HSE Directive No. 35 Processing of undesired incidents and exemptions
Access to medicines for women and children - ohchr.org · Contraceptive Use/Unmet needs Every year,...
Transcript of Access to medicines for women and children - ohchr.org · Contraceptive Use/Unmet needs Every year,...
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Access to medicines for women
and children
ACCESS TO ESSENTIAL MATERNAL AND
REPRODUCTIVE DRUGS: WHERE ARE WE?
Dr. Raffaela Schiavon
Ipas Mexico
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Index
Maternal and Reproductive Health Indicators
(MDG 5):
• Maternal Mortality Rate
• Contraceptive Prevalence/Unmet Needs
• Mexico as a case study.
Access and procurement of RMNH commodities:
• Model Lists of Essential Medicines (MLEMs)
and interventions
• EC and misoprostol as case studies
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Maternal Mortality Ratio 1990-2013
http://www.who.int/gho/maternal_health/mortality/maternal/en/index1.html
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Contraceptive Use/Unmet needs
In 2014, there are 1,556 million women of reproductive
age; 877 million want to avoid pregnancy (36% to stop
and 21% to delay childbearing).
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Contraceptive Use/Unmet needs Every year, there are 123 million desired and 87 million undesired pregnancies. Most of them are due to non-use or under-use of modern contraceptives. Reducing the number of unintended pregnancies could avert 60% of maternal deaths and 57% of child deaths (WHO, 2014).
Undesired/ Pregnant Women
Undesired/Non-pregnant Women (n,%)
Pooled 12,874 (100%) 111, 301 (100%)
Modern Methods 11.3% 50.5%
Traditional Methods 10.3% 20.9%
No Method 78.4% 28.6%
Bellizzi S et al. Hum. Reprod. 2015;humrep.deu348
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Modern Contraceptive Use & Abortion Rates
Westhoff CW. DHS Analytical Studies No. 13 A New Approach to Estimating Abortion Rates, USAID 2008
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Mexico: Maternal Mortality
MMR 1990-2013: actual vs. committed
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
19901991199219931994199519961997199819992000200120022003200420052006200720082009201020112012
Pre-Eclampsia Otras causas
Hemorragia obstétrica Causas indirectas
Aborto Infección puerperal
% of MM causes 1990-2013
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-
100.0
200.0
300.0
400.0
500.0
600.0
700.0
800.0
900.0
-
20.0
40.0
60.0
80.0
100.0
120.0
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
Aborto c/complicación Patológicas Aborto s/complicación Total aborto
*/ Rate: N° of Abortion-related Hospitalization per 100,000 women 15-44 ys. Source: Ipas México, 2015
Mexico: Abortion Hospitalization Rates
2000-2013
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Mexico: Contraceptive use….
63.1
36.4
55.4
72.5
44.7
62.9
0
10
20
30
40
50
60
70
80
90
TOTAL 15-19 20-24 25-29 30-34 35-39 40-44 45-49
…& Unmet needs
1992 2009
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Index
Maternal and Reproductive Health Indicators
(MDG 5):
• Maternal Mortality Rate
• Contraceptive Prevalence/unmet needs,
• Mexico as a case study.
Access and procurement of RMNH commodities:
• Model Lists of Essential Medicines (EMs) and
interventions
• EC and misoprostol as case studies
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Access to and consistent
procurement of reproductive,
maternal and neonatal health
commodities
Role of international
agencies and networks
Model Lists of Essential
Medicines (EMs) and
interventions
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Essential Drugs in SRMN Health
http://www.rhsupplies.org/fileadmin/user_upload/Maternal_Health_Supplies/Essential_Medicines/
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WHO MLEM: Contraceptives
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Map of Emergency Contraceptive
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WHO MLEM: Oxytocics
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Misoprostol
Technical
Guidelines
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Total World Market for Misoprostol
Source: RHSC:Investing in production of high quality misoprostol for low resource settings, 2015
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Map of misoprostol
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Emergency
Contraception
Misoprostol
Mexico case study
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Mexico: Essential Interventions & Drugs
in SRMN Health
ICD -10 ICD-9
Essential Drug List
(Cuadro Básico de Medicamentos)
Federal Normative Support & Technical Guidelines (NOMs/GPCs)
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EC in the FP Norm
1. Yuzpe Regimen
2. LevoNorgestrel only: > 12 commercial brands
3. Progestin- Receptor Modulator: Ulipristal
AE de Progestina sola
CLAVE 2210
levonorgestrel 0.750 mg. con dos tabletas
22
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CAUSES 2014: Contraceptives # 89 FP Methods: Hormonal
OC Dg 0.15 mg + EE2 0.03 mg
Lng 0.15 mg + EE2 0.03 mg
Lng 0.03 mg
NET .400 mg + EE2 0.035 mg
Inyectables MAP 25 mg + Cipionate E2 5 mg IM
NET 50 mg + EE2 IM
NET 200 mg IM
Implant EtoNg 68.0 mg
Transdermal Patch Norelgestromin 6.00 mg EE2 0.60 mg
EC Lng 0.750 mg
# 91 FP Methods: IUD
Medicated IUD Lng 0.52 mg
Copper IUD IUD Cu 380, IUD Cu 375 short, IUD Cu 375 std,
Tshaped IUD nulliparous
#240/#251 Permanent FP Method Women/men
Permanent Methods TL/vasectomy
#90 Contraceptive counselling/condoms
Condom MALE AND FEMALE
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EC sales in Mexico 2004-2013
24
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CAUSES 2014: Abortion
Normative Support: Technical Guidelines (MoH) GPC IMSS 088 08 Misoprostol recommended CAUSES #243 Dx & Tx of Incomplete Abortion (does not
include Legal Termination of Pregnancy) ICD-10: O02, O03, O04, O05, O06 ICD-9: 69.02 D&C; 69.52 MVA No oxytocic included
Prevención, Diagnóstico y Manejo
de la Hemorragia Obstétrica
Lineamiento Técnico
Centro Nacional de Equidad de Género
y Salud Reproductiva
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CAUSES 2014: Post-partum
Hemorrhage
Normative Support: 3 NOMs & 3 GPC Misoprostol mentioned CAUSES #194 Tx of Obstetric/Puerperal Hemorrhage
ICD-10: O72
Oxytocic included: Ergometrin Oxytocin
Prevención, Diagnóstico y Manejo
de la Hemorragia Obstétrica
Lineamiento Técnico
Centro Nacional de Equidad de Género
y Salud Reproductiva
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http://reprolineplus.org/misoprostol-case
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What do we need?
Alignement in SRMN Health
Technical Norms & Guidelines Programs and Services
▫ Different Goals/Indicators ▫ “Coverage” vs. Access ▫ Interventions vs. Supplies ▫ Unmet/Met need
Budget: ▫ Federal & State level ▫ Different sources of Budgetary lines
Accountability ▫ Transparency (robust and public information systems) ▫ Effective mechanisms for enforcement, justiceability, redress
and remedy
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Access to medicines for women and
children
THANKS Dr. Raffaela Schiavon
Ipas Mexico