What is the difference between timing and spacing?

• Timing refers to the healthiest ages for pregnancy to occur.
• For the healthiest outcomes, a woman should time her pregnancy at the best age possible.
• This means to avoid pregnancy before age 18 and over age 34 when the risk for adverse outcomes increases.
• Spacing refers to the amount of time a woman should wait after a live birth, abortion or miscarriage, before attempting to get pregnant again.

What's the difference between optimal birth spacing intervals (OBSI) and healthy timing and spacing of pregnancy (HTSP)?

• Original research commissioned by CATALYST, ESD’s predecessor project, made clear the inadequacy of existing birth spacing guidelines. For years, donors, governments, and providers have advised women to wait at least two years between births if they want to minimize health risks. While a two-year inter-birth interval was found to be associated with a lower risk of adverse outcomes compared to shorter intervals, CATALYST’s research found that an “optimal birth spacing interval (OBSI) of three to five years was associated with the healthiest pregnancy outcomes.
• However, CATALYST’s focus group data conducted in Pakistan, India, Bolivia and Peru showed that women and couples are interested in the safest time to become pregnant – not in optimal intervals to give birth- as in OBSI.
• When pregnancies occur (i.e., the timing and spacing of pregnancies) is important for healthy maternal and child outcomes. When a woman becomes pregnant too soon after a birth or too soon after a miscarriage/abortion, both the mother and the newborn face higher risks of complications or even death. Similarly, timing of a first pregnancy is equally important. Research shows pregnant women who are younger than 18 years of age face increased risks of complications for both the mother and the newborn, compared to women 20-24 years.
• The OBSI message focused heavily on when to give birth rather than when to become pregnant.
• In contrast, HTSP captures all pregnancy-related intervals – and when to become pregnant – after a live birth, still birth, miscarriage or abortion, including timing of first pregnancies

Can families who practice healthy timing and spacing of pregnancy still have a lot of children?

• Yes, it depends on a woman’s fertility intention. HTSP is not about limiting family size or limiting fertility.
• HTSP is about healthy fertility – the healthiest time to become pregnant - to have the best health outcomes for mother and child.
• When a mother has fewer complications during pregnancy and childbirth and is healthy, she is able to care for her infant and have healthier subsequent  pregnancies.
• In general, babies born healthy and well nourished are more likely to survive through infancy and childhood, which helps couples build healthy families.

How do you counsel a woman who has recently had a stillbirth?

• It is difficult to counsel a woman who has had a stillbirth. A health provider should help the woman consider her choices by providing her with accurate information on the benefits of spacing and the risks of becoming pregnant too soon after a stillbirth.
• Studies show that if a preceding pregnancy resulted in a stillbirth, there is increased risk that the next pregnancy will have the same outcome. We recommend that the client wait at least six months after a stillbirth before trying to become pregnant again, by using a family planning method of her choice during that time.
• Providers should give special attention to these women to ensure they have adequate access to antenatal care and skilled delivery services.

Will it cost more to integrate healthy timing and spacing into existing programs?

• It’s easy to integrate HTSP into existing activities without much cost.For example, HTSP training activities can be included in pre-service and in-service trainings for health providers - not only family planning service providers but those providing antenatal care, postpartum care, child health services, prevention-of-mother-to-child transmission (PMTCT) services, and counseling and testing (CT) services.
• Therefore, HTSP messages can be provided not only to clients attending FP services but also to clients in a waiting room in maternity clinics, antenatal and postpartum clinics, in well-baby clinics, in PMTCT clinics and CT sessions.
• Non-health events and programs can also be used to integrate HTSP messages - during community mobilization events and youth-focused events.
• How do you ensure that services are available to help women practice HTSP?
• Advocacy: reaching decision makers with HTSP evidence.
• Leadership: informed leaders ensuring inclusion of HTSP recommendations in national standards/guidelines/protocols/curricula, at the Policy Level

Service Delivery Level

• Behavior Change Communication (BCC): effective counseling by trained health workers using for example, “counseling cards”, “take-home reminder materials”, that educates men, women and youth about the benefits of HTSP and family planning.
• Community Based Distribution: community based distribution of family planning methods, including (but not limited to), condoms, pills and injectables.
• Contraceptive Security: ensuring a steady supply of contraceptives including long acting and permanent methods.

Community Level

• Community based family planning: community systems strengthening – training community based organizations - and community participation - involving religious leaders, community health workers, community leaders, educators, parents and families to support the concept of HTSP and family planning

What behavior changes do the HTSP messages promote?

As a result of hearing HTSP messages, and understanding HTSP benefits, healthier behavior is encouraged such as:

(1) pregnancies delayed until at least 18 years of age

(2) pregnancies spaced to occur at least 24 months after a live pregnancy

(3) pregnancies spaced to occur at least six months after a miscarriage or induced abortion

*Please keep in mind however, that HTSP recommendations should always take into consideration, a client’s fertility intention and informed choice, because ultimately it is the client’s decision.