How Contraception

Saves Lives

Anna Buchsbaum, MD, MPHFamily Planning FellowEmory UniversityJune 2, 2013

Developing Tomorrow’s Leadersin Reproductive Health

For more information and to apply online, please visit www.familyplanningfellowship.org

• Advanced clinical and research training

• Generous funding package, including MPH or MSc tuition and meeting attendance

• Fully funded global health opportunity

• Research funding

• Post-fellowship academic career opportunities and funding support

• Connection to a national network of more than 250 family planning specialists

The Fellowship in Family Planning

•29 sites in the US

•Research and clinical skills in contraception and abortion.

MICHIGAN

MICHIGAN

Fellowship in Family Planning Program Sites

29 programs in departments of Obstetrics and Gynecology in 17

States

CALIFORNIA

NEVADA

OREGON

WASHINGTON

IDAHO

UTAH

ARIZONA

COLORADO

NEW MEXICO

MONTANA

WYOMING

SOUTH DAKOTA

NORTH DAKOTA MINNESOTA

WISCONSIN

IOWA

MISSOURI

NEBRASKA

KANSAS

OKLAHOMA

TEXAS

ALASKA

HAWAII

ARKANSAS

LOUISIANAMISSISSIPPI

ALABAMA

GEORGIA

FLORIDA

TENNESSEE

KENTUCKY

INDIANAILLINOIS

OHIO

PENNSYLVANIA

WEST VIRGINIA VIRGINIA

NORTH CAROLINA

SOUTH CAROLINA

WASHINGTON, DCMARYLAND

DELAWARE

NEWYORK

NEW JERSEY

CONNECTICUT

RHODE ISLAND

MASSACHUSETTS

NEW HAMPSHIRE

MAINEVERMONT

States with a Current Fellowship Site

States with a Potential Fellowship Site

States with No Fellowship Sites

Objectives

Review history of global family planning

Describe Millennium Development Goals in context of family planning

The Role of Family Planning & Contraception in Preventing Maternal Mortality

Physician’s Role in Promoting Family Planning

WHO Tools for Family Planning guidance

Cairo Conference

International Conference of Population and Development

Sept 5-13, 1994

Programme of Action

15 Principles

Principle IV

Advancing gender equality

Empowerment of women

Elimination of all kinds of violence against women

Ensuring women's ability to control their own fertility

Universal human rights for all including women and girls

Full and equal participation of women in civil, cultural, economic, political, and social life, at the national, regional and international levels,

Eradication of sex discrimination

Principle VIII

Right to the enjoyment of the highest attainable standard of physical and mental health

Universal access to health-care services, including those related to reproductive health care, which includes family planning and sexual health

Reproductive health-care programs should provide the widest range of services without coercion

All couples and individuals have the basic right to decide freely and responsibly the number and spacing of their children and to have the information, education and means to do so.

Goals

Sustained economic growth in the context of sustainable development

Education, especially for girls

Gender equity and equality

Infant, child and maternal mortality reduction

Provision of universal access to reproductive health services, including family planning and sexual health

Millenium Development Goals (MDG)

Adapted from: Cates. Family planning: the essential link to achieving all eight Millennium Development Goals. Contraception 2010;81(6):460-61.

MDG 1:Eradicate extreme poverty

and hunger Per capita gross national product is correlated with

the prevalence of modern contraceptive methods

FP reduces demand for scarce food products 1997: 775 million undernourished 2017: 1.2 billion undernourished

Birth spacing reduces low birth weight and poor maternal nutrition

FP results in more wealth and less hunger

Cates et al. Family Planning and the Millenium Development Goals. Science. Sept 2010.Barnett, Stein.

MDG 2:Achieve Universal Primary

Education

Girls drop out of school due to unintended pregnancies or the need to care for younger siblings

Family Planning prolongs education

Cates et al. Family Planning and the Millenium Development Goals. Science. Sept 2010.

MDG 3:Promote gender equality and

empower women FP empowers women and supports development efforts

FP Allows work and career progression for women

Women who use contraceptives: more likely to be employed in Egypt Long-acting user more likely to work for pay in Brazil and

Indonesia

Involving men can change gender norms

Ability to achieve desired family size is the most important driver of modern development efforts

Cates et al. Family Planning and the Millenium Development Goals. Science. Sept 2010.

MDG 4:Reduce Child Mortality

Prevention of unintended pregnancies averts 1.2 million infant deaths each year

640,000 newborn deaths could be prevented If all contraceptive needs were met

FP is less expensive than treating complications of unintended pregnancy

FAMILY PLANNING INCREASES CHILD SURVIVAL

Cates et al. Family Planning and the Millenium Development Goals. Science. Sept 2010WHO Best Practice GuidelinesSingh et al, AGI 2009

.

MDG 5:Improve Maternal Health

Reduce maternal mortality ratio by three quarters

Universal access to reproductive health

Main causes of maternal morbidity and mortality: Pregnancy and delivery in low-resource settings Complications from unsafe abortion

Cates et al. Family Planning and the Millenium Development Goals. Science. Sept 2010.

Causes of Maternal Death

Distribution of Maternal Mortality

Source: WHO 2012

Distribution of Unsafe Abortion

Family Planning Needs

Unwanted pregnancy & unsafe abortion are signs that contraceptive services are not meeting women’s needs

40% of pregnancies worldwide are unintended

>80% of unintended pregnancies in developing countries occur to women who have an unmet need for contraception

Contraception as Primary Prevention

Indirect Impact

220,000 children worldwide lose mothers each year from abortion related death

Haddad, 2009

Indirect Impacts

Investing in Family Planning 215 million women with unmet need

Drop in unintended pregnancies by 66% 75 million to 22 million per year

Avert 70% maternal deaths 550,000 to 160,000

Avert 44% newborn deaths 3.5 million to 1.9 million

Drop in unsafe abortion by 73% 20 million to 5.5 million

Adding it Up, 2009.

UNFPA, 2009

Contraception

What can we do?

Contraception

Counseling opportunities – information dissemination

Who can use which method

Efficacy of method

How to use the method

Opportunities for Contraception Counseling Post-abortion

Avoid future unintended pregnancy and repeat abortion

Post-partum Pregnancy spacing

Prenatal care Pregnancy spacing

General Gynecology visit Postpone initial or subsequent pregnancy

General Medical visit Prevent pregnancy with medical comorbidities

Opportunities for Contraception Counseling Vital signs

LMP Sexual activity Contraception Future fertility goals

Four Cornerstones of Family Planning

WHO Medical Eligibility Criteria (MEC)

Purpose:

who can use contraceptive methods

Why is evidence-based guidance needed?

To base family planning practices on the best available evidence

To address misconceptions regarding who can safely use contraception

To reduce medical barriers

To improve access and quality of care in family planning

Conditions associated with increased risk as a result of unintended

pregnancy Breast cancer Complicated valvular heart disease Diabetes: insulin-dependent; with

nephropathy/retinopathy/neuropathy or other vascular disease; or of >20 years’ duration

Endometrial or ovarian cancer Epilepsy Hypertension (systolic >160 mm Hg or

diastolic >100 mm Hg) History of bariatric surgery within the past 2

years HIV/AIDS Ischemic heart disease

Conditions associated with increased risk as a result of unintended

pregnancy Malignant gestational trophoblastic disease Malignant liver tumors (hepatoma) and

hepatocellular carcinoma of the liver Peripartum cardiomyopathy Schistosomiasis with fibrosis of the liver Severe (decompensated) cirrhosis Sickle cell disease Solid organ transplantation within the past 2 years Stroke Systemic lupus erythematosus Thrombogenic mutations Tuberculosis

WHO MEC

1 – No restriction for use of contraception

2 – Advantages of method generally outweigh theoretical or proven risks

3 – Theoretical or proven risks usually outweigh advanctages of using method

4 – Unacceptable health risk if method is used

WHO MEC

HYPERTENSION

E+P P Cu-IUD

Controlled 4 2 1

Uncontrolled 3 2 1

Efficacy

Efficacy

Efficacy

WHO Standard Practice Recommendations

Purpose:

How to use contraceptive methods

Summary

Maternal mortality is a significant problem globally

Family planning and contraception can save maternal lives but indirectly can improve child and infant mortality

We must improve access and quality of contraceptive services to all women

WHO tools to guide family planning decision making

Thank You