Healthy Timing and Spacing of Pregnancy - Research Brief 1

Publication Date
January 1, 2017

“A woman is considered to be of advanced maternal age (AMA) when she is age 35 or older, and she is considered high parity (HP) when she has had five or more pregnancies”.

This brief presents research findings around perceived advanced maternal age (AMA) and high parity (HP) pregnancy risks, and how healthcare providers in Togo and Nigeria discuss these risks with their clients. This brief is one of a series of three briefs that emerged out of research conducted by the Health Communication Capacity Collaborative (HC3) to better understand the knowledge, attitudes, practices and socio-cultural factors in Togo and Niger that lead women to continue having children later in life and after they have already had many births.

The findings are based on an analysis of Togo and Niger Demographic and Health Survey data, as well as other research. HC3 also conducted qualitative research in both countries with women, male partners, healthcare providers, and community leaders.

In brief, in terms of risk perception, the findings of the research showed that AMA and HP pregnancies are frequent in Niger and Togo, and are often not perceived to be high risk. Age- and parity-related pregnancy risks were better understood in Togo than Niger, and were most understood in urban Togo.

In relation to healthcare provider communication barriers, interviews with maternal and infant health professionals revealed that communication about the dangers of having too many births or having children after a certain age was limited or nonexistent. Generally, clinic- and community-based providers in both countries lack the skills, training, and tools needed to adequately and appropriately communicate AMA and HP pregnancy risks. Even when the knowledge levels are present, communicating these dangers to clients remained difficult due to social and cultural norms that encourage large families, as well as lack of provider understanding of these issues, which lead to mistrust between clients and providers.

Based on the findings, HC3 recommends that Togo and Niger – and other contextually similar countries – develop an integrated AMA and HP pregnancy communication strategy at national, district, and community levels.  The brief offers recommendations for developing a strategy, which are briefly discussed here: 

  • Advocate prioritising AMA and HP pregnancy on national agendas - advocacy is needed to identify intervention opportunities, and to make resources available to systematically address and prevent such high-risk pregnancies.
  • Include AMA and HP pregnancy information into existing maternal, newborn and child health (MNCH) and FP programs - women can, for example, be reached when they are already thinking
    about their child’s health or a next pregnancy, such as during child immunization or post-partum visits.
  • Strengthen healthcare providers’ capacity to communicate the risks of AMA and HP pregnancies to clients - this should focus on understanding the cultural pressures female clients face, and the engagement of male partners in the conversation.
  • Develop effective tools to support AMA and HP communication at the service delivery level - these need to be culturally appropriate and incorporate imagery, messages, and language that priority audiences will understand and appreciate.

To read the full report on which this brief is based, see: “Engaging Families for Healthy Pregnancies: Family Planning for Women of Advanced Maternal Age and High Parity: Global Evidence on Health Outcomes and Secondary Analysis of DHS Data”

Based on the findings and recommendations arising from the original research report, HC3 developed the Healthy Timing and Spacing of Pregnancies Implementation Kit (I-Kit),  a resource for programme managers on how to address AMA and HP pregnancy through existing maternal health and family planning programmes.


HC3 website on February 2 2017.