many of whom could relate to it.
PreviousNext
Back to top

In this issue

Global Health: Science and Practice: 1 (2)
Global Health: Science and Practice
Vol. 1, No. 2
August 01, 2013
  • Table of Contents
  • About the Cover
  • Index by Author
  • Complete Issue (PDF)
Print
Download PDF
Article Alerts
Sign In to Email Alerts with your Email Address
Email Article

Thank you for your interest in spreading the word about Global Health: Science and Practice.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Operations research to add postpartum family planning to maternal and neonatal health to improve birth spacing in Sylhet District, Bangladesh
(Your Name) has forwarded a page to you from Global Health: Science and Practice
(Your Name) thought you would like to see this page from the Global Health: Science and Practice web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
Operations research to add postpartum family planning to maternal and neonatal health to improve birth spacing in Sylhet District, Bangladesh
Salahuddin Ahmed, Maureen Norton, Emma Williams, Saifuddin Ahmed, Rasheduzzaman Shah, Nazma Begum, Jaime Mungia, Amnesty Lefevre, Ahmed Al-Kabir, Peter J Winch, Catharine McKaig, Abdullah H Baqui
Global Health: Science and Practice Aug 2013, 1 (2) 262-276; DOI: 10.9745/GHSP-D-13-00002

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Share
Operations research to add postpartum family planning to maternal and neonatal health to improve birth spacing in Sylhet District, Bangladesh
Salahuddin Ahmed, Maureen Norton, Emma Williams, Saifuddin Ahmed, Rasheduzzaman Shah, Nazma Begum, Jaime Mungia, Amnesty Lefevre, Ahmed Al-Kabir, Peter J Winch, Catharine McKaig, Abdullah H Baqui
Global Health: Science and Practice Aug 2013, 1 (2) 262-276; DOI: 10.9745/GHSP-D-13-00002
del.icio.us logo Digg logo Reddit logo Twitter logo CiteULike logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Statistics from Altmetric.com

Jump to section

  • Article
    • ABSTRACT
    • BACKGROUND
    • STUDY AREA
    • INTERVENTION DESCRIPTION
    • METHODS
    • PRELIMINARY RESULTS
    • DISCUSSION
    • Acknowledgments
    • Notes
    • REFERENCES
  • Figures & Tables
  • Supplements
  • Info & Metrics
  • Comments
  • PDF

Related Articles

  • PubMed
  • Google Scholar

Cited By...

  • Aiming beyond equality to reach equity: the promise and challenge of quality improvement
  • Prevalence and factors associated with modern contraceptive use among women of reproductive age in 20 African countries: a large population-based study
  • Quality and Cost Interventions During the Extended Perinatal Period to Increase Family Planning Use in Kinshasa, DRC: Results From an Initial Study
  • Postpartum family planning integration with maternal, newborn and child health services: a cross-sectional analysis of client flow patterns in India and Kenya
  • Interventions for Preventing Unintended, Rapid Repeat Pregnancy Among Adolescents: A Review of the Evidence and Lessons From High-Quality Evaluations
  • Investing in Family Planning: Key to Achieving the Sustainable Development Goals
  • It's about time: WHO and partners release programming strategies for postpartum family planning
  • Google Scholar

More in this TOC Section

  • How Poor Is Your Sample? A Simple Approach for Estimating the Relative Economic Status of Small and Nonrepresentative Samples
  • Designing for Impact and Institutionalization: Applying Systems Thinking to Sustainable Postpartum Family Planning Approaches for First-Time Mothers in Bangladesh
  • Transitioning to Digital Systems: The Role of World Health Organization’s Digital Adaptation Kits in Operationalizing Recommendations and Interoperability Standards
Show more METHODOLOGY

Similar Articles

Subjects

  • Health Topics
    • Family Planning and Reproductive Health
    • Maternal, Newborn, and Child Health
  • Cross-Cutting Topics
    • Service Integration
US AIDJohns Hopkins Center for Communication ProgramsUniversity of Alberta

Follow Us On

  • Twitter
  • Facebook
  • LinkedIn
  • RSS

Articles

  • Current Issue
  • Advance Access Articles
  • Past Issues
  • Topic Collections
  • Most Read Articles
  • Supplements

More Information

  • Submit a Paper
  • Instructions for Authors
  • Instructions for Reviewers
  • GH Journals Database

About

  • About GHSP
  • Advisory Board
  • FAQs
  • Privacy Policy
  • Contact Us

© 2023 Creative Commons Attribution 4.0 International License. ISSN: 2169-575X

Powered by HighWire