By Olufunke ( Funke ) Akiyode Shout Global Health info@shouthealth.com

1. Global Contraceptive Prevalence and Maternal Mortality – A Study of Women’s Reproductive Health and Rights By Olufunke (Funke) Akiyode Shout Global Health info@shouthealth.com

2. Presenting Author’s Disclosure No financial relationship

3. What are contraceptives? • Contraceptives are chemicals, medicines or device that prevent conception8. • It is the use of any practices, methods, or devices to prevent pregnancy from occurring in a sexually active woman3 • They are also known as Birth Controls or Fertility Controls, and Family Planning3. • Contraceptive methods are either designed to prevent fertilization of egg or implantation of a fertilized egg in the uterus3. • Methods can be reversible or irreversible

4. Contraceptive Type • 1. Continuous Abstinence4 – Not having sex • 2. Natural Family Planning / Rhythm Method – Not having sex on most fertile days • 3.Barrier Methods – Sponge, cervical cap, diaphragm, cervical shield, female condom, and male condom. • 4.Hormonal Methods- oral contraceptives, patch, shot/ injections, and vaginal ring • 5.Implantable Devices – Implantable rod, Interuterine Devices (IUDs)9 • Permanent Birth Control Methods – Sterilization- surgical and inplant9 • 6. Emergency contraception – Used if primary birth control fails9.

5. Most Effective form of Contraceptive • 1. Abstinence • 2. Condoms • 3. Birth control combination pill, patch or ring • 4. Progestin only pills • 5. Depoprovera shot • 6. Implanon • 7.Inter uterine device • 8.Emergency contraception • 9 Essure5

6. Contraceptive Prevalence • The United Nations defined “contraceptive prevalence as the percentage of women who are currently using, at least one method of contraception, regardless of the method used.7” • Usually reported for women who are married or in union between ages 15 to 19

7. Contraceptive Prevalence Computed as – Contraceptive Prevalence = Women of reproductive age (15 – 49) who are married or in union and are currently using any method of contraceptive ________________________________________________________ X 100 Total number of women of reproductive age (15 – 49) who are married or in union7

8. Global Contraceptive Prevalence

9. Global Contraceptive Prevalence (CP) • Contraceptive prevalence is generally higher in high income countries than in low income countries • CP in high income countries is higher that the CP of the world • There is a higher prevalence of sterilization among female than among males all over the world • The rate of sterilization method is predominantly higher in low income countries than in high income countries

10. Contraceptive Prevalence (CP) by Regions

11. Contraceptive Prevalence by Regions • Africa has the least contraceptive prevalence in the world while Latin America and the Caribbean has the highest CP in the world. • Sterilization is not popular in Africa and there is zero prevalence rate in sterilization method in males • Asia has a slightly high CP and a high prevalence in female sterilization as a method of contraceptive

12. Contraceptive Prevalence and MMR

13. Global Contraceptive Prevalence (CP) and MMR

14. Contraceptive Prevalence and MMR • There is an inverse relationship between contraceptive Prevalence and Maternal Mortality. • There is a high Maternal Mortality rates in region with low contraceptive prevalence • Can we conclude that contraceptive prevalence might be one of the contributory factors of maternal mortality since more than a quarter of all pregnancies are unwanted?

15. Contraceptive Prevalence and Other Health Status Indicators

16. Contraceptive Prevalence and Other Health Status Indicators • Infant Mortality Rates are higher in regions with low contraceptive prevalence than in regions with high contraceptive prevalent rates. • Life expectancy is lower in regions with low contraceptive rate than in regions with high contraceptive prevalence rate. • Low heath status are an indication of a failed health system, therefore we may infer that low contraceptive prevalence is also an indication of failed health system

17. Global Contraceptive Prevalence (CP) and Abortion Rate

18. Contraceptive Prevalence and Abortion Rate

19. Global Contraceptive Prevalence (CP) and Abortion • The higher the contraceptive prevalence, the lower the abortion rates and hence abortion deaths • Unwanted pregnancy often times lead to Abortion. • Abortion accounts for 13% of maternal mortality. 1 • These deaths rate can be greatly reduced with a high Contraceptive Prevalence.

20. Global Contraceptive Prevalence (CP) and Abortion • The estimated number of deaths due to unsafe abortion in 2008 was 47,000.1 • When Eastern Europe made contraception widely available, abortion rate reduced by 50% 1. • A woman’s likelihood of committing abortion is higher in the developing countries where the contraceptive prevalence is lower and where unsafe abortion is prominent.

21. Contraceptive Prevalence and Reproductive Health • Reproductive Health has been defined according to the International Conference on Population and Development as a ‘state of complete physical, mental and social well being and not merely absence of disease or infirmity in all matters relating to the reproductive system and to its function and processes’ • In countries and places with low contraceptive prevalence women are more exposed to unwanted pregnancies, resulting in higher rate of maternal mortality, abortion rate and unsafe abortion.

22. Contraceptive Prevalence and Reproductive Health Rights • Reproductive health rights as defined in the Beijing Platform of action are certain human rights recognized in the national and international legal and human rights documents, including the basic rights of all couples and individuals to decide freely and responsibly the number and spacing of their children, and to have information, education and means to do so; the right to make decisions concerning reproduction free of discrimination, coercion and violence

23. Contraceptive Prevalence and reproductive Health Rights • Low contraceptive prevalence will deny couples “means” to freely decide the spacing and number of children they want to have, thus violating their RHR • Low contraceptive prevalence is an indication of low access to family planning services which is a violation of reproductive health rights

24. Conclusions and Recommendations • Places with low contraceptive prevalence rates tend to have high Abortion rate, unsafe abortion, abortion deaths and relatively high maternal mortality rate. • Places with an improvement in contraceptive rates have experienced a considerable decrease in Abortion Rates and deaths.

25. Conclusions and Recommendation • Thus an increase in contraceptive prevalence will lead to decrease In Abortion rates, unsafe abortion, and abortion deaths • Efforts should be made to improve contraceptive rates globally (especially in the low income countries) in order to improve maternal mortality rates, reproductive health and rights. • Efforts should also be made by countries to make effective form of contraceptives readily available. • Countries should improve access to information on issues of contraception. • The mass media can be used as a way to disseminate information about reproductive health needs.

26. Bibliography • 1. Infoplease, 2012; Global Abortion Rates; internet accessed at <http://www.infoplease.com/science/health/global-abortion-rates.html >, August, 2012 • 2. Ellen M Gee; 2012; Mortality; internet accessed at < http://www.deathreference.com/Me-Nu/Mortality-Infant.html> August, 2012 • 3. Medicine Net; ; 2012 "Definition of Birth control". Internet accessed at http://www.medterms.com/script/main/art.asp?articlekey=53351 • 4. Planned Parenthood 2012; internet accessed at <http://www.ppsev.org/media/documents/Top10BestFormsofContraception.pdf; >May 2012 • 5. . Statista, 2012; Average Life Expectancy in Asia; internet accessed at <http://www.statista.com/statistics/199598/life-expectancy-in-asia/ >, August, 2012 • 6.Statista, 2012; Average Life Expectancy in the Caribbean” internet accessed at <http://www.statista.com/statistics/199591/life-expectancy-in-latin-america-and-the-caribbean/ >, August 2012 • 7. United Nations, Department of Economic and Social Affairs, Population Division (2009). World Contraceptive Use 2009 (POP/DB/CP/Rev2009). Internet accessed at http://www.un.org/esa/population/publications/WCU2009/WCP_2009/Data.html • 8. Unknown Author; 2012; Yahoo Dictionary; internet accessed at http://education.yahoo.com/reference/dictionary/entry/contraceptive August 2012 • 9.Women’s Health; 2012; Birth Control Factsheet; internet accessed at http://womenshealth.gov/publications/our-publications/fact-sheet/birth-control-methods.cfm#b on August 2012 • 10. World Health Organization; Trends in maternal Mortality, 1990 – 2012; Internet accessed at http://whqlibdoc.who.int/publications/2012/9789241503631_eng.pdf. August 2012 • 11. Worldstat; 2012; Oceania internet accessed at <http://en.worldstat.info/Oceania/List_of_countries_by_Infant_mortality_rate>, August 2012 • 12.Worldstat, 2012; Carribean; internet accessed at <http://en.worldstat.info/Oceania/List_of_countries_by_Life_expectancy_at_birth,total >, August 2012 • 13. WHO, 2011; Life Expectancy; internet accessed at < http://apps.who.int/ghodata/?vid=710 >, August, 2012