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Contraceptive Security: Incomplete

Contraceptive Security: Incomplete. without Long-Acting and Permanent Contraception (LA/PMs). Jane Wickstrom, MA and Roy Jacobstein, MD, MPH, EngenderHealth International Conference on Family Planning: Research and Best Practices Kampala, Uganda, 15-18 November, 2009. Methodology.

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Contraceptive Security: Incomplete

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  1. Contraceptive Security: Incomplete without Long-Acting and Permanent Contraception (LA/PMs) Jane Wickstrom, MA and Roy Jacobstein, MD, MPH, EngenderHealth International Conference on Family Planning: Research and Best Practices Kampala, Uganda, 15-18 November, 2009

  2. Methodology • Review of key documents • 13 national & regional contraceptive security strategies • Contraceptive security (CS) literature • Materials of key organizations working in CS • E.g. RH Supplies Coalition, USAID|DELIVER, World Bank, UNFPA, IPPF • Secondary analysis of DHS data • Demand, met & unmet need for spacing & limiting births • FP method mix among spacers & limiters

  3. The four LA/PMs • Long-Acting Reversible Methods • IUDs: • CuT380A, ML-375 • LNG-IUS • Implants: • Jadelle • Sino-implant II • Implanon • Permanent Methods • Female Sterilization • Male Sterilization (Vasectomy)

  4. Language conditions thought International Definitions of Contraceptive Security: “Ensuring that all people … can access and use affordable, high-quality supplies to ensure their better reproductive health.” (RH Supplies Coalition website) “Reproductive health contraceptive security exists when people are able to choose, obtain and use the RH supplies they want…..” (JSI/DELIVER SPARHCS)

  5. Language conditions thought (cont.) Contraceptive Security in National Strategies “Definition of Contraceptive Security” “For family planning programs, the vital importance of contraceptives is often summed up by the slogan: No Product, No Program. Without contraceptive security, families will be unable to space their births, limit their family size, and time pregnancies.” (Albania, National Contraceptive Security Strategy, June 2003)

  6. Medical instruments needed to provide clinical methods of family planning http://www.engenderhealth.org/files/pubs/family-planning/LAPM-Equipment-List.pdf

  7. Necessary, but not sufficient … Medical Instruments + Equipment + FP Commodity = Supplies Services AreNeeded to Provide Clinical Methods of Family Planning Medical Instruments + Expendable Medical Supplies + FP Commodity = “Supplies” ≠ “Contraceptive Security”

  8. So, why is this important? 1. LA/PMs are highly effective 2. High unmet need for delaying, spacing and limiting births 3. Sub-optimal fit between reproductive intent and method use 4. People want and use LA/PMs when they are made available Photo by P. Perchal/EngenderHealth Photo by Staff/EngenderHealth

  9. LA/PMs are highly effective Pregnancy Rates by Method Typical use “Perfect” use (but humans are imperfect)

  10. The cost of failure: unintended pregnancies per 1000 users, by method Source:Trussell J. Contraceptive efficacy. In Hatcher RA, Trussell J, Nelson AL, Cates W, Stewart FH, Kowal D. Contraceptive Technology: Nineteenth Revised Edition. New York NY: Ardent Media, 2007.

  11. Unmet need to space/delay Using other FP method to space/delay Using IUD/implant to space/delay High demand, high unmet need, low IUD & implant use Spacing and Delaying Births, MWRA Source: DHS

  12. Unmet need to limit Using other FP method to limit Using LA/PM to limit Variable demand, unmet need, & LAPM use Limiting Births, MWRA Source: DHS

  13. Long-Acting Reversible Methods Reproductive intent and contraceptive choice: implants and IUDs have great potential to meet needs of delayers and spacers MWRA (15-49 yr) 5.0 million (2003) Kenya Source: MEASURE/DHS, Kenya DHS Survey, 2003; World Population Prospects: The 2008 Revision. Only 8% of spacers/delayers use an IUD or implant

  14. Long-Acting and Permanent Methods Sterilization17% Reproductive intent and contraceptive choice: LA/PMs are underutilized among limiters in Kenya MWRA (15-49 yr) 5.0 million (2003) Kenya Source: MEASURE/DHS, Kenya 2003 DHS Survey. World Population Prospects: The 2008 Revision. Only 28% of limiters use any of the LA/PMs

  15. When available, people choose and like LA/PMs Source: DHS

  16. LA/PMs need to be included explicitly and fully in CS definitions, strategies, plans, and programming For true CS that includes LA/PMs, we need: Medical instruments and supplies Skilled, motivated, enabled providers Suitable service setting There is high demand and unmet need for LA/PMs to better meet individuals’ and couples’ RH intentions Countries and donors increasingly interested in FP (MDG 5 and other MDGs) Contraceptive security is incomplete without LA/PMs Photo credits (from left to right): N. Rajani/EngenderHealth, C. Svingen/EngenderHealth, M. Reyners/EngenderHealth, C. Svingen/EngenderHealth, D. Peacock/EngenderHealth.

  17. www.respond-project.org

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