Contraceptive Security: Incomplete

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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
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Methodology

• Review of key documents
• 13 national regional contraceptive security
  strategies
• Contraceptive security (CS) literature
• Materials of key organizations working in CS
• E.g. RH Supplies Coalition, USAIDDELIVER, World
  Bank, UNFPA, IPPF
• Secondary analysis of DHS data
• Demand, met unmet need for spacing limiting
  births
• FP method mix among spacers limiters

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The four LA/PMs

• Long-Acting Reversible Methods
• IUDs
• CuT380A, ML-375
• LNG-IUS
• Implants
• Jadelle
• Sino-implant II
• Implanon
• Permanent Methods
• Female Sterilization
• Male Sterilization (Vasectomy)

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Language conditions thought

• 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.. (JSI/DELIVER
SPARHCS)
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Language conditions thought (cont.)

• 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)
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Medical instruments needed to provide clinical
methods of family planning
http//www.engenderhealth.org/files/pubs/family-pl
anning/LAPM-Equipment-List.pdf
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Necessary, but not sufficient

• Medical Instruments Equipment FP Commodity
  Supplies
• Services Are Needed to Provide Clinical Methods
  of Family Planning

Medical Instruments Expendable Medical
Supplies FP Commodity Supplies ?
Contraceptive Security
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So, why is this important?

• 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
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LA/PMs are highly effective
Pregnancy Rates by Method
Typical use Perfect use (but humans are
imperfect)
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The cost of failure unintended pregnancies per
1000 users, by method
SourceTrussell 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.
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High demand, high unmet need, low IUD implant
use
Spacing and Delaying Births, MWRA
Source DHS
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Variable demand, unmet need, LAPM use
Limiting Births, MWRA
Source DHS
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Reproductive intent and contraceptive choice
implants and IUDs have great potential to meet
needs of delayers and spacers
MWRA (15-49 yr) 5.0 million (2003)
Kenya
Source MEASURE/DHS, Kenya DHS Survey, 2003
World Population Prospects The 2008 Revision.
Only 8 of spacers/delayers use an IUD or implant
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Reproductive intent and contraceptive choice
LA/PMs are underutilized among limiters in Kenya
MWRA (15-49 yr) 5.0 million (2003)
Kenya
Source MEASURE/DHS, Kenya 2003 DHS
Survey. World Population Prospects The 2008
Revision.
Only 28 of limiters use any of the LA/PMs
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When available, people choose and like LA/PMs
Source DHS
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Contraceptive security is incomplete without
LA/PMs

• LA/PMs need to be included explicitly and fully
  in CS definitions, strategies, plans, and
  programming
• 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)

Photo credits (from left to right) N.
Rajani/EngenderHealth, C. Svingen/EngenderHealth,
M. Reyners/EngenderHealth, C. Svingen/EngenderHeal
th, D. Peacock/EngenderHealth.
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www.respond-project.org