More than half a million women die each year as a result of complications related to pregnancy and childbirth in developing countries across the world; 1,2 in India, there were 68,000 maternal deaths in 2008. 3 Of the 7.7 million child deaths reported worldwide in 2010, 22% occurred in India. [1][2][3] Recent Indian National Family Health Survey (NFHS) data further show that 12% of children ever born to currently married women have died. 4 Available studies demonstrate that the chances of infant and maternal survival would be 2.5 times as high with birth intervals of 3-5 years as with intervals of two or fewer years. [5][6][7][8] In this context, the postpartum period is particularly important. Family planning method use in India leans heavily toward methods that limit fertility. The latest NFHS shows that 77% of sterilized women did not use a family planning method before sterilization. 4 Between the 1970s and the 1990s, the Indian Family Planning Program emphasized sterilization and set targets for the number of procedures. 9As a consequence, the name Family Planning Program became associated with sterilization. Despite changing its name to the Family Welfare Program and removing the target approach, the program has not been successful in educating people about the concept and advantages of interpregnancy spacing or the use of contraceptive methods for spacing births. Although contraceptive methods are available for free through the public health system at the village level, promotion of spacing methods is not considered important by health workers. Studies suggest that providers tend to focus their counseling on limiting methods and find it challenging to counsel young couples about spacing methods.9-13 Counseling about spacing methods can be time-consuming and providers must work against the myths and misconceptions about family planning use that are prevalent in the community. In addition, the lack of decision-making power about contraceptive use among young women makes providers view this counseling as futile. 12,13 Consequently, the interpregnancy interval has remained short. The median birth interval in India is 31 months; it is only 25 months for women aged 15-19 years. Young, low-parity, postpartum women in Uttar Pradesh are at high risk of closely spaced births; it is essential that programs focus their attention on this group to help prevent maternal and child mortalities and morbidities. The dependence of postpartum women on such traditional practices as postpartum abstinence and prolonged

EXECUTIVE SUMMARYThe Indian Family Welfare Program, though successful in increasing contraceptive use among couples who have achieved their desired family size, has failed in educating people about the importance and need of using contraceptive methods for spacing births. The concept of interpregnancy spacing and its advantages was never given serious attention as a program objective. The latest National Family Health Survey (NFHS) results show that 77 percent of sterilized women did not use a family planning method before their sterilization (IIPS and Marco International 2007). Furthermore, available studies demonstrate that a birth interval of 3 to 5 years could increase chances of infant and maternal survival by 2.5 times more than children born at an interval of 2 years or fewer. Thus, Healthy Timing and Spacing of Pregnancy (HTSP) is considered an important family planning intervention to improve maternal and child health.

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