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Dr Ruwaida Rashid MOH / WCHD Director 2011

Improving Access to Long-Acting Contraceptives in Jordan Situation, Issues, and Recommended Actions. Dr Ruwaida Rashid MOH / WCHD Director 2011. Topics. 1. Situation of family planning methods use in Jordan.

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Dr Ruwaida Rashid MOH / WCHD Director 2011

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  1. Improving Access to Long-Acting Contraceptives in JordanSituation, Issues, and RecommendedActions Dr Ruwaida Rashid MOH / WCHD Director 2011

  2. Topics 1. Situation of family planning methods use in Jordan. 2. Interventions to improve access to long acting contraceptives in Jordan. • Jordan Contraceptives Logistic System. • Improving Access to IUDs at MCH Centers. • Introducing Long Acting Hormonal Methods (Implants) in the Jordan Contraceptives Logistic System. • Family Planning Sentinel Surveillance at MCH Centers. 3. Recommended Actions.

  3. 1. Situation of family planning methods use in Jordan.

  4. Current Use of Family Planning Methods and Method Mix / 2009

  5. Trends in the Use of Modern Family Planning Methods(%)

  6. Trends in Current Use of Family Planning Methods Percentage of currently married women 15-49 using any method 59

  7. Contraceptive Discontinuation 2009

  8. Main Reason for Discontinuation

  9. Impact of Changing Method Mix on Jordan’s TFR

  10. Method Mix Issues in Jordan • Fear of side effects • Provider bias • Provider availability (female provider) • User preferences • Availability of financial resources • Quality of counseling services (practices & space)

  11. 2. Interventions to improve access to long-acting contraceptives in Jordan

  12. Jordan Contraceptive Logistic System (JCLS) No Products………… No programs ►Established in 1997 at MoH. All contraceptives were provided by USAID. ►In 2005, USAID started to phase out and completed in 2009. MoH started to purchase all contraceptives. ►A budget item in MoH budget is specified for contraceptives procurement in 2011.

  13. FP Methods Available in Jordan Contraceptive Logistic System • Pills (combined and estrogen only pills). • IUDs (copper T). • Injectables (3 months ). • Implant (one rod). • Male condoms.

  14. Programs Under Jordan Contraceptive Logistic System • Ministry of Health (health centers and hospitals) • Royal Medical Services. • UNRWA Clinics. • Jordan Association for Family Planning and Protection. • Governmental universities hospitals. • Private sector clinics through PSP project . • Other NGOs Total of 662 clinics provided with contraceptives for free.

  15. Method Mix at MoH-2010

  16. Method Mix for the whole System-2010

  17. Contribution of Partners under the System to CYP - 2010

  18. Important Issues Related to JCLS • New choices of contraceptives methods should be added to the system. some of the barriers are: • Concerns regarding stock out ,over stock, when adding different brands of combined oral pills to the system. • Limited brands of oral pills (COCs ,POPs) and types of contraceptives registered at JFDA. • Limited market for family planning methods in Jordan. • Long and complicated procurement procedures.

  19. Improving Access to Intra Uterine Devices (IUDs) at MCH Clinics ► IUD is a long term, effective, and well accepted family planning method in Jordan. However, access to this method is limited due to shortage of female providers.

  20. MoH Pilot Project on IUDs Insertion by Midwives ► Objective : Improve Access to IUD Services at MoH Primary Health Care Level. ► Started in 2003 and continued successfully until 2009. ► 182 midwives at MCH centers were trained to offer IUD insertion service and permitted to provide the services. ► Results : • No significant complications were reported.

  21. NUMBER OF HEALTH CENTERS PROVIDING IUD SERVICES 2003-2009

  22. PERCENTAGE OF IUDs INSERTEDBYMIDWIVES 2004-2010

  23. ► Policy Change Recently, the Minister of Health approved adding the “task of IUD insertion under physician’s supervision” in job description for midwives.

  24. Introducing Long Acting Hormonal Methods-Implants- in Jordan Contraceptives Logistics System ► Why Implants ?? • Effective and long acting. • Acceptable from male physician providers. • Expand choices of contraceptives. ►Implants was introduced in Jordan Contraceptive Logistic system in 2006 in cooperation with Organon in a limited scale (two training courses).

  25. ►In cooperation with HSS2, a core of 13 trainers were trained in 2010, then several training courses were conducted.►Currently, - Total number of trained physicians: 94 (from MOH, JAFPP, RMS) - Number of health facilities providing implants: 48 (at MOH, RMS)

  26. ►Issues • High over turn of trained health providers. • Limited promotional activities towards Implants. • The need for assessment of acceptance, side effects, and discontinuation of implants.

  27. Family Planning Sentinel Surveillance at MCH Clinics Established in cooperation with HSS project for discontinuation of combined pills and IUDs using prospective study design.

  28. Contraceptive Discontinuation Rate (%) by Reason and Method-(2009-2010)

  29. Percent Distribution of Contraceptive Discontinuation by Reason

  30. ► Issues based on the results • High discontinuation rate especially among COCs users (although less than national rate). • Most of discontinuers (42%) switch to another method mainly condom which is less effective. • High % of IUD users (39%) switch to COCs which is short term, while 27% of COCs users switch to IUD which is long term. • Side effects play a major role in discontinuation and switching.

  31. 3. Recommended Actions

  32. Recommended Actions ►Conduct an assessment of the feasibility and effectiveness of introducing new brands and varieties of pills to Jordan FP logistic system. ►Introduce new family planning methods to the Jordan FP logistic system. ►Simplify the procurement procedure of FP methods.

  33. Recommended Actions ►Operationalize the Minister’s decision which approved adding IUDs insertion to midwife job description. ►Collect and analyze information on Implanon discontinuation rate, side effects, and acceptance, to be used as a tool for evidence based promotion for service providers. ►Strengthen FP communicationactivities on increasing demand for long-acting hormonal contraceptives, decreasing demand for traditional methods, and on birth spacing and limiting to promote appropriate method selection.

  34. Recommended Actions ► Conduct an assessment of the family planning counseling services. ►Strengthen counseling services with focus on provision of special counseling and follow up for COCs users, and sufficient information and counseling on side effects and on most suitable methods for limiting and spacing.

  35. Thank You

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