taking a new look: expanding contraceptive method choice and access through improved programming for...

Taking a new look: Expanding Contraceptive Method Choice and Access through Improved Programming for Long-acting and Permanent Methods (LA/PMs)/Global

Lynn Bakamjian, MPH

Director, RESPOND Project, EngenderHealth

Long-acting and Permanent Methods of Contraception

Long-Acting Methods– IUD: CuT380A, MultiLoad

375, Levonorgesterol-IUS (Mirena®)

– Implants: Implanon®, Jadelle®, Sino-implant II

Permanent Methods– Female Sterilization / Bilateral

Tubal Ligation

– Male Sterilization / Vasectomy (NSV)

LA/PMs are most effective methods

No method 850

Withdrawal 270

Female Condom 210

Male Condom 150

Pill 80

Injectable 30

Copper T 380A 8

Female Sterilization 5

LNG-IUS 2

Vasectomy 1.5

Implants 0.5

No. of unintended pregnancies among 1,000 women in 1 year (typical use)

Source: Trussell J. Contraceptive efficacy, In Hatcher RA, et al. Contraceptive Technology: Ninteenth Revised Edition. New York NY: Ardent Media, 2007.

10,950 pills (1 every day)

120 injections (1 every 3 months)

6 to 10 implants (1 every 3 to 5 years)

3 IUDs (1 every 10 years)

1 sterilization (one-time only)

Number of client actions required to maintain method over RH lifetime

A case of two countries:

Cambodia: 4% = 10,000 users and 2,500 unintended pregnancies averted

Pakistan: 4% = 100,000 users and 25,000 unintended pregnancies averted

If only 4% of current oral contraceptive users switched to IUDs or implants, how many unintended pregnancies would be averted over a five-year period? (based on Hubacher et al, Contraception, 2008)

DDSS

Long Acting: Implants and IUDs

Permanent: Vasectomy,

Female Sterilization

LLDelaying first births-Youth-Nulliperous

Spacing between births

-Postpartum-Postabortion

Limiting births after desired fertility goals are reached

HH

HIV+ can use any LAPM

LA/PMs and Meeting Reproductive Intentions

Demand for spacing, unmet and met by type of method

0

5

10

15

20

25

30

35

Indone

sia,

07

Jord

an, 0

7

Thaila

nd, 8

7

Philipp

ines

, 03

Cambod

ia, 0

5

Bangla

desh,

07

Pakis

tan, 0

7

Vietn

am, 0

2

Nepal

, 06

India

, 06

Unmet need

Traditional

Short-acting

Long-acting

% MWRA

Demand for Limiting, unmet and met by type of method

01020304050607080

Vietn

am, 0

2

Thaila

nd, 8

7

Nepal

, 06

India

, 06

Bangla

desh,

07

Philipp

ines

, 03

Cambod

ia, 0

5

Indone

sia,

07

Jord

an, 0

7

Pakis

tan, 0

7

Unmet Need

Traditional

Short-acting

Long-acting

Permanent

% MWRA

Why are these methods underutilized?

PhysicalCost

Knowledge

Lack ofawareness

Providerbias

Provider- dependent

Medical barriers(inappropriate

criteria)

Gender and socio-cultural norms

Time

Myths andmisconceptions

Proven strategies for expanding access to LA/PMs:

Communicate to level the playing field for LA/PMs

Advocate at all levels

Engage communities to address barriers, including gender lens

Focus on the fundamentals of care (choice, safety and quality) in service delivery

Look for no missed opportunities to integrate services/referrals (postpartum, postabortion, private sector, mobile outreach, etc.)

Address supply, demand and policy/environment factors holistically

Program examples:

Repositioning IUD in public sector through supply, demand and supportive environment approach in India (Pop Council, 2008)

Clinic franchising and health fairs to increase awareness and access to IUDs in Nepal, Pakistan (PSI, 2006)

Overcoming myths and misconceptions for vasectomy in Bangladesh (ACQUIRE, 2008)

www.respond-project.org