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Unmet Needs for Contraception- What Is The Cost?
Dr Carol LimDept of O&G, HoSHAS, Temerloh
4 July 201317 th Malaysian Family Medicine Scientific Conference 2013
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Unmet need for contraception for limitingProportion of currently married women who do not
want any more children but are not using anyform of contraception
Unmet need for contraception for spacingProportion of currently married women who want
to postpone their next birth for 2 years but arenot using any form of contraception
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Unmet need for contraception
Especially high among: Adolescents Migrants Urban slum dwellers (urban poor) Refugees Women in the postpartum period
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What is the cost? Unmet Need for Contraception
Unintended pregnancies
Abortion Morbidity & Mortality(unsafe abortion) (maternal & perinatal)
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Unintended pregnanciesWorldwide, in 2008
208 million pregnancies worldwide86 million or 41% where unintended
33 million led to unplanned births11 million ended in miscarriages
&41 million ended in abortion
(50% happened under unsafe conditions, mostlyin developing countries.)
The majority of unintended pregnancies indeveloping countries occur among women
using traditional or no contraception .4/7/2013 Kuantan 6
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Other reasons for high unmet need forcontraception:
1. Side effects2. Women no longer fecund3. Sexually inactive4. Religious objections5. Husband out of country
for a year
Demographic & Health Surveys (DHS)4/7/2013 Kuantan 8
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Reasons for unintended pregnancies were :1. Substantial unmet need for family planning
services in many areas of the world.2. Poverty.3. Education.4. Contraception method failure.5. Incorrect or inconsistent use of
contraceptives.6. Socio economic/cultural,
political/religious & regulatoryconditions.
United Nations4/7/2013 Kuantan 9
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January 2012
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January 2012
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UnintendedPregnancy
Abortion
Miscarriage
Live Birth MaternalMortality
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Malaysia
The population of Malaysia is estimated to be28 million
30% of the population are in the reproductiveage group
243,600 per annum
668 abortions per day = 28 per hour
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July 31, 2012
The figure 1 shows that the statistics of total baby abandonment from 2005 to 2010 are 407 cases.
The highest case of baby dumping is 105 cases in Selangor. The lowest number of baby dumping cases is 1 case in Perlis.
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Maternal mortalityWHO report *trends in maternal mortality : 1990 to 2008
546,000 women per year in 1990.
358,000 women per year in 2008 (34%).
Still 1,000 women are dying worldwide everyday.
40 women are dying world wide every hour dueto pregnancy.
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Aim to reduce maternal mortality ratio of 75% between1990 & 2015.
Important step is to increase family planning access &acceptance, to lower maternal mortality.
Estimated that 215 million women who wants to avoid apregnancy, but who are not using a modern method of contraception.
Estimated that for every $100 million invested in FamilyPlanning:-
- 2.1 million unintended pregnancies are prevented.- 825,000 abortions saved.- 70,000 infants death avoided.- 4,000 mothers are able to stay alive.
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Malaysia Maternal Mortality
YEAR RATE
1995 1996 Published 2000 41/100,000 Live birth
1997 2000 Published 2005 30/100,000 Live birth
2001 2005 Published 2010 29/100,000 Live birth
MOH-CEMD
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Malaysia Maternal Deaths byFamily Planning
4/7/2013 KuantanMOH-CEMD
YEAR Ever User
Never User
Dont
Know
1991 to 1996 (Published2000) 18.8% 70.6% 10.5%
1997 to 2000 (Published2005) 23% 63% 14%
2001 to 2005 (Published2010) 22% 62% 10%
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Family Planning in Malaysia
2004 WestMalaysia Sabah Sarawak
Unmet Need forContraception
36% 31.3% 30%
ContraceptionPrevalence Rate(CPR) for anymethod
51.9% 50.4% 53%
CPR for modernmethods
34.4% 37.4% 42.3%
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CPR: proportion of women of reproductive age who are using (or whosepartner is using) a contraceptive method at a given point in time.
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Ne study revealed that 72% of unmarried youths in Malaysia did not use anycontraception.
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Postpartum Family Planning (PPFP)
Prevention of unintended and closely spacedpregnancies through the first 12 monthsfollowing childbirth
First 12 months after childbirth: Pregnancy in this period greatest risk for
mother & baby Greatest opportunity in terms of contacts with
health care services
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PPFP Methods:
Intrauterine device (PPIUD) immediately after& up to 48hr after birth, or after 4 weeks;
BTL can be performed up to one week afterbirth or after 6 weeks
Vasectomy
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PPIUDCounsel & decision-making during antenatal care or
pre-dischargeOpportunities to receive PPIUD: Postplacental: within 10min after
placental expulsion Intracaesarean: before closing the
uterine incision Pre-discharge: 10 min up to
48 postpartum Interval IUD: after 4 weeks postpartum
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The Challenge
1) Among Women Ambivalence towards contraception
Myths & misperceptions Fear of hormonal contraception Cultural taboos Limited access & cost Poor compliance to methods Management of side effects
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The Challenge
2) Among Health Care Professional Education - MEC Training Supply Chains Limitations on counselling skills & efforts Making it available, eg. point of care at postnatal
wards Champion to lead the way!
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The Challenge
3) Government & NGO Political will Resources Inter-agency Coordination
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Take home messages Create awareness women & HCPsStart from antenatal clinics (health education) &
postnatal wards (counseling & provision of FPmethods)
Various FP methods accessible, affordable,available eg Implanon
Use MEC Wheel / USMEC Chart to assistConsider Postpartum Family Planning (PPFP)MOH Adolescent SRH Guidelines
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"And Above all, we need to PrioritiseReproductive Healthcare and Access toall girls and women, married orunmarried, who are in dire need of such
services rather than sitting on ourmoralistic high chair and watch tragedyafter tragedy unfolding in front of oureyes"
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Want? Need?
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It Takes Two!!
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The pertinent question
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Thank [email protected]
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The pertinent questionis not how to do thingsright but how to find the
r igh t th ings to do, andto concentrateresources and effor ts on them.
Peter F. Drucker