The HTSP Implementation Kit

Section 1: Why Focus on AMA and HP Pregnancies

While much HTSP work to date has focused on delaying early pregnancies and safely spacing birth-to-pregnancy intervals, less attention has been paid to AMA and HP, even though research has shown a number of serious adverse health outcomes. Table 1 shows the adverse health outcomes that are common for AMA and HP, and those unique to each. The results of these complications can be quite serious, particularly in settings without consistent or easy access to quality health care.


Table 1: Adverse health outcomes associated with AMA and HP pregnancies

Advanced Maternal Age Pregnancies High Parity Pregnancies
Birth and chromosomal abnormalities Anemia
Fetal (especially respiratory) distress Fetal malpresentation
Low or elevated birth weight Macrosomia/elevated birth weight (often due to gestational diabetes)
  Placental complications
  Postpartum hemorrhage
Maternal hypertension
Gestational diabetes

Intrauterine fetal death and stillbirth

(due to complications from other conditions, such as maternal hypertension, anemia, or pre-term delivery)

Caesarean section

(required when vaginal delivery is considered too difficult or dangerous due to any of the conditions listed here)

Preterm delivery

Maternal mortality

(due to complications from other conditions, such as postpartum hemorrhage, hypertension or complications from a Caesarean delivery)

Women, men and communities often are aware of at least some of these problems but not of their association with the mother’s age and parity. HP and AMA are prevalent in many countries in sub-Saharan Africa, where a large number of women give birth after age 35 and a large number of women are HP.

If FP messages focus on properly spacing between births, but fail to address preventing AMA births, women could continue to give birth well past age 35 as they aim to increase spacing between births. Similarly, if birth spacing messages do not include information on the risks associated with having many births, women could continue to have children well past the number that is safe for both them and their children.

High incidence of AMA and HP births and the many adverse health outcomes of these births demonstrate a clear need for programs that include tailored messages for women at risk, including women who are already AMA or HP, and women “approaching” AMA and HP. In this I-Kit a woman is considered to be “approaching” AMA or HP if she will turn 35 in the next two years, or if her next birth will be her fifth.

Learning about the risks associated with AMA and HP pregnancies can motivate women and couples to seriously consider modern contraception to prevent these dangerous types of pregnancy.



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(Next Step) Section 2: Understand the Local Situation for AMA and HP Pregnancies
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