Global Unmet Needs for Contraception, Reproductive Health...
Transcript of Global Unmet Needs for Contraception, Reproductive Health...
Global Unmet Needs for Contraception,
Reproductive Health and Justice
John W Townsend Future of Contraceptive Initiative (FOCI)
Meeting Seattle, Washington
29 October 2011
Outline of Presentation
• Definition of unmet needs
• Unmet needs and MDGs
• Reasons for non-use of contraception
• Context of Unmet Need – population growth, age structure and urbanization
• Implications for new products and services
• Potential risks
• Challenges for the future
Three perspectives on same Issue
• On October 31, the 7 billionth person, a girl, will be born in poverty in Africa or Asia
• On the same day, a young pregnant mother will have died due to post-partum hemorrhage in the next village
• During the same week, a woman is beaten by her spouse as she cannot conceive. He suspects that that she is infected with HIV
Right to Health
Realization of the right to health requires the removal of barriers that interfere with individual decision-making on health-related issues and with access to health services, education and information, in particular on health conditions that only affect women and girls. Report of Special Rapporteur of the Human Rights Council, August 2011
Definition of Unmet Need and Magnitude of Expression
• “Fertile sexually active women who do not want to get pregnant in next two years but are not using a contraceptive method” -Survey
• About 215 million women (26%) in developing countries have unmet need for spacing or limiting
• These women account for 82% of all unintended pregnancies
Unmet need and Maternal Child Health: MDGs 4, 5 and 6
• MDG 5: 75% reduction in maternal mortality ratio and universal access to reproductive health by 2015
• Indicators for universal access
Contraceptive prevalence rate Adolescent birth rate Antenatal care coverage Unmet need for family planning
• MDG 5 on maternal health, MDG 4 on child health and
MDG 6 on HIV are linked on issues of unmet needs – potential synergies with health system development
Why do unintended pregnancies
happen?
• Unmet need: Non-use of contraception – when sexually active and a pregnancy is not desired • Switching or discontinuing a contraceptive method • Incorrect use or method failure • Unplanned sex • Unwanted sex
Non-consensual and/or violent sex Early marriage
Fertility Use of
contraception
Fertility
preferences
Unmet need,
Unsatisfied
demand
Cost/benefits
of children
Costs
of birth control
Socioeconomic
development
and mortality
decline
Family planning
programs
Demand for
birth
control
Analytic framework for the determinants of fertility
Planning status and outcome of all
pregnancies in developing countries 2008
Source: S. Singh et al Studies in Family Planning 41, 241-250 (2010).
0
20
40
60
80
100
120
Per
cen
t o
f A
ll P
reg
nan
cies
Pregnancy Planning Status
Unintended
Intended
Pregnancy Outcome
Abortion
Unintended Birth
Miscarriage
Intended Birth
Reasons for non-use of contraception in SS Africa, SE Asia and South Central Asia
22%
21% 17%
10%
16%
8% 4% 2%
Health/Side Effects
Infrequent Sex
Postpartum/Breastfeeding
Partner opposed
Woman opposed
No access/high cost
Unaware of methods
Perceived subfecund
Women with unmet need are diverse in goals but more likely to be young, poor and rural
Sub-Saharan Africa
49%
68%
56%
70%
58%
59%
62%
68%
46%
64%
49%
70%
58%
0% 20% 40% 60% 80% 100%
Urban
Rural
Nonpoor
Poor
35+
25-34
20-24
<20
Unmarried
Married
Stop births
Space births
Delay f irst birth
South Central Asia
29%
35%
29%
40%
23%
33%
51%
72%
7%
34%
25%
63%
78%
0% 20% 40% 60% 80% 100%
Southeast Asia
31%
30%
29%
33%
30%
30%
33%
37%
55%
30%
29%
32%
74%
0% 20% 40% 60% 80% 100%
% of women with unmet need for modern methods
Unmet need declines in married women but can it be eliminated?
18 16
18
26
12 10
11
24
0
5
10
15
20
25
30
LAC N Africa & WAsia
S & SE Asia SS Africa
1990-1994
2000-2005
Source: Guttmacher, 2008
% o
f m
arri
ed w
om
en 1
5-4
9 w
ith
un
met
ne
ed
Less developed regions: alternative population projections: 2005-2050 and components of
population growth
0
1000
2000
3000
4000
5000
6000
7000
8000
9000
1950 2000 2050 2100
Po
pu
lati
on
siz
e (
mill
ion
s)
Standard projection
Effect of: - High fertility - Mortality, migration - Young age structure
Effect of Age Structure on Growth
Urbanization in sub-Saharan Africa
• In 2009 Africa’s total population exceeded one billion, of which 395 million (40%) lived in urban areas
• Africa’s population will increase 60% between 2010 and 2050, with the urban population tripling to 1.23 billion during this period
Source: UNEP, 2010
Implications for Contraceptive Development and Product Use in Developing Countries
• New products with health benefits as side effects, and are easier to use, especially those compatible with infrequent sex, do not interfere with intercourse or necessarily involve partners
• Adaptations of current contraceptive approaches to make products more acceptable to young users, more accessible and affordable in diverse segments at scale
• Long-term investment in new modes of contraceptive action that do not cause systemic side effects, can be used on-demand but not at intercourse, and address multiple unmet needs, including prevention of HIV
Potential Outlets: Clinic , Pharmacy, and Community
Potential Risks of Pursuit of Elimination of Unmet Need
• Uncertain link between unmet need and demand at individual level
• Potential demand is uncertain and anticipated costs are too high
• Miss opportunities for integration with HIV, working with men in multiple roles, to support market development with private sector
• Risk of coercion to meet development goals
Challenges for the Future
• New methods that respond to needs and rights of women and men in developing countries
• Development of technologies that support health system development , RH justice and gender equity
• Products that address multiple purposes (MPTs): contraception, infection prevention, pleasure
• News financing strategies that support outreach in diverse market segments to complement and challenge public sector care systems