Background

Healthy Timing and Spacing of Pregnancy (HTSP) is an intervention to help women and families delay or space their pregnancies in order to achieve the healthiest outcomes for women, newborns, infants and children. According to WHO, qualitative studies conducted by USAID in Pakistan, India, Bolivia, and Peru showed that women and couples are interested in the healthiest time to become pregnant

In this way, HTSP differs from previous birth spacing approaches that refer only to the interval after a live birth and when to give birth. HTSP also provides guidance on the healthiest age for the first pregnancy. Thus, HTSP encompasses a broader concept of the reproductive cycle starting from healthiest age for the first pregnancy in adolescents, to spacing subsequent pregnancies following a live birth, still birth, miscarriage or abortion – capturing all pregnancy-related intervals in a woman’s reproductive life.

Why HTSP?

Multiple studies have shown that adverse maternal and perinatal outcomes are related to closely spaced pregnancies. As shown in the table below, the risks are particularly high for women who become pregnant very soon after a previous pregnancy, miscarriage, or abortion.

Life Stage and HTSP

Considerable unmet need and demand for spacing still exist in the younger 15-29 age cohorts as well as in postpartum women:

• For women in younger age cohorts, ages 15-29: Spacing or delaying pregnancies is the main reason for family planning demand among women in this age group. Among married women 29 years or younger who wanted family planning, FP demand for spacing ranged from 66% to over 90%.  Data from developing countries also show that younger, lower parity women have the highest demand and need for delaying and spacing births. Commonly, between 90% and 100% of the demand for spacing in the 15 to 24 year age cohort, is made up of women with parity of two or less.
• For postpartum women: Unmet need for spacing among this group is very high - 95-98% of postpartum women do not want another child within two years – yet only 40% are using family planning. In short, 60% of postpartum women who want to space their pregnancy have an unmet need.

What are the core messages?

• For adolescents, the messages are:
  • For your health and your baby’s health, wait until you are at least 18 years of age, before trying to become pregnant.
  • Consider delaying pregnancy by using a family planning method of your choice without interruption until you are 18 years old.
• For couples who desire a next pregnancy after a live birth, the messages are:
  • Wait at least 24 months, but not more than 5 years, before trying to become pregnant again.  
  • Consider using a family planning method of your choice without interruption during that time.
• For couples who decide to have a child after a miscarriage or abortion, the messages are:
  • For the health of the mother and the baby, wait at least six months before trying to become pregnant again
  • Consider using a family planning method of your choice without interruption during that time.

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What are the main interventions?

Key HTSP interventions include:

• Advocacy at the policy level
• Education and counseling of women and families, and linkage to FP services at the service delivery level
• Monitoring and evaluation

Banner photo: A family carries harvested vegetables in the Philippines. © 2016 Maria Francesca Avila, Courtesy of Photoshare