National VSC Meeting June 2003

Presented by Dr. Ky Kien Hong

National Reproductive Health Program

Voluntary Surgical Contraception in

CambodiaRacha and The Partnership Focus Areas

National VSC Meeting June 2003

HISTORY

Permanent methodUsed since abdominal surgery startedIntroduced in 1997 (NMCHC, Kampot, Pursat

and Siem Reap province and RHAC)

Teams trained in Bangladesh and Indonesia

National VSC policy and guidelines published by MOH in October 1998

National VSC Meeting June 2003

The principals of minilaparotomy & no scalpel vasectomy

Both methods:• Performed under local anesthesia

• Small wound• Limited operating duration • Quick recovery• Less or no stay in the hospital• But requires special attention: Gentle handling, contact with client

National VSC Meeting June 2003

The key principals of mini-laparotomy

Local anesthesia in a “diamond” plan

Small incision

(Modified) Pomeroy technique

Additional anesthesia drops if needed

Uterine elevator and tubal hook

National VSC Meeting June 2003

The key principals of no scalpel vasectomy

• Introduced in China by

Dr. Li Shunqiang in 1974

• Since than over 9 million vasectomies wold wide have been performed

National VSC Meeting June 2003

Voluntary Surgical Contraception Criteria

When can tubal ligation be performed?

1. Meet the MOH guidelines

2. Interval Any time if you are reasonably sure the woman is not pregnant. During 7 days beginning with the onset of menses. During the use of birth spacing methods:

Pills, Injectable, IUD, Condoms...

National VSC Meeting June 2003

3. Early postpartum

• preferably within the first 2 days (48 hours)

postpartum.

• But can be performed up to 7 days postpartum.

4. Late postpartum

• once the uterus is fully involuted (6 weeks).

5. Post abortion

• preferably within the first 7 days post abortion,

if you are sure the woman is free of infection.

National VSC Meeting June 2003

When can vasectomy be performed?

Whenever the couple meets the MOH guidelines and conditions, and the man is willing to get the intervention.

Voluntary Surgical Contraception Criteria

National VSC Meeting June 2003

Barriers and obstacles

Cultural Barriers: community views on fertility, fear of surgery, rumors Physical Barriers: location of services, provision of services Economic Barriers: posted costs, hidden costs (time, transport) Lack of specific Counseling & IEC Medical Barriers: screening criteria, target population.

National VSC Meeting June 2003

VSC Strategy Cambodia

Site visit and needs assessment In-country, competency-based training

Theory and demonstration of techniques

Practice on models Clinical practice guided by trained

coaches

1. Site visit and needs assessment 2. In-country, competency-based training

Theory and demonstration of techniques Practice on models Clinical practice guided by trained coaches

3. Equipment and commodities4. Information session at OD level5. IEC: leaflets, banners, video, ..6. Free services and travel7. Supportive supervision

National VSC Meeting June 2003

How to move the barriers and obstacles?

National VSC Meeting June 2003

• information sessions for leaders and authorities

for health staff on the methods for better counseling

How to move the barriers and obstacles?

National VSC Meeting June 2003

In-country Training

Started in 2001 4 sessions: 2001(2) - 2002 – 2003

(1+1)

surgeons: 30 (ML & NSV) counselors: 36 (ML & NSV) average # of clients: 62

(8 for each participant)

National VSC Meeting June 2003

Year New Cumulative

1997: 5 5

2001: 5 10

2002: 6 16

2003: 3 (+3) 19 (22)

Expansion and access

National VSC Meeting June 2003

VSC Expansion 1997 – 2003in 19 Operational Districts

National VSC Meeting June 2003

Total number of acceptors

0

200

400

600

800

1000

1200

1400

1997 1998 1999 2000 2001 2002 <2003> 2003may

NSV TL Total

3 2 6 7

416

203252

1052

142134

188 256

983 1015

423

5

144140

195

672

11861267

528

National VSC Meeting June 2003

Number Living Children

0

50

100

150

200

250

300

1 2 3 4 5 6 7 8 9 10 >10 NA

Vasectomy Clients Mini-laparotomy Clients

Median (Mean) number

Vasectomy: 5 (4.87)

Mini-laparotomy: 4 (4.21)

National VSC Meeting June 2003

Age distribution of VSC Clients

0

50

100

150

200

250

300

350

400

450

20 - 24 25 - 29 30 - 34 35 - 39 40 - 44 45 - 49 50 - 54 >55 NA

Vasectomy Mini -laparotomy

Median age

Vasectomy: 36

Mini-laparotomy: 34

National VSC Meeting June 2003

Other Birth Spacing methods used among elective clients

Pill49%

Injectable44%

IUD3%

NA2%

Condom2%

National VSC Meeting June 2003

Clients demand for services

Clients demand for services

QualityServicesQualityServices

Support

What makes a program successful?

National VSC Meeting June 2003

sUmGrKuN

Thank for your attention