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Back to the Future: A Call to Action for FP and LAPMs

Back to the Future: A Call to Action for FP and LAPMs. Scott Radloff Director Office of Population and Reproductive Health USAID ACQUIRE End-of-Project Meeting September 17, 2008. Family Planning: responds to a panoply of problems…. Enables couples to decide number/spacing of births

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Back to the Future: A Call to Action for FP and LAPMs

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  1. Back to the Future: A Call to Action for FP and LAPMs Scott Radloff Director Office of Population and Reproductive Health USAID ACQUIRE End-of-Project Meeting September 17, 2008

  2. Family Planning: responds to a panoply of problems… • Enables couples to decide number/spacing of births • Reduces child mortality • Reduces maternal mortality/morbidity • Reduces abortion • Improves women’s opportunities • Key intervention in HIV settings • Essential component of health programs • Mitigates adverse effects of population dynamics on: • natural resources • economic growth • state stability

  3. Unmet need of 201 million in developing countries translates to: • 23 million unplanned births • 22 million abortions • 2 million miscarriages • 1.4 million infant deaths • 142,000 pregnancy-related deaths [1/2 in Africa] • 53,000 from unsafe abortion • 89,000 from other causes Source: Guttmacher Policy Review, Summer 2008, Vol 11, Number 3

  4. Pop Quiz Question

  5. As CPR rises, demand for limiting rises

  6. As CPR rises, demand for limiting occurs at earlier ages Age at which demand for limiting equals demand for spacing by modern CPR, all available DHS since 2000 (n=44)

  7. Answer Pop Quiz

  8. Substantial demand for limiting and spacing in African countries

  9. Still, Africa is characterized by high unmet need and low use of LAPMs…

  10. 2 children, 30 years of contraceptive use -options: • 10,950 pills (1 every day) • 360 packets of pills (1 every month) • 120 injections (1 every 3 months) • 6 implants (1 every 5 years) • 3 IUDs (1 every 10 years) • 1 sterilization (1 in a lifetime)

  11. LAPMs have lower discontinuation ratesand longer duration of effectiveness… AQUIRE 2007

  12. LAPMs are underutilized among limiters in Kenya Long-Acting and Permanent Methods MWRA (15-49 yr) 5.1 million (2005) % LAPM use to limit: 27% Source: MEASURE/DHS, Kenya 2003 DHS Survey. Ross, Stover, and Adelaja, 2005.

  13. Long-Acting methods have potential for use among spacers in Kenya Long-Acting and Permanent Methods % LA use to space:8% Source: MEASURE/DHS, Kenya DHS Survey, 2004.

  14. And, LAPMs are suitable for various reproductive intentions… Long Acting: Implants and IUDs Permanent: Vasectomy, Female Sterilization H+ L S D Delaying first births -Youth -Nulliparous Limiting births after desired fertility goals are reached- High Parity- Low Parity- Any age HIV+ women can use any LAPM Spacing pregnancies -Postpartum -Postabortion

  15. But, there are still barriers to LAPMs… Barriers to LAPM services Outcomes when barriers are overcome: Physical • ↑↑Access • ↑↑Choice • ↑↑Quality Location Knowledge Cost Inappropriate eligibility criteria Process Socio-cultural norms Time Provider bias Poor CPI

  16. BREAK DOWN THAT WALL ! ! !

  17. What can be done to increase the use of LAPMs?

  18. “Unpack” LAPMs • LAPMs ‘Packed’ = specific clinical requirements for service provision • LAPMs ‘Unpacked’ = suitable for multiple reproductive intentions • Spacing – Long-acting methods • Delaying – Long-acting methods • Limiting – Long-acting methods, permanent methods • “Long-Acting” effectiveness is not the same as “Long-Term” use(it’s not all or none)

  19. Integrate LAPMs into all other PRH technical priorities… • Contraceptive security including clinical equipment and supplies • Community-based FP Frees up clinical capacity for LAPMs, increases referrals • Healthy timing and spacing of pregnancies IUDs and implants help achieve longer spacing intervals • FP/MCH integration Postpartum and PAC, immediate use of IUD, M/F sterilization • FP/HIV integration All LAPMs are safe methods and good options for HIV/AIDS

  20. Future opportunities for LAPMs… • The Sino-implant revolution • Meeting the latent, and growing demand for limiting, at younger ages • Increasing L-A use for spacing, delaying • Reaching postpartum and post-abortion clients • Engaging private sector services • Expanding approaches to reach rural areas • Expanding urban and peri-urban services • Offering comprehensive men’s health care

  21. BACK (AND FORWARD) TO THE FUTURE Sometimes, going forward requires going back to “Big, Boring Programs” or “Proven, Time-Tested Approaches Adapted to New Settings”

  22. In closing……

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