A is for Access

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A is for Access

• Increasing the use of Long-term methods
• Brad Lucas
• Director, Reproductive Health
• PSI

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IUD usage rates vary tremendously by
country/region

• North Africa
• Egypt 36
• Tunisia 28
• Sub-Saharan Africa
• Kenya 2.4
• Most countries gt 1.0

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IUD usage rates vary tremendously by
country/region

• Central Asia (Kazakhstan) 42
• China 45
• Vietnam 38
• Cambodia 1.8
• Pakistan 3.5
• India 1.7
• Nepal 2.0

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Why such big differences in IUD CPR?

• We dont actually know
• Government buy-in to introduction
• Country champion
• Lack of other method choices
• Religion
• Promotion of sterilization
• Tendency for 1 or 2 methods in a country to
  dominate

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Is there still a need to invest in long-term
methods?

• Unmet need for contraception runs at 20-30 in
  most developing countries
• Countries that have reached high CPR rates have
  done so either with IUDs or sterilization, or
  both
• Increases in CPR have stagnated in many
  countries, e.g. East Africa
• CPR rates are not translating to decreases in
  fertility rates in countries relying solely on
  short-term methods

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What are the primary barriers to LTM use?

• Bad product history
• Provider misconceptions about who can use
• Consumer myths
• All true, but No. 1 barrier is simply
• ACCESS!

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Barriers to Accessing LTMs

• Lack of interest (focus)
• Lack of competent providers offering insertion
  services
• Lack of equipment and supplies
• Lack of incentives to providers to make it worth
  their while
• Lack of demand creation activities

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Sound hopeless?

• The solution?
• Bring affordable, high-quality LTM service
  delivery to potential clients
• The Evidence?
• There is high latent demand for LTMs in almost
  all countries

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How?

• Second trained providers to high-volume MCH
  clinics

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How?

• 2. Deploy Outreach teams

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How?

• 3. Build a provider franchise network

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Match Demand to Supply

• Event Days
• Community Educators
• On-site educators/counselors

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Make offering LTMs worthwhile for providers

• Recognize their practice is a business (their
  time is money)
• Compensate them through pay-for-performance
  schemes or voucher programs if market price is
  above client ability to pay.
• Provide non-monetary incentives affordable
  commodities, equipment, consumables, training,
  other business opportunities (ie. Cervical cancer
  screening)

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Ensure Competency based training and supervision

• Inactive providers are not competent
• Provide on-the-job coaching
• Build quality assurance ME system

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LTMs are a good investment now!

• IUDs are very inexpensive and cost-effective
• IUDs are an option to sterilization, i.e.
  reversible sterilization
• New implants are vast improvement over Norplant
• LTMs have high potential to fulfill unmet need
  for contraception
• Strong potential to re-energize stagnate CPR
  trends in some countries

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Its not THAT hard

• Thank You