Addressing Advanced Maternal Age and High Parity Pregnancies: A Healthy Timing and Spacing of Pregnancy Implementation Kit

Healthy timing and spacing of pregnancy (HTSP) is an approach to family planning (FP) and maternal and child health (MCH) education, counseling, and services to help families have planned pregnancies at the healthiest times of their lives for the best maternal, neonatal and child health (MNCH) outcomes. To learn more about the social and behavioural drivers for women giving birth after age 35 (advanced maternal age, or AMA) and for women having five or more births (high parity, or HP), the Health Communication Capacity Collaborative (HC3) conducted a desk review, an evidence review, Demographic and Health Survey (DHS) secondary analysis, and qualitative data collection on knowledge, attitudes, and perceived social norms around these behaviours in Niger and Togo. HC3 used this research to develop a collection of social and behaviour change (SBCC) materials focused on HTSP messaging for AMA/HP and pretested them in Niger and Togo. The culmination of these activities produced the HTSP Implementation Kit (I-Kit), which is a complementary resource to help programme managers include AMA and HP pregnancy risk in their existing FP or MCH programmes.

The I-Kit outlines a 5-step process:

• Step 1: Review the evidence on AMA and HP pregnancies (See Sections 1 and 2).
• Step 2: Use SBCC approaches to design a program strategy, including: i) identifying primary and secondary audiences, ii) developing a positioning concept, and iii) drafting key AMA/HP messages (See Sections 3, 4 and 5).
• Step 3: Integrate AMA and HP into your FP and MCH programme and develop an action plan for roll out (See Sections 6 and 7).
• Step 4: Review and adapt AMA and HP communication tools (See Section 8).
• Step 5: Prepare to monitor and evaluate your plan (monitoring and evaluation, or M&E) (See Section 9).

It is organised as follows:

• Section 1: Why Focus on AMA and HP Pregnancies? - An introduction to HTSP and the evidence related to AMA and HP pregnancies.
• Section 2: Understand the Local Situation for AMA and HP Pregnancies - Key questions to examine the local AMA and HP context.
• Section 3: Use SBCC to Address AMA and HP Pregnancies - Brief overview of behavioural determinants and the use of SBCC approaches.
• Section 4: Identify and Define Audiences - Suggested primary and secondary audiences for AMA and HP programmes and messages.
• Section 5: Position AMA and HP and Develop Key Messages - Illustrative examples to present key HP and AMA information in culturally sensitive and relevant ways.
• Section 6: Integrate and Implement - Guidance and illustrative activities on how to integrate AMA and HP into FP and MCH programmes.
• Section 7: Develop an Action Plan - A simple checklist and key questions to guide next steps.
• Section 8: Adapt Communication Tools- An overview of the I-Kit's adaptable tools for AMA and HP.
• Section 9: Monitor and Evaluate - Recommended indicators for AMA and HP.
• Annexes - A collection of SBCC resources and communication tools.

The I-Kit includes a collection of adaptable SBCC resources and tools, such as: key SBCC theories in FP, illustrative positioning statements, communication approaches and activities, client brochures (for less conservative and more conservative audiences), a guide for working with community-based groups, a counseling guide for providers and one for community health workers (CHWs), a reminder poster for providers, a guide for researchers, a guide for journalists, and infographics for health priority decision-makers.