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