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  • Healthy Timing and Spacing of Pregnancies (HTSP)

Healthy Timing and Spacing of Pregnancies (HTSP)

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.

​

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


 

Resources

  • Tools
  • Examples

The HTSP Implementation Kit

Training or Facilitation Guide
Website

The HTSP I-Kit is designed to help program managers address the risks of pregnancies among women aged 35 and older (of advanced maternal age, or AMA) and women having five or more births (high-parity, or HP) in their family planning or maternal and child health programs.

View ResourceView Resource

HTSP Online Course

Online Course
Training or Facilitation Guide

By the end of this online course, the student will be able to:

View Resource

Accelerator Behaviors

Training or Facilitation Guide
Website

This is USAID's website about the topic of Accelerator Behaviors. These 10 Accelerator Behaviors are identified in the USAID Behavior Change Framework as priority behaviors because they currently have low global uptake and they have the potential

View Resource

HTSP 101: Everything You Want to Know About Healthy Timing and Spacing of Pregnancy

Fact Sheet
Reports and Studies
Healthy Timing and Spacing of Pregnancy (HTSP) is an intervention to help women and families delay or space their pregnancies, to achieve the healthiest outcomes for women, newborns, infants and children, within the context of free and informed choice, taking into account fertility intentions and desired family size.
 
Download
View Resource

Basics Healthy Timing and Spacing of Pregnancy Toolkit & User Guide

Toolkit
Training or Facilitation Guide

This toolkit was developed to promote USAID/BASICS strategy to utilize maternal and child health entry points to care to introduce messages around healthy timing and spacing and or limiting pregnancies to mothers, couples and care givers that access child health services. 

View Resource

HTSP Changes Lives

Infographic

This infographic provides basic information about the value of HTSP for women and their families, along with statistics in support of HTSP implementation.

Download
View Resource

Healthy Timing and Spacing of Pregnancy Fact Sheet

Fact Sheet

This web page offers basic information about HTSP, including:

  • Definition
  • Target behaviors
  • Information about age of women (teens, older women), and safety of becoming pregnant at that age
View Resource

Healthy Timing and Spacing of Pregnancy (HTSP) Online Course

Online Course

This is a 2-hour online course which is free of charge.  

By the end of this course, the student will be able to do the following:

View Resource

Reaching First-Time Parents and Young Married Women for Healthy Timing and Spacing of Pregnancies in Burkina Faso

Reports and Studies
Success Story

In Burkina Faso, this project promoting HTSP had three components:

View Resource

Healthy Timing and Spacing Of Pregnancy: A Trainer’s Reference Guide

Training or Facilitation Guide
This guide is to be used as a resource for trainers in developing in-service training for facility-based healthcare providers and community health workers (chws) who already have some basic experience with and understanding of FP/RH.
View Resource

Healthy Timing and Spacing of Pregnancy Counseling Pathways: A Counseling Tool for Healthcare Providers

The Healthy Timing and Spacing of Pregnancy (HTSP) Counseling Pathways: A Counseling Tool for Health Care Providers can be used to identify a woman who may be at risk of a closely spaced pregnancy or pregnancy at too early an age.

View Resource

Communication for Healthy Living (CHL): Mabrouk! Initiative Spacing Pamphlet

Egypt

The CHL Mabrouk!

Download

Frequently Asked Questions on Family Planning/Childbirth Spacing Methods

Nigeria

The Nigeria Urban Reproductive Health Initiative is designed to increase contraceptives use in selected urban sites in Nigeria (FCT, Kaduna, Ilorin, Ibadan, Zaria and Benin) with a focus on the urban poor.

Download

National FP/Child Spacing Services Advocacy Kit

Nigeria

Geared towards policy makers and community leaders, this advocacy kit provides detailed information on family planning from a national perspective. Items in the kit provide stakeholders with specific actions to take to show their support of FP/child spacing.

Download

Spacing Your Children at Least Two Years Apart [Poster, Kenya]

Kenya

These posters were part of a mass media campaign in Kenya which focused on changing beliefs and behaviors among young men and women ages 25-35 to promote child spacing and informed choice of modern contraceptive methods.

DownloadDownloadDownloadDownloadDownloadDownload

Modern Family Planning/Childbirth Spacing Methods [Cue Card]

Nigeria

A two page cue card for service providers, showing different methods of family planning and their benefits. The message reads "Modern family planning is safe and easy to use. Help couples to choose a method that fits their lifestyle and needs." The cue cards list each method, its effectiveness, and for whom it is a good option.

Download

Saving Women's Lives through Family Planning / Birth Spacing in Edo State: Role of Health Sector Policy Makers

Nigeria

A short, illustrated policy brief about the need for family planning in Edo State, Nigeria. Outlines contraceptive prevalence rates and health indices.

Download

What Do You Know about Family Planning / Childbirth Spacing Methods? [Poster]

Nigeria

A poster describing various modern family planning methods, the facts about the method, and timing issues for each method.

Download

Healthy Timing and Spacing of Pregnancy (HTSP): For Healthy Babies, Healthy Mothers, and Healthy Communities

Kenya

This presentation was used in religious leader orientation by the Christian Health Association of Kenya to introduce the community-based family planning (FP) services of church-based health facilities in the IRH 2011 project.

View Resource

Thinking about Getting Pregnant Again? When is a Good Time?

This poster can be hung in facility waiting or exam rooms to present HTSP/FP information to clients. It asks clients if they want to get pregnant again, and helps them decide what is the best timing for their next pregnancy.

View Resource

HTSP 4 Key Messages

This is a generic type poster that can be used to explain four key messages of HTSP: too young, too old, too close, too soon.

 

 

View Resource

HTSP and the First 1000 Days

Healthy Timing and Spacing of Pregnancies (HTSP) is an approach to helping couples time their pregnancies to occur during a mother’s healthiest years (ages 18-34) and space pregnancies by 3 to 5 years, improving both maternal and child health.

View Resource

Healthy Timing and Spacing of Pregnancy Animation

This video explains the basics of HTSP in a short animated form. 

View Resource
February 23, 2017
March 25, 2019

This website is made possible by the support of the American People through the United States Agency for International Development (USAID) under the Breakthrough-ACTION Project, supported by USAID’s Office of Population and Reproductive Health, Bureau for Global Health, under Cooperative Agreement #AID-OAA-A-17-00017 with the Johns Hopkins University.

Breakthrough-ACTION is based at the Johns Hopkins Bloomberg School of Public Health’s Center for Communication Programs (JHU∙CCP). The contents of this website are the sole responsibility of JHU∙CCP. The information provided on this website is not official U.S. Government information and does not necessarily represent the views or positions of USAID, the United States Government, or The Johns Hopkins University.

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