Family Planning: Succeeding in Meeting Needs To Make a Better World. Amy Tsui April 12, 2011

Transcription

1 Family Planning: Succeeding in Meeting Needs To Make a Better World Amy Tsui April 12, 2011

2 Family Planning, One of the Ten Best Public Health Achievements of the 20 th Century and Now Remarkable health innovation since Behavioral change among couples Efficacy of modern contraceptives Growing use among young sexually active persons Health and economic benefits Meeting prevailing and unmet needs regionally, equitably and securely

3 The number of couples using contraception in the developing world has increased ten-fold since the early 1960s. % using m ~70m Total East Asia Latn Amr So Asia ME & Nafr S-Sah Afr 3

4 There is much inter-regional variation in the growth of contraceptive use in sub-saharan Africa. Modern contraceptive prevalence % Sub-Saharan Africa Northern Africa (excluding Sudan) Eastern Africa Middle Africa Northern Africa Southern Africa Western Africa Source: United Nations World Contraceptive Use 2010

5 Contraceptive use is primarily responsible for the recent rapid fertility decline in Iran. Source: Erfani and McQuillan, 2007

6 Contraceptive use at 73%, primarily with modern methods (59%), is among the highest in the world. Other Withdrawal Condom Pill IUD Vasectomy Tubal ligation Source: Erfani and McQuillan, 2007

7 The Clinical Science behind Contraceptive Development and Practice

8 Contraceptive Method Efficacy under Perfect and Typical Use Conditions: USA Method % women experiencing unintended pregnancy in 1 st year of use Perfect use Typical use Combined Pill 0.3% 9.0% Implanon 0.2% 0.2% IUD % % Injectable 0.2% 6.0% Implant 0.05% 0.05% Condom 2% 18.0% Female Sterilization 0.5% 0.5% Male Sterilization 0.1% 0.15% Withdrawal 4.0% 22.0% No method 85% 85% Source: Trussell,

9 Expanding Access with Newer Contraceptive Technologies NES-EE 1-year hormonal ring Depo-subQ injectable in Uniject Subdermal contraceptive implant Source: Spieler, 2011

10 Introducing New Methods Increases Contraceptive Choice and Use: Indonesia, Percent of Women in Union Using Contraception by Method. % using Sterilization Pill Injectable IUD Condom Traditional Implants 10

11 What continues to challenge universal access to contraception?

12 There remain major economic inequalities in access to contraceptive and other reproductive health services. Source: Lule, World Bank,

13 Despite increased access and use of modern methods, the incidence of unintended pregnancies remains high. % USING MODERN CONTRACEPTION Figure 2. Relationship between national rates of unintended pregnancy and modern contraceptive prevalence among women aged across 158 Demographic and Health Surveys in developing countries, Modern contraceptive prevalence among women aged in 158 Demographic and Health Surveys, % OF RECENT PREGNANCIES UNINTENDED (MISTIMED OR UNWANTED) Source: MEASURE DHS StatCompiler, accessed January 11, 2010 Source: Tsui et al., 2010

14 Most unintended pregnancies occur among women who were not using any contraceptive. Modern method 20% Traditional method 14% 66% No method Unintended pregnancies in developing countries, by women s contraceptive use Source: Guttmacher Institute, 2009

15 Concentration index Limiting Earlier survey Later survey Family planning programs in sub-saharan Africa show varying success in reaching all social segments, but inequities persist in all countries. Spacing Less inequality More inequality Source: Creanga et al., Bulletin of the WHO, 2011

16 Youth and contraception

17 The World s Youth Population Will Become More Concentrated in Africa (and Asia) Population Ages by World Region: 1950 and 2050

18 There is an increasing trend in sexual activity among unmarried youth. Earlier survey Later survey Percentage Dominican Rep Malawi Peru Cambodia Guatemala Niger Mali Rwanda Bolivia Ethiopia Nicaragua Colombia Brazil Chad Kazakhstan Zimbabwe Haiti Guinea Kenya Uganda Benin Ghana Nigeria Mozambique Cameroon Tanzania Zambia Togo Madagascar Namibia Cote D'Ivoire 0 Source: Blanc et al., 2010

19 Contraceptive use among sexually active youth has also been rising: 34 DHS countries Annual rate of change in contraceptive prevalence among year old sexually active unmarried females Cambodia Chad Eritrea Niger Rwanda Guinea Zimbabwe Nigeria Togo Cameroon Benin Dominican Kazakhstan Cote D'Ivoire Colombia Haiti Peru Ethiopia Guatemala Ghana Burkina Madagascar Mali Senegal Namibia Brazil 0.00 Annual rate of change Malawi Tanzania Kenya Uganda Zambia Nicaragua Bolivia Mozambique Source: Blanc et al., 2010

20 Family Planning Patterns among Youth Are Unique Use often exceeds that of older married counterparts Reflects efforts to prevent unplanned pregnancies Experimentation and inconsistent use, leading to method failure Significant implications for contraceptive demand with expansion in youth cohort size Source: Blanc et al., 2010

21 Consequences Health and economic benefits of preventing unwanted childbearing

22 Contraceptive prevalence is closely linked to fertility Relationship between Contraceptive Prevalence and Total Fertility Rates: Based on 199 Demographic and Health Surveys and Reproductive Health Surveys, levels: A 17-percentage Source: StatCompiler point increase accessed January implies 11, 2011 a decline of one birth in the Total Fertility Rate Tpta; Fertility Rate TFR = * CPR R 2 = y = x R 2 = Contraceptive Prevalence % mong Childbearing-Aged Women in Union Source: StatCompiler, accessed 2010

23 Association Between Fertility and Poverty Countries with a higher percentage of people living in poverty often have higher fertility rates. Percent of Population Living on <$2 per Day 100 Niger 80 Mongolia Jordan Total Fertility Rate Source: Population Reference Bureau, Population & Economic Development Linkages 2007 Data Sheet.

24 Trends in Number of Working-Age Adults per Dependent Number of Working-Age Adults (Ages 15-64) per Dependent (Under Age 15 and Ages 65 and Over) 3 Eastern Europe South-eastern Asia 2 South-central Asia Latin America and the Caribbean Sub-Saharan Africa Source: United Nations, World Population Prospects: The 2004 Revision, 2005.

25 Age Pattern of Labor Income and Consumption for 4 Low-Income and 4 High-Income Countries LDC: Kenya, Nigeria, Costa Rica, Brazil MDC: US, Sweden, Finland, Austria Source: R Lee and A Mason, 2010

26 Total human capital investment is higher where fertility is lower. Source: R Lee and A Mason, 2010

27 Association Between Fertility and Female Education Countries with higher fertility typically have fewer girls enrolled in school Percent of Girls Enrolled in Secondary School Uruguay Palestinian Territory Morocco Total Fertility Rate Source: Population Reference Bureau, Population & Economic Development Linkages 2007 Data Sheet.

28 The lifetime risk of dying at birth rises with childbearing. Recent declines in fertility are estimated to have prevented 3.6 million deaths between Source: Marston and Cleland, 2004; Ross and Blanc, 2011

29 Women of reproductive age are disproportionately affected by HIV Percentage of population HIV+ by sex and age Women Men Family Planning and HIV Special supplement 2009 Source: Kenya DHS, 2003.

30 Efforts to integrate family planning, maternal, newborn and child and sexual health care are improving. Adapted from K.J. Kerber, et al., Continuum of Care for Maternal, Newborn, and Child Health: From Slogan to Service Delivery, 370 Lancet 1358 (2007). 1

31 Fulfilling unmet need for modern FP methods would cost $3.6 billion (2008 $) on top of $3.1 billion for current FP users For $4.50 per capita ($24.6b) existing FP and maternal and newborn needs can be met. Source: Guttmacher Institute, 2010

32 $103m spent on family planning can generate $208m in social sector savings by 2015 in Ethiopia. $220 $210 $200 $190 $180 $170 $160 $150 $140 $130 $120 $110 $100 $90 $80 $70 $60 $50 $40 $30 $20 $10 $0 US Dollars in Millions Total: $208 Malaria, $10 Maternal Health $105 Immunization $44 Total Savings Water and Sanitation $26 Education $23 $103 Family Planning Total Costs Source: USAID. Healthy Policy Initiative, Achieving the MDGs: The Contribution of Family Planning, Ethiopia

33 Securing family planning s successes 1. Ideation and knowledge 2. Self-reliance in contraceptive financing

34 The importance of some reasons for non-use has changed over time: Greater concern over health and side effects 100 % of married women aged with unmet need Dominican Republic Colombia Peru Kenya Ghana Uganda Mali Bolivia Dominican Republic Colombia Peru Kenya Uganda Ghana Mali Bolivia Lack of knowledge Health/side effects Opposition

35 SIFPSA, India Aao Baatein Karein Spacing Campaign Behavioral Change Communication Programs can efficiently address awareness and knowledge gaps.

36 Over time there has been growing divergence between Percent developing of Governments and Reporting developed Direct Support countries for Contraceptive Access: support for contraceptive access Percent M D LDC Access MDC Access Source: United Nations Population Policy Inquiry Database

37 Contraceptive Security and Self-Reliance: A Priority for the 21 st Century $20,000,000 $18,000,000 $16,000,000 $14,000,000 $12,000,000 $10,000,000 $8,000,000 Zimbabwe Sri Lanka Guatemala Ghana Donor support for contraceptive procurement has been enduring but will not be indefinite. $6,000,000 $4,000,000 $2,000,000 $ Source:

38 Family planning is to maternal survival what a vaccination is to child survival. Khama Rogo World Bank

39 Thank you