Family Planning and Malaria in Pregnancy

In a recent New York Times column Nicholas Kristof addressed both the needs for and difficulty in promoting family planning programs.  Even though the U.S. is more supportive of family planning services internationally, the goal is difficult.

Kristof gives the example of Haiti where there may be high unmet need for contraceptives, but low utilization rate. The experience of one Haitian woman exemplified the problem on a personal basis.

She tried injectables, but she says they caused excess bleeding that frightened her. The clinic had little counseling to explain and reassure her, so she stopped after nine months. A sexually transmitted infection at the time meant that she couldn’t use an IUD just then, and a doctor told her that the pill would be inappropriate because she has vascular problems. Reluctant to return to a clinic that seemed scornful of poor women, she drifted along with nothing.

This woman ultimately had 10 children by last count.  What are the implications of her story for millions of other women who get pregnant in malaria endemic areas?

Malaria in pregnancy is particularly dangerous for a woman, an unborn child and a newborn.  Malaria leads to anemia which in turn increases chances of maternal mortality.  When pregnant women have malaria, there is growth retardation in the fetus as well as miscarriage and stillbirth. Children are often born with low birth weight and have a poorer chance of survival in the first month and year or life.

Family planning clearly enables women to spread out and reduce the risks of malaria exposure during pregnancy, and can thus save lives. This is why one reader of Krisof’s column commented that, “You have to look at the small print of the United Nations’ Millennium Development Goal 5, ‘Improve Maternal Health,’ under Target 2, to find this language: ‘An unmet need for family planning undermines achievement of several other goals,’” which include reducing the burden of malaria in pregnancy.

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