Contraception

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• Contraception
• A Fundamental Health Issue

2

• Contraception a fundamental health issue
• Aim To have an increased appreciation of the
  importance of contraception locally, nationally
  and world wide
• Objectives A T E O T S T S W B A T
• Discuss the factors that influence fertility
• control
• Reflect on the issues of population growth

3

• Examine how effective contraception can be
  promoted
• Debate the difficulties of providing all couples
  world wide with contraception
• Determine the role of health professionals in
  providing effective contraception

4

• Current population 6.4 billion
• Increase of 76 million every year
• 209,000 each day
• Took all of human history for population
• to reach 1 billion in 1880s
• 1960s to reach 3 billion
• Growth rate decreasing from 2 to 1.5
• but larger population but most women are
  still having more than two child average 2/3rds
  all countries still above replacement level
• Population Action International 2006

5

• So may young people entering child birth
• years having only having two children would
• still take several decades for growth to
• subside
• If growth not decreased further population
• will double by 2040 ie 12 billion
• Population Action International 2006

6

• Reproductive health implies that people are
• able to have a satisfying and safe sex life
• and that they have the capability to
• reproduce and the freedom to decide if and
• when and how often to do so
• United Nations
  1994

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• When couples are denied the right to limit
• the size and spacing of their families, they
• may struggle to feed clothe and educate
• their children, which in turn become
• entrapped in a downward spiral of poverty
• Marie Stopes International 2003

8

• A mothers ill health or premature death caused
  by too frequent or too many births, places her
  existing children at greatly increased risk of
  dying in infancy.
• Sadly, some 500,000 women still die each and
  every year from pregnancy related causes, of
  which an estimated 80,000 maternal deaths are a
  result of unsafe abortion
• ( UNFPA 2002)
• The premature death of a mother impacts on her
  childrens ability to survive and pushes more and
  more families into extreme poverty

9

• family planning can reduce infant mortality by
  25 by allowing women to space and avoid
  pregnancy

10

• Unplanned pregnancy due to contraception failure
• 8-30 million
• 50-60 million abortions
• 20 million in unsafe conditions
• 70,000 maternal deaths
• UK 180,000 abortions
• Despite massive programmes from UNFPA, WHO,
• Population Council and the World Bank
• Further work needed in educating, training,
  supporting
• medical paramedical and aid workers in family
  planning
• (Newton
  2001)

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• couples in developing world using
• contraception
• 1960s 10 2000
  50
• total fertility fallen, no of children per couple
  
• 1960s 6 2000
  3
• strong evidence that couples everywhere,
• under virtually all circumstances will use
• contraception if given the knowledge and the
• means
• but 1 4 births unwanted

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• 150 million women unmet need for contraception
• If met would reduce fertility by 18
• 1) money
• Annual global spending on contraception 3.75
  billion
• (same amount as spent on confectionery in UK)
• in real terms foreign aid for population
• assistance has not increased within last 20 years
• 2) Bureaucracy
• FP hampered by import duties slow decision
• making, corruption, archaic prescription,
• advertising regulation, dumping of free products

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• 3) Doctors
• Over emphasis of risks
• Mortality for pregnancy 20 times that of
• contraception , 10 times for abortion
• Doctors expensive, overworked, based in cities,
  scarce
• Recommend appropriately trained paramedics
• Programmes selling contraceptives as branded
• consumer goods, sold in ordinary outlets at
• subsidised prices proving efficient and effective
• 
  Black 1999

15

• In many counties finance for fp services
  restricted,
• infrastructure and delivery systems poor,
• methods constrained due to lack of finance,
  social
• pressures, pts fears
• UNFPA, WHO, Population Council and the World
• Bank investing in contraception
• but work needed on education and supporting
• medical paramedical and aid workers in family
• planning
• Newton
  2001

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• Fertility Transformation Morocco falling birth
  rate
• Most significant achievement repeal of the French
  law 1967
• prohibiting the advertising, sale and
  distribution of
• contraceptives
• Government crucial in meeting rising demand
  particularly in
• making modern contraceptives available to rural
  poor
• Narrowing the gap between rich and poor
  difference
• in family size narrowed by three children
• Use of contraception for poorest up from 18 to
  51
• 
  Ayed and Roudi 2006

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• 80-90 sexually active couples not using
  contraction will conceive within one year
• western women pregnant or trying to get pregnant
  for just 10 of reproductive life 90 preventing
  

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• Compliance
• Unplanned pregnancy rate due to contraceptive
  failure
• estimated to be 8-30 million
  Newton 2001
• Pill scare 1999 resulted in increase abortion
  rate of 8.3
  Ticktin 1999
• Pill failure rate 0.1 but varies due to taker
  compliance
• results in 3,000 pregnancies per 3 million women
• Side effects 75 less than pregnancy
• Pill discontinued for perceived side effects and
  nuisance of
• having to take it daily
• All methods IUD lowest rate of discontinuation
• Long acting contraceptives continuation rates
  higher than
• for oral contraceptives
• Inadequate contraception in adolescents resulting
  in higher
• levels of pregnancy
• Short
  2002

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• 70 woman aged 16-49 yrs use some form
• of contraception but still
• 50 pregnancies unplanned
• 20 end in legal abortion 185,600 in 2004
• increase of 600 on 2003
• economic benefit proven by studies as early
• as 1982
• Kishen and Belfield
  2006

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• Economics of Sexual Health estimate
• 1 billion savings in 15 years to health and
• social service budgets
• investing in contraceptive services
• speeding up access to abortion
• raising profile of different methods
• changing prescription patterns
• Armstrong and Donaldson 2005

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• Taylor Nelson Sofres Survey 2004
• Clinicians report restricted access the new and
• long acting reversible methods
• Great variation in abortion services
• Restricted availability in training
• Clients being turned away from walk in clinics
  due
• to poor staffing levels plus being over whelmed
  by
• Work, these are usually situated in deprived
• areas are open in the evenings and serve
• marginalised and vulnerable groups

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• Methods choice and easy access essential
• Network of generalist and specialist
• providers using defined care pathways
• GPs provide 80 of contraception but
• no requirements for nationally accredited
• Training,
• no national standard but these are addressed by
• working group
• 300 million government funding not reaching
• front line services ? used to cover financial
  deficits

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• Nurses Role Survey 2004/2004
• 30 increase in nurses working in FP since
• 2000 (739 Nurses)
• Increasing responsibilities
• Nurse led clinics 158 increase of 33
• Nearly all use Patient Group Directives
• One third working as independent p
• prescribers
• 72 F grade or above

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• Tasks previously undertaken by doctors
• IUCD fitting in 17 services
• Implants 41 services
• Decline in number of doctors in FP is 15
• 2.7 million contacts increase 1 million since
• 2000 but other services being offered eg
• colposcopy abortion
• 
  NANCSH 2005