unmet needs in contracpetiopn-what is the cost_4jul2013_v2

7/27/2019 Unmet Needs in Contracpetiopn-What is the Cost_4Jul2013_v2

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Unmet Needs for Contraception- What Is The Cost?

Dr Carol LimDept of O&G, HoSHAS, Temerloh

4 July 201317 th Malaysian Family Medicine Scientific Conference 2013


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Unmet need for contraception for limitingProportion of currently married women who do not

want any more children but are not using anyform of contraception

Unmet need for contraception for spacingProportion of currently married women who want

to postpone their next birth for 2 years but arenot using any form of contraception

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Unmet need for contraception

Especially high among: Adolescents Migrants Urban slum dwellers (urban poor) Refugees Women in the postpartum period

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What is the cost? Unmet Need for Contraception

Unintended pregnancies

Abortion Morbidity & Mortality(unsafe abortion) (maternal & perinatal)

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Unintended pregnanciesWorldwide, in 2008

208 million pregnancies worldwide86 million or 41% where unintended

33 million led to unplanned births11 million ended in miscarriages

&41 million ended in abortion

(50% happened under unsafe conditions, mostlyin developing countries.)

The majority of unintended pregnancies indeveloping countries occur among women

using traditional or no contraception .4/7/2013 Kuantan 6


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Other reasons for high unmet need forcontraception:

1. Side effects2. Women no longer fecund3. Sexually inactive4. Religious objections5. Husband out of country

for a year

Demographic & Health Surveys (DHS)4/7/2013 Kuantan 8


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Reasons for unintended pregnancies were :1. Substantial unmet need for family planning

services in many areas of the world.2. Poverty.3. Education.4. Contraception method failure.5. Incorrect or inconsistent use of

contraceptives.6. Socio economic/cultural,

political/religious & regulatoryconditions.

United Nations4/7/2013 Kuantan 9


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January 2012

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January 2012

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UnintendedPregnancy

Abortion

Miscarriage

Live Birth MaternalMortality

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Malaysia

The population of Malaysia is estimated to be28 million

30% of the population are in the reproductiveage group

243,600 per annum

668 abortions per day = 28 per hour


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July 31, 2012

The figure 1 shows that the statistics of total baby abandonment from 2005 to 2010 are 407 cases.

The highest case of baby dumping is 105 cases in Selangor. The lowest number of baby dumping cases is 1 case in Perlis.


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Maternal mortalityWHO report *trends in maternal mortality : 1990 to 2008

546,000 women per year in 1990.

358,000 women per year in 2008 (34%).

Still 1,000 women are dying worldwide everyday.

40 women are dying world wide every hour dueto pregnancy.

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Aim to reduce maternal mortality ratio of 75% between1990 & 2015.

Important step is to increase family planning access &acceptance, to lower maternal mortality.

Estimated that 215 million women who wants to avoid apregnancy, but who are not using a modern method of contraception.

Estimated that for every $100 million invested in FamilyPlanning:-

- 2.1 million unintended pregnancies are prevented.- 825,000 abortions saved.- 70,000 infants death avoided.- 4,000 mothers are able to stay alive.


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Malaysia Maternal Mortality

YEAR RATE

1995 1996 Published 2000 41/100,000 Live birth



MOH-CEMD


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Malaysia Maternal Deaths byFamily Planning

4/7/2013 KuantanMOH-CEMD

YEAR Ever User

Never User

Dont

Know

1991 to 1996 (Published2000) 18.8% 70.6% 10.5%

1997 to 2000 (Published2005) 23% 63% 14%

2001 to 2005 (Published2010) 22% 62% 10%


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Family Planning in Malaysia

2004 WestMalaysia Sabah Sarawak

Unmet Need forContraception

36% 31.3% 30%

ContraceptionPrevalence Rate(CPR) for anymethod

51.9% 50.4% 53%

CPR for modernmethods

34.4% 37.4% 42.3%

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CPR: proportion of women of reproductive age who are using (or whosepartner is using) a contraceptive method at a given point in time.


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Ne study revealed that 72% of unmarried youths in Malaysia did not use anycontraception.

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Postpartum Family Planning (PPFP)

Prevention of unintended and closely spacedpregnancies through the first 12 monthsfollowing childbirth

First 12 months after childbirth: Pregnancy in this period greatest risk for

mother & baby Greatest opportunity in terms of contacts with

health care services

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PPFP Methods:

Intrauterine device (PPIUD) immediately after& up to 48hr after birth, or after 4 weeks;

BTL can be performed up to one week afterbirth or after 6 weeks

Vasectomy

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PPIUDCounsel & decision-making during antenatal care or

pre-dischargeOpportunities to receive PPIUD: Postplacental: within 10min after

placental expulsion Intracaesarean: before closing the

uterine incision Pre-discharge: 10 min up to

48 postpartum Interval IUD: after 4 weeks postpartum

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The Challenge

1) Among Women Ambivalence towards contraception

Myths & misperceptions Fear of hormonal contraception Cultural taboos Limited access & cost Poor compliance to methods Management of side effects

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The Challenge

2) Among Health Care Professional Education - MEC Training Supply Chains Limitations on counselling skills & efforts Making it available, eg. point of care at postnatal

wards Champion to lead the way!

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The Challenge

3) Government & NGO Political will Resources Inter-agency Coordination

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Take home messages Create awareness women & HCPsStart from antenatal clinics (health education) &

postnatal wards (counseling & provision of FPmethods)

Various FP methods accessible, affordable,available eg Implanon

Use MEC Wheel / USMEC Chart to assistConsider Postpartum Family Planning (PPFP)MOH Adolescent SRH Guidelines

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"And Above all, we need to PrioritiseReproductive Healthcare and Access toall girls and women, married orunmarried, who are in dire need of such

services rather than sitting on ourmoralistic high chair and watch tragedyafter tragedy unfolding in front of oureyes"

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Want? Need?


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It Takes Two!!

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The pertinent question


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Thank [email protected]

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The pertinent questionis not how to do thingsright but how to find the

r igh t th ings to do, andto concentrateresources and effor ts on them.

Peter F. Drucker

unmet needs in contracpetiopn-what is the cost_4jul2013_v2

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