The HTSP Implementation Kit

The HTSP Implementation Kit

The HTSP Implementation Kit

About the HTSP Implementation Kit

cover imageHealthy Timing and Spacing of Pregnancy (HTSP) is an under-utilized 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 outcomes for mother and child. Although many FP and MCH programs promote birth spacing, HTSP elevates the role of spacing between pregnancies, rather than births, and stresses the impact on maternal, neonatal and child health. Specifically, HTSP emphasizes preventing four types of high-risk pregnancies:

  1. Those too closely spaced (a birth-to-pregnancy interval of less than 24 months)
  2. Those that occur too early in a mother’s life (before the age of 18)
  3. Those that occur too late in a mother’s life (at or after age 35)
  4. Those that occur to a mother with who has had many (five or more) live or stillborn births already
HTSP activities and research to date have focused on the first two approaches in this list: delaying pregnancies until after age 18 and spacing pregnancies at least 24 months after the preceding birth. However, a recent HC3 desk review revealed that little to no work has focused on social and behavior change communication (SBCC) around the last two themes: pregnancies in women aged 35 and older (of advanced maternal age, or AMA) and women having five or more (high-parity, or HP) births.

HC3 conducted qualitative research around the drivers and determinants of AMA and HP pregnancies in Togo and Niger, and pretested approaches to address them using SBCC. HC3 then developed this implementation kit (I-Kit) to help program managers emphasize and include AMA and HP pregnancy risk information in their existing FP and MCH programs.

What Is the Purpose of the Implementation Kit?

This I-Kit aims to help program managers use SBCC to include AMA and HP pregnancy topics in their existing or planned FP or MCH programs. The I-Kit includes a set of adaptable HTSP communication materials and tools that focus on preventing AMA and HP pregnancies for various priority audiences.

Who is the Audience for the Implementation Kit?

The HTSP AMA/HP I-Kit is for international or local non-governmental organization (NGOs), government divisions or community group program managers who want to use communication approaches to help reduce AMA and HP pregnancies in their community.

How is the Implementation Kit Organized?

The I-Kit outlines a five-step process to integrating AMA and HP into existing FP and MCH programs:

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 program 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 (M&E) (See Section 9).

Additional information about SBCC’s guiding theories and resources are provided in Annex A.

What Does the Implementation Kit Include?

To get started click on the sections below:

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 behavioral determinants and the use of SBCC approaches.

 Section 4: Identify and Define Audiences

Suggested primary and secondary audiences for AMA and HP programs 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 programs.

 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 Implementation Kit’s adaptable tools for AMA and HP.

 Section 9: Monitor and Evaluate

Recommended indicators for AMA and HP.


A collection of SBCC resources and communication tools.

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