Abstract
Pregnancy among women of advanced maternal age (those 35 years or older) or among women of high parity (those having had 5 or more births) is linked to maternal and infant mortality. Yet little is known about the drivers of these pregnancies as they are often neglected in existing family planning and reproductive health programs. To better understand the context in which advanced maternal age and high parity pregnancies occur and the acceptability of discussing associated pregnancy risks, the Health Communication Capacity Collaborative (HC3) conducted formative qualitative research between January and March 2015 on the perception and determinants of such pregnancies in rural and urban areas of Niger and Togo. We supplemented this research with secondary analyses of data from Demographic and Health Surveys and a 2014 Niger survey. Our formative research showed that urban Togolese participants demonstrated more knowledge about advanced maternal age and high parity pregnancy risks than did participants in Niger as a whole. We found that such pregnancies were generally seen as part of reproductive norms in situations where fertility rates remain exceptionally high, especially in Niger. Social, gender, and religious norms, including competition between co-wives, also drove women into high parity and advanced maternal age situations, particularly in Niger, highlighting the need to bring men and community and religious leaders into family planning conversations to increase acceptance. The study also provided important insights needed to address these high-risk pregnancies through culturally appropriate health communication interventions. A main insight was that providers often had incomplete information about advanced maternal age and high parity pregnancies and lacked communication skills, protocols, and tools to appropriately discuss such pregnancy risks with clients. HC3 used these and additional findings to create an Implementation Kit (I-Kit) for family planning and maternal and child health program managers with guidance and tangible tools to address advanced maternal age and high parity pregnancy through social and behavior change communication. The I-Kit includes health communication materials to engage women, men, decision makers, communities, health care providers, journalists, and others. In 2016 and 2017, one organization each in Niger and Togo piloted the I-Kit, integrated selected I-Kit tools into their unique programs, and documented their experiences. Both organizations credited the I-Kit with expanding the scope of their programs to now address advanced maternal age and high parity pregnancy and provided concrete suggestions for adapting the materials according to activity and intended audience.
Highlights
Planning remains a key aspect of the global health agenda
While Goal 3 of the Sustainable Develop-ment Goals (SDGs) includes a specific target to “ensure universal access to sexual and reproductive health services, including for family planning,”[2] the argument has been made that investing in family planning will accelerate achievement across all 5 SDG themes.[3]
Childbearing is more common in Niger, where 40.4% of women ages 15 to 19 are mothers or pregnant with their first child. This statistic is much lower in Togo, where 16.5% of women between ages 15 and 19 have begun childbearing.[14]. Another reason we focused on Niger and Togo is that both countries have critical family planning needs
Summary
Planning remains a key aspect of the global health agenda. Following a decline in global funding in the late 2000s, family planning has regained momentum and international attention in recent years.[1]. To understand what drives these high-risk pregnancies, we conducted formative research in 2 countries with considerable advanced maternal age and high parity rates: Niger and Togo. This statistic is much lower in Togo, where 16.5% of women between ages 15 and 19 have begun childbearing.[14] Another reason we focused on Niger and Togo is that both countries have critical family planning needs. The overall goals of the formative research were to: (1) understand the knowledge, attitudes, and behaviors that contribute to advanced maternal age and high parity pregnancy incidence/ prevalence, and (2) understand how the findings www.ghspjournal.org could be used to improve maternal and child health and family planning programs through a pilot intervention focused on social and behavior change communication
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