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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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
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…..”
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 + Equipment + FP Commodity = Supplies
Services AreNeeded to Provide Clinical Methods of Family Planning
Medical Instruments + Expendable Medical Supplies
+ FP Commodity = “Supplies”
≠ “Contraceptive Security”
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
Pregnancy Rates by Method
“Perfect” use (but humans are imperfect)
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.
Using other FP method to space/delay
Using IUD/implant to space/delayHigh demand, high unmet need, low IUD & implant use
Spacing and Delaying Births, MWRA
MWRA (15-49 yr) 5.0 million (2003)
Source: MEASURE/DHS, Kenya DHS Survey, 2003; World Population Prospects: The 2008 Revision.
Only 8% of spacers/delayers use an IUD or implant
Sterilization17%Reproductive intent and contraceptive choice: LA/PMs are underutilized among limiters in Kenya
MWRA (15-49 yr) 5.0 million (2003)
Source: MEASURE/DHS, Kenya 2003 DHS Survey. World Population Prospects: The 2008 Revision.
Only 28% of limiters use any of the LA/PMs
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.