Back to the Future: Back to the Future: A Call to Action for FP A Call to Action for FP and LAPMs and LAPMs Scott Radloff Director Office of Population and Reproductive Health USAID ACQUIRE End-of-Project Meeting September 17, 2008
Jan 05, 2016
Back to the Future: Back to the Future: A Call to Action for FP A Call to Action for FP
and LAPMsand LAPMs
Scott Radloff
Director
Office of Population and Reproductive Health
USAID
ACQUIRE End-of-Project Meeting
September 17, 2008
Family Planning: responds to a panoply of problems…
Enables couples to decide number/spacing of births Reduces child mortality Reduces maternal mortality/morbidity Reduces abortion Improves women’s opportunities Key intervention in HIV settings Essential component of health programs Mitigates adverse effects of population dynamics
on:– natural resources– economic growth– state stability
Unmet need of 201 million in developing countries translates to:
23 million unplanned births 22 million abortions 2 million miscarriages 1.4 million infant deaths 142,000 pregnancy-related deaths [1/2 in
Africa]
– 53,000 from unsafe abortion
– 89,000 from other causesSource: Guttmacher Policy Review, Summer 2008, Vol 11, Number 3
As CPR rises, demand for limiting occurs at earlier ages
Age at which demand for limiting cross demand for spacing by modern CPR, most recent DHS, 44 countries
R2 = 0.822
20
25
30
35
40
45
0 - 10 10 - 20 20 - 30 30 - 40 40 - 50 50 - 60 60 - 70
Modern CPR (married)
Ag
e
Age at which demand for limiting equals demand for spacing by modern CPR, all available DHS since 2000 (n=44)
Still, Africa is characterized by high unmet need and low use of LAPMs…
0
10
20
30
40
50
60
70
80
Chad 2004
Niger
200
6
Guinea
200
5
Mal
i 200
1
Benin 2
001
Niger
ia 2
003
Burkin
a Fas
o 20
03
Seneg
al 2
005
Rwan
da 20
05
Camer
oon 2
004
Ethio
pia
2005
Ghana 20
03
Uganda 2
006
Mad
agas
car 2
004
Tanza
nia 2
004
Moza
mbiq
ue 200
3
Zambia
2002
Mal
awi 2
004
Kenya 2
003
Zimbab
we 200
6
Per
cen
t M
WR
A
LAPMs Modern method (non-LAPMs) use Trad CPR Unmet need
2 children, 30 years of contraceptive use -options:
10,950 pills (1 every day)
360 packets of pills (1 every month)
120 injections (1 every 3 months)
6 implants (1 every 5 years)
3 IUDs (1 every 10 years)
1 sterilization (1 in a lifetime)
LAPMs have lower discontinuation ratesand longer duration of effectiveness…
MethodDiscontinuation
Rate by 1 yrDuration of effectiveness
Pill 50% Daily use
Condom 50% Event use
Injectable 40% 1-3 mos
Implanon 48% 3 yrs
Jadelle/Norplant 25% 5-7 yrs
IUD (hormonal, copper) 25% 5-12 yrs
Sterilization (M/F) 10% lifetimeAQUIRE 2007
Injectables35%
Pills17%
Condoms3%
LAM0%
Traditional17%
Implants5%
IUD6%
Sterilization17%
Source: MEASURE/DHS, Kenya 2003 DHS Survey.Ross, Stover, and Adelaja, 2005.
MWRA (15-49 yr) 5.1 million (2005)
%
LAPM use to limit: 27%LAPM use to limit: 27%
Long-Acting and Permanent Methods
Long-Acting and Permanent Methods
LAPMs are underutilized among limiters in Kenya
Pills18%
Condoms10%
Traditional25%
Injectables39%
IUD4%
Implants4%
Source: MEASURE/DHS, Kenya DHS Survey, 2004.
%
Long-Acting and Permanent Methods
Long-Acting and Permanent Methods
LA use to space: 8%LA use to space: 8%
Long-Acting methods have potential for use among spacers in Kenya
And, LAPMs are suitable for various reproductive intentions…
DD
Long Acting: Implants and IUDs
Delaying first births-Youth-Nulliparous
SS H+H+ LLPermanent: Vasectomy,
Female Sterilization
Spacing pregnancies-Postpartum-Postabortion
HIV+ women can use
any LAPM
Limiting births after desired fertility goals are reached
- High Parity- Low Parity- Any age
TimeSocio-cultural
norms
Cost
Process
Physical
Inappropriate eligibility criteria
Poor CPIProvider
bias
KnowledgeLocation
↑↑ Access
↑↑ Choice
↑↑ Quality
Barriers to LAPM services
Barriers to LAPM services
Outcomes when barriers are overcome:
Outcomes when barriers are overcome:
But, there are still barriers to LAPMs…
“Unpack” LAPMs
LAPMs ‘Packed’ = specific clinical
requirements for service provision
LAPMs ‘Unpacked’ = suitable for multiple
reproductive intentions – Spacing – Long-acting methods
– Delaying – Long-acting methods
– Limiting – Long-acting methods, permanent methods
“Long-Acting” effectiveness is not the same
as “Long-Term” use (it’s not all or none)
Integrate LAPMs into all other PRH technical priorities…
• Contraceptive security including clinical equipment and supplies
• Community-based FP Frees up clinical capacity for LAPMs, increases referrals
• Healthy timing and spacing of pregnancies IUDs and implants help achieve longer spacing intervals
• FP/MCH integration Postpartum and PAC, immediate use of IUD, M/F
sterilization
• FP/HIV integration All LAPMs are safe methods and good options for HIV/AIDS
Future opportunities for LAPMs…
– The Sino-implant revolution– Meeting the latent, and growing demand for
limiting, at younger ages– Increasing L-A use for spacing, delaying– Reaching postpartum and post-abortion
clients– Engaging private sector services– Expanding approaches to reach rural areas– Expanding urban and peri-urban services– Offering comprehensive men’s health care
BACK (AND FORWARD) TO THE FUTURE
Sometimes, going forwardrequires going back to
“Big, Boring Programs”or
“Proven, Time-Tested ApproachesAdapted to New Settings”