Pub 460 Lecture 5 - Family Planning And Mch PDF

FAMILY PLANNING AND MCH PUB 460 Dr. Gauri Desai Family Planning • Family Planning: “the ability of individuals and couples to anticipate and attain their desired number of children and the spacing and timing of their births… achieved through use of contraceptive methods and the treatment of involu...

FAMILY PLANNING AND MCH PUB 460 Dr. Gauri Desai Family Planning • Family Planning: “the ability of individuals and couples to anticipate and attain their desired number of children and the spacing and timing of their births… achieved through use of contraceptive methods and the treatment of involuntary infertility” (WHO, 2017). • Family planning is the information, means and methods that allow individuals to decide if and when to have children. • Includes wide range of contraceptives • Also includes information about how to become pregnant when it is desirable, as well as treatment of infertility Family Planning • Sustainable Development Goal 3: Ensure healthy lives and promote well-being for all at all ages • Indicator 3.7.1: Proportion of women of reproductive age (aged 15–49 years) who have their need for family planning satisfied with modern methods • Access to safe, voluntary family planning is a human right. Family Planning – An Unmet Need for Many • Global fertility rates: >6 children/woman in the 1960s to <3 children/woman in the 1990s • Among the 1.9 billion Women of Reproductive Age group (15-49 years) worldwide in 2019, • 1.1 billion have a need for family planning; • Of these, 842 million are using contraceptive methods, and • 270 million have an unmet need for contraception • The proportion of the need for family planning satisfied by modern methods, SDG indicator 3.7.1, has stagnated globally at around 77% from 2015 to 2020 Family Planning – An Unmet Need for Many Unmet need for modern contraceptive methods in the Family Planning 2020 (now 2030) initiative countries, 2017 data If interested, country-level data details: https://fp2030.org/countries Cahill, N., et al. (2018). "Modern contraceptive use, unmet need, and demand satisfied among women of reproductive age who are married or in a union in the focus countries of the Family Planning 2020 initiative: a systematic analysis using the Family Planning Estimation Tool." The lancet 391(10123): 870-882. Family Planning – An Unmet Need for Many According to 2017 estimates, 214 million women of reproductive age in developing regions have an unmet need for contraception. Reasons for this include: • • • • • • Limited access to contraception Limited choice of methods Fear or experience of side-effects Cultural or religious opposition Poor quality of available services Gender-based barriers. https://www.who.int/health-topics/contraception#tab=tab_1 Rationales for Family Planning Programs Four rationales: 1. Population and development, or the “demographic rationale” 2. Maternal and child health 3. Human rights and equity 4. Environment and sustainable development Rationales for Family Planning Programs 1. Population and development, or the “demographic rationale” • 1960s and 1970s: This rationale was widely used to support family planning programs • Negative effects of rapid population growth and high fertility on living standards, human welfare, economy • Some evidence suggests a positive association between slower population growth and economic development Rationales for Family Planning Programs 2. Maternal and child health • Helping women avoid becoming pregnant too early, too late or too often benefits them and their children. • Meeting the unmet need for contraceptives would – • Reduce global rates of maternal mortality by 35% • Reduce the number of abortions worldwide by 64% each year • Contraceptive use reduces the number of high-risk and high-parity births, thereby reducing maternal mortality https://www.guttmacher.org/article/2008/07/world-population-day-six-reasons-support-family-planning Rationales for Family Planning Programs 2. Maternal and child health • Access to contraceptives also helps to prevent unwanted pregnancies, some of which result in unsafe abortions—one of the leading causes of global maternal deaths. • More than half of all abortions occurring in low- and middleincome countries are unsafe, and fewer unsafe abortions would lead to fewer maternal deaths and injuries Access to contraceptives is associated with lower maternal mortality https://www.mhtf.org/topics/family-planning-maternal-health/ Rationales for Family Planning Programs 2. Maternal and child health • Babies who have an increased risk of dying before their first birthday fall into three broad categories: • those born to very young mothers, • those born to women past their prime childbearing years, and • those born too soon after a previous birth • A three-year interval between births in low- and middle-income countries would further lower rates of infant mortality by 24% and rates of child mortality by 35% All data are from Demographic and Health Surveys; averages based on 49 countries. https://www.mhtf.org/topics/family-planning-maternal-health/ https://www.guttmacher.org/report/family-planning-can-reduce-high-infant-mortality-levels Rationales for Family Planning Programs 3. Human rights and equity • The right of couples and individuals to decide freely and responsibly on the number and spacing of their children was articulated at the 1968 International Conference on Human Rights (UN 1968) • Subsequent international population conferences in 1974, 1984, and 1994 reaffirmed this right • Wealthier women have lower fertility rates and better access to family planning than poorer women • The number of unwanted births in the poorest quintile was more than twice that in the wealthiest quintile, at 1.2 and 0.5, respectively Gillespie, D., et al. (2007). "Unwanted fertility among the poor: an inequity?" Bull World Health Organ 85(2): 100-107 Rationales for Family Planning Programs 4. Environment and sustainable development • Growing attention to environmental issues, climate change, and concerns about food security • We have consumed more resources in the last 50 years than the whole of humanity before us • Population growth not evenly distributed over the world • The impact of so many humans on the environment takes two major forms: • consumption of resources such as land, food, water, air, fossil fuels and minerals • waste products as a result of consumption such as air and water pollutants, toxic materials and greenhouse gases https://www.science.org.au/curious/earth-environment/population-environment Contraceptive Methods Reproductive, Maternal, Newborn, and Child Health: Disease Control Priorities, Third Edition (Volume 2). Washington (DC): The International Bank for Reconstruction and Development / The World Bank; 2016 Contraceptive Methods Traditional methods: a) Periodic abstinence (rhythm, calendar method) b) Withdrawal (coitus interruptus) c) Country-specific traditional methods, folk methods (herbs, amulets etc.) https://www.un.org/development/desa/pd/sites/www.un.org.development.desa.pd/files/files/documents/2020/Jan/un_2019_contraceptiveusebymethod_data booklet.pdf Contraceptive Methods https://www.un.org/development/desa/pd/sites/www.un.org.development.desa.pd/files/files/documents/2020/Jan/un_2019_contraceptiveusebymethod_data booklet.pdf Contraceptive Methods https://www.un.org/development/desa/pd/sites/www.un.org.development.desa.pd/files/files/documents/2020/Jan/un_2019_contraceptiveusebymethod_data booklet.pdf How are Contraceptive-Related Services Delivered? 1. 2. 3. 4. Community-based programming Social marketing mHealth Cash transfers • Several other methods also used Reproductive, Maternal, Newborn, and Child Health: Disease Control Priorities, Third Edition (Volume 2). Washington (DC): The International Bank for Reconstruction and Development / The World Bank; 2016 How are Contraceptive-Related Services Delivered? 1. Community-based programming • Designed to extend the reach of clinics to serve clients who are unable to travel to clinics or who do not know about clinic services for family planning • Focused on rural areas • Trained community members provide family planning information and selected resupply methods at the doorstep of those with less mobility or awareness • Evidence shows that this is a high impact method of improving access to contraceptives • Community-based Access to Injectable Contraception: Radical Common Sense [7:01] - https://www.youtube.com/watch?v=B5Uml5FYK7E&ab_channel=FHI360 Reproductive, Maternal, Newborn, and Child Health: Disease Control Priorities, Third Edition (Volume 2). Washington (DC): The International Bank for Reconstruction and Development / The World Bank; 2016 How are Contraceptive-Related Services Delivered? 2. Social marketing • Use of commercial marketing techniques (analyzing target audiences, tailoring messages, adapting strategies like branding) to promote the adoption and maintenance of health behaviors • Combines the “4Ps” of marketing—product, price, place, and promotion—to increase contraceptive awareness and use by population groups • Used most widely to promote condoms and oral contraceptives, with strong evidence of impact Reproductive, Maternal, Newborn, and Child Health: Disease Control Priorities, Third Edition (Volume 2). Washington (DC): The International Bank for Reconstruction and Development / The World Bank; 2016 How are Contraceptive-Related Services Delivered? 3. mHealth or mobile health • Use of mobile phones and other wireless technology in medicine and public health • mHealth has been used to offer educational information about sexual and reproductive health, as well as the locations of family planning service providers • Fewer logistical barriers; individuals can quickly, conveniently, and confidentially seek information about family planning and related resources instead of having to go to a clinic or see a health care provider to obtain this same information Reproductive, Maternal, Newborn, and Child Health: Disease Control Priorities, Third Edition (Volume 2). Washington (DC): The International Bank for Reconstruction and Development / The World Bank; 2016 https://www.ghspjournal.org/content/8/4/813 How are Contraceptive-Related Services Delivered? 3. mHealth or mobile health • Most mHealth research on family planning and uptake of modern contraceptives has occurred in higher-income countries • Few trials and studies in lowand middleincome countries Example from a study in Uganda https://www.ghspjournal.org/content/8/4/813 Kamulegeya LH, Bwanika J, Banonya J, Atuhaire J, Musinguzi D, Nakate V, Kyenkya J, Namatende L, Horvath KJ, Kiragga A Feasibility and Acceptability of a Ugandan Telehealth Engagement Platform for Informational Messaging on Modern Contraception: Pilot Cross-sectional Study. JMIR Form Res 2022;6(6):e34424. doi: 10.2196/34424PMID: 35763336PMCID: 9277522 How are Contraceptive-Related Services Delivered? 4. Conditional cash transfers • A government agency provides an economic incentive for families who engage in a certain healthy behavior • Conditional cash transfers – cash transfer for certain agreed upon behaviors; for example, giving birth in a hospital or participating in nutrition and baby care programs • Such programs should not and generally do not make contraceptive use a condition for acceptance into the program • Providing cash for other basic needs such as food, primary healthcare, school fees etc. enables families to access family planning services – added benefit but needs to be further tested https://www.ghspjournal.org/content/8/4/813 How are Contraceptive-Related Services Delivered? 4. Conditional cash transfers • In Mexico’s Oportunidades program, contraceptive use increased more among the beneficiaries in communities with the conditional cash transfer program, compared with women in communities in which the program had not been initiated • Nicaragua’s conditional cash transfer program, Red de Proteccíon Social, is credited with increasing birth spacing among beneficiaries Reproductive, Maternal, Newborn, and Child Health: Disease Control Priorities, Third Edition (Volume 2). Washington (DC): The International Bank for Reconstruction and Development / The World Bank; 2016 Infertility as a Public Health Issue • More than 6.7 million women in the U.S. have fertility issues. • Infertility may be caused by a myriad of factors: • genetic abnormalities, • aging, • acute and chronic diseases, • treatments for certain conditions, • behavioral factors, • exposure to environmental, occupational, and infectious agents • Much of infertility remains unexplained, despite continued research. Kotch's Maternal and Child Health: Problems, Programs, and Policy in Public Health https://www.cdc.gov/reproductivehealth/infertility/pdf/DRH_NAP_Final_508.pdf Infertility as a Public Health Issue • Early environmental, chemical, or occupational exposures (e.g., in utero, in childhood) could permanently change fecundity or biologic capacity by affecting gynecologic, urologic, or pregnancy health. • These exposures could also affect – • fertility outcomes (e.g., multiple births, prematurity) • increase the likelihood of later adult-onset diseases, such as ovarian, testicular, or prostate cancers, metabolic syndrome, and polycystic ovary syndrome. https://www.cdc.gov/reproductivehealth/infertility/pdf/DRH_NAP_Final_508.pdf Infertility as a Public Health Issue • In this way, infertility may serve as a marker of past, present, and future health • • Provide a window of opportunity to improve care for affected reproductive-aged women and men Thus, infertility could have public health implications beyond simply the ability to have children. https://www.cdc.gov/reproductivehealth/infertility/pdf/DRH_NAP_Final_508.pdf Infertility as a Public Health Issue • 3 components: 1. Prevention of infertility 2. Detection of infertility 3. Management/Treatment of infertility https://www.cdc.gov/reproductivehealth/infertility/pdf/DRH_NAP_Final_508.pdf Infertility as a Public Health Issue 1. Prevention of infertility • To prevent infertility, understanding its cause is essential https://library.med.utah.edu/kw/human_reprod/seminars/seminar2A.html • Prospective cohorts needed to identify risk factors and precursors of various infertility types https://www.cdc.gov/reproductivehealth/infertility/pdf/DRH_NAP_Final_508.pdf Infertility as a Public Health Issue 1. Prevention of infertility • Infertility is generally diagnosed only when a man, woman, or couple attempts to become pregnant. • People who are not actively trying to conceive will typically not have the opportunity to be evaluated or receive a diagnosis of infertility. • Current surveillance systems are not designed to identify the spectrum of women and men who may have unrecognized infertility. • Preventing something whose cause and risk factors are not well understood is challenging. https://www.cdc.gov/reproductivehealth/infertility/pdf/DRH_NAP_Final_508.pdf Infertility as a Public Health Issue 1. Prevention of infertility • For the known risk factors of infertility, prevention efforts need to be comprehensive: 1. Comprehensive approaches to STI screening, treatment, prevention, education 2. Chronic disease prevention and health promotion programs to reduce the incidence and severity of diabetes, polycystic ovary syndrome, and infertility related to polycystic ovary syndrome. 3. Programs aimed at behavioral factors that may affect infertility, such as programs to prevent use of illicit drugs, tobacco, and anabolic steroid 4. Methods to accurately assess environmental and occupational exposures 5. Measures to protect the reproductive health and fertility potential of workers who may be exposed to environmental and occupational hazards https://www.cdc.gov/reproductivehealth/infertility/pdf/DRH_NAP_Final_508.pdf Infertility as a Public Health Issue 2. Detection of infertility • Public health surveillance of infertility depends on the systematic, recurring collection and management of accurate data • Standard diagnostic criteria and case definitions for both male and female infertility are essential to compare data across regions and over time • Existing systems that collect infertility-related data: • National Vital Statistics System (NVSS), • National ART Surveillance System (NASS), • Pregnancy Risk Assessment Monitoring System (PRAMS), • National Health and Nutrition Examination Survey (NHANES), • National Survey of Family Growth (NSFG) • These surveys are based on varying definitions of infertility, collect data on varying risk factors and types of infertility • Difficult to combine/compare data https://www.cdc.gov/reproductivehealth/infertility/pdf/DRH_NAP_Final_508.pdf Infertility as a Public Health Issue 3. Treatment of infertility • May include a variety of services, ranging from counselling to invasive procedures • May/may not pose health risks for men, women, future offspring • Although newer treatments are much safer than previous ones, more research needed to fully understand the long-term effects of treatments https://www.cdc.gov/reproductivehealth/infertility/pdf/DRH_NAP_Final_508.pdf Infertility as a Public Health Issue 3. Treatment of infertility • Infertility treatment can also be expensive, and disparities exist in access to and use of these services https://www.cdc.gov/reproductivehealth/infertility/pdf/DRH_NAP_Final_508.pdf https://www.kff.org/womens-health-policy/issue-brief/coverage-and-use-of-fertility-services-in-the-u-s/ Infertility as a Public Health Issue 3. Treatment of infertility • Infertility treatment can also be expensive, and disparities exist in access to and use of these services https://www.cdc.gov/reproductivehealth/infertility/pdf/DRH_NAP_Final_508.pdf https://www.kff.org/womens-health-policy/issue-brief/coverage-and-use-of-fertility-services-in-the-u-s/ Infertility as a Public Health Issue 3. Treatment of infertility • Infertility treatment can also be expensive, and disparities exist in access to and use of these services https://www.cdc.gov/reproductivehealth/infertility/pdf/DRH_NAP_Final_508.pdf https://www.kff.org/womens-health-policy/issue-brief/coverage-and-use-of-fertility-services-in-the-u-s/ Question Bank 1. What are the rationales behind family planning programs? Describe any one. 2. Briefly describe any one way in which contraceptive-related services are delivered Housekeeping • Short HW 1 open; due 14th Sept., 1:00 pm