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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

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
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
the four la pms
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)
language conditions thought
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)

language conditions thought cont
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)

medical instruments needed to provide clinical methods of family planning
Medical instruments needed to provide clinical methods of family planning

http://www.engenderhealth.org/files/pubs/family-planning/LAPM-Equipment-List.pdf

necessary but not sufficient
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”

so why is this important
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

la pms are highly effective
LA/PMs are highly effective

Pregnancy Rates by Method

Typical use

“Perfect” use (but humans are imperfect)

the cost of failure unintended pregnancies per 1000 users by method
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.

high demand high unmet need low iud implant use

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

variable demand unmet need lapm use

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

slide13

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

reproductive intent and contraceptive choice la pms are underutilized among limiters in kenya

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

contraceptive security is incomplete without la pms
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.