Healthy Timing and Spacing of Pregnancy: Research Brief 3

Publication Date
January 1, 2017

“When we go to a prenatal or pediatric exam, they advise us about FP methods for spacing the births…at home, when we tell our husbands, they refuse under the pretext that these methods create illnesses that will still be their responsibility, when you return to inform the midwives they will tell you to bring your husband in, but he always refuses. There is no other way, you are condemned not to do it because he threatened you at home, because you are afraid to disobey him you will do nothing but spawn children.” - Woman, not using FP, urban Togo

This brief presents research findings on how gender norms contribute the prevalence of advanced maternal age (AMA) and high parity (HP) pregnancies. The brief is one of a series of three briefs published 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 (35 years and older) and after they have already had many births (see Related Summaries below). The findings outlined in the briefs are based on an analysis of Togo and Niger Demographic and Health Survey data, as well as data from a larger 2014 Camber Collective family planning study, referred to here as the AMA/HP Niger Women Insights Research. HC3 also conducted qualitative research in Niger and Togo with women, male partners, healthcare providers, and community leaders.

The following is a brief overview of some of the findings:

  • Gender roles in both countries disempower women in matters of their own reproductive lives and health. Early marriage, remarriage, polygamy, and strong religious beliefs all contribute to AMA and HP pregnancy prevalence in Togo and Niger.
  • While women’s attitudes are generally positive toward family planning (FP) in both Togo and Niger, male partners’ refusal of FP or limiting pregnancies is a primary barrier to women accessing, using, and continuing FP methods. The AMA/HP Niger Women Insights Research showed that 23.6 percent of participants reported that their husband’s refusal prevented them from considering a modern FP method. Generally around decision making power, research showed that less than half (48 percent) of women reported they could make decisions about their health.
  • While men made final decisions on FP use, women were often blamed when they had too many children or their pregnancies were too closely spaced.
  • Women and health service providers commented on how difficult it was to engage men in discussions about FP methods. They explained that men rejected FP use because they feared their wife being unfaithful, they did not trust the methods’ safety, or they simply wanted their female partner to have many children.
  • According to the AMA/HP Niger Women Insights Research, access to information positively influenced contraceptive use by AMA and HP women. Generally, the research found that women who 1) had access to FP information, 2) held FP decision-making power, and 3) were employed were more motivated to use FP.

Based on the findings, the report offers the following recommendations:

  • "Use evidence-based communication strategies to shift harmful maternal health and FP norms. It is important to work with local organizations and structures to develop holistic, gender-transformative (e.g., those that facilitate gender equity and address imbalanced gender norms) and community-centered programs that address harmful norms - specifically those encouraging large families, male-dominated decision-making, competition between co-wives in polygamous relationships and mistrust of FP methods and services - head on to reduce AMA and HP pregnancy prevalence.
  • Engage male partners in efforts to prevent AMA/HP pregnancies.  Programs should involve men, inform them about pregnancy risks associated with AMA and HP and engage them to make changes in their own families.
  • Capitalize on community leaders’ willingness to support AMA/HP prevention initiatives. Religious and community leaders are important sources of information and influence. These gatekeepers can model and promote more equitable gender norms, encourage community members to use and accept FP, accept or plan smaller family sizes, communicate with their partners about FP use and promote women’s agency in making FP decisions. Work with these groups should also highlight the harmful effects of early marriage and polygamy, particularly as it relates to reproductive health decision making and the health of women and children.
  • Develop effective tools to support AMA and HP communication at the service delivery level. FP healthcare providers play a frontline role in educating women and couples about age- and parity-related pregnancy risks, and in facilitating behavior change for pregnancy risk management and prevention. Culturally appropriate materials that include guidance on structured couples counseling is key to ensure men understand the benefits of birth spacing and FP and are supportive of their partner’s use of these approaches."

Click here to download the full report, “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 finding and recommendations from this research, 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 14 2017.