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