Integrating Family Planning Into CSHGP and MCH Programs

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Integrating Family Planning Into CSHGP and MCH Programs

Victoria Graham, USAID

CORE Group Spring Meeting, April 29, 2010

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  • So how many health workers do we need? Looking at the data collection on the workforce needed to meet the MDG goals is a proxy. The number 2.5 is based on studies of immunization coverage and skilled attendants at birth; this is the number of workers needed to achieve 80% coverage. Other more complex interventions may require a higher density. Critical shortage is defined as les than 2.5/1000 and not meeting 80% coverage. Many people are not comfortable with how these numbers were calculated, but they are the best available.
  • Nearly 100% of women postpartum want to delay or avoid the next pregnancy A 24 months between birth and pregnancy improves health of mother and child. In spite of this 57-60% of births in developing countries occur with birth-to-birth intervals of less than 36 months.
  • I’d like to take a moment to make a couple clarifications. We use the conventional term CBD for consistency and to embrace activities carried out by community member with limited clinical training. It includes: Paraprofessionals, Health Extension Agents, Nursing assistants, CHW, CRHW, VHT, CHOs, CHWs, When we say injectable contraceptives, we are referring to Depo-Provera (depot medroxyprogestrone acetate) also known as Depo Provera. This is not to rule out the use of Net En, Cyclofem and in the future Depo-Sub Q. We use the shorthand abbreviation of CBD of DMPA. We’re talking about promoting Depo-Provera in the context of a balanced method mix and with the goal of increasing client choice – not promoting it at exclusion of others. Finally, we are talking about adding Depo-Provera to existing CBD programs -- not creating CBD programs. The programs we work with for this innovation are already running, funded, and have met criteria showing they are strong enough to introduce the additional method of Depo-Provera.
  • The existing literature shows us that: With appropriate training, para-professionals can safely and effectively provide injectable contraception. Clients are equally satisfied with service if not more than their clinic-going counterparts. And finally, an increase in CPR has been shown in areas with CBD of injectable programs and they have been taken to scale in several countries. Despite its strong record of safety and effectiveness, Depo-Provera is still a rare component of CBD programs.
  • Note that in most countries where the CPR has increased significantly (Ethiopia, Ghana, Malawi, Senegal, Tanzania) it is due exclusively to Depo-Provera use. It is assumed that CPR would NOT have increased to this extent if women did not have access to Depo-Provera. This indicates a trend emerging that the women in many African countries prefer Depo-provera. Why do they like Depo-Provera?
  • Save Lives
  • The measurement of worldwide abortion-related mortality and morbidity is difficult. Because of the clandestine nature of a illegal procedures, there are powerful disincentives to reporting. Women don’t report their condition and might not relate it to a complication of an earlier unsafe abortion. Community studies around the world indicate a higher magnitude of unsafe abortion than do health statistics. An estimated 13% maternal deaths worldwide are due to unsafe abortions. 709 deaths per 100,000 unsafe abortions among African women. (100 of times higher than deaths due to safe, legal abortions in developed nations) Abortion Rate and Ratios – number of abortions per every 100 births). Leave 220,000 children to grow up without their mothers Causes loss of productivity, economic burden of public health systems and families Long-term health problems including Infertility Drinking turpentine, bleach or tea made with livestock manure Inserting herbal preparations into the vagina or cervix Placing foreign bodies, such as a stick, coat hanger or chicken bone, into the uterus Jumping from the top of stairs or a roof
  • Integrating Family Planning Into CSHGP and MCH Programs

    1. 1. Integrating Family Planning Into CSHGP and MCH Programs Victoria Graham (USAID) April 29 2010
    2. 2. Presentation Overview <ul><li>Contribute of FP to MCH Programs </li></ul><ul><li>Historical Perspective of Flex Fund Program </li></ul><ul><li>Integration of FP into MCH Programs </li></ul><ul><ul><li>Increasing Community Access to FP </li></ul></ul><ul><ul><li>Youth </li></ul></ul><ul><ul><li>Birth Spacing </li></ul></ul><ul><ul><li>Postpartum </li></ul></ul><ul><ul><li>Abortion Prevention and Post Abortion Care </li></ul></ul>
    3. 3. Contributions of Family Planning to MCH Programs
    4. 4. Saving Lives by Meeting Unmet Need for Contraception, 2005-2015
    5. 5. Estimated Total Contribution of Unintended Pregnancies to Maternal Mortality <ul><li>Total Unintended Pregnancies = 79 Million </li></ul><ul><li>Abortions = 46 million </li></ul><ul><ul><li>Abortion deaths = ~ 70,000 </li></ul></ul><ul><li>Unintended Births = 33 million </li></ul><ul><ul><li>Maternal Deaths = ~ 110,000 </li></ul></ul><ul><li>Total Maternal Deaths = ~180,000 </li></ul><ul><li>% Contribution = 34% among 529,000 maternal deaths </li></ul>
    6. 6. Why is it essential that family planning be an integral part of Community-Based PHC? <ul><li>Family planning – </li></ul><ul><ul><li>Is a service wanted by the women themselves </li></ul></ul><ul><ul><li>Directly affects maternal and child survival </li></ul></ul><ul><ul><li>Promotes family welfare by preventing unintended pregnancies </li></ul></ul><ul><ul><li>Facilitates social development by slowing population growth </li></ul></ul><ul><ul><li>Increases the capability to women to participate in the development process </li></ul></ul>
    7. 7. Health Workforce Needed to Meet the MDGs <ul><li>To meet MDG goals, 2.5 health workers/1000 pop. are needed </li></ul><ul><li>An additional 2.4 million professionals needed globally </li></ul><ul><li>Sub-Saharan Africa has the largest need gap – requiring an increase of 140% </li></ul><ul><li>Community-based provision of injectables can reduce the burden on clinic-based staff as well as extend the reach of services. </li></ul>
    8. 8. Historical Perspective of the Flexible Fund Supporting Integration and Innovation in Family Planning
    9. 9. The Flexible Fund Goals and Critical Inputs Critical Inputs Flex Fund will support CA’s to provide Technical Assistance to Fund Recipients: 1) Monitoring and Evaluation 2) Program Strengthening Flex Fund will support centrally funded CAs to promote shared learning among Fund recipients Flex Fund will support PVO Programs through the CSHGP Shared Learning Goal #2 Increase Shared Learning of SOTA on community-based FP/RH approaches Goal #1 Increase access to quality FP/RH services through NGO/PVO Activities. Flex Fund will support PVO Programs through the CSHGP
    10. 10. Breakdown of Flexible Fund Support by Fiscal Year Fiscal Year US$ (000)
    11. 11. PVO and NGO Programs <ul><li>US-Based PVOs </li></ul><ul><li>ADRA/Ethiopia </li></ul><ul><li>ADRA/Guinea </li></ul><ul><li>ADRA/Madagascar </li></ul><ul><li>CEDPA/Nepal </li></ul><ul><li>HAI/East Timor </li></ul><ul><li>MIHV/Uganda </li></ul><ul><li>MCDI Madagascar </li></ul><ul><li>Plan/Ethiopia </li></ul><ul><li>Plan/Guinea </li></ul><ul><li>Save/Ethiopia </li></ul><ul><li>Save/Uganda </li></ul><ul><li>Save/Guatemala </li></ul><ul><li>Local NGOs </li></ul><ul><li>AHS/Malawi </li></ul><ul><li>ASDAP/Mali </li></ul><ul><li>COCIN/Nigeria </li></ul><ul><li>GSPS/Mali </li></ul><ul><li>Fair Foundation/Bangladesh </li></ul><ul><li>Organizational Integration </li></ul><ul><li>Child Fund </li></ul><ul><li>International Youth Foundation </li></ul><ul><li>Save the Children </li></ul><ul><li>World Vision </li></ul>
    12. 12. CSHGP Projects w/ Flexible Fund Support <ul><li>Project Hope Uzbekistan </li></ul><ul><li>2003-2007 </li></ul><ul><li>Navoi, Uzbekistan (target 94,000) </li></ul><ul><li>Cost XT $1,300,000 (FP $430,000) </li></ul><ul><li>Program Level of Effort </li></ul><ul><li>30% Maternal Child Health </li></ul><ul><li>30% Family Planning </li></ul><ul><li>10% Breastfeeding </li></ul><ul><li>10% Control of Diarrheal Disease </li></ul><ul><li>10% Pneumonia Case Mgmnt </li></ul><ul><li>10% Nutrition </li></ul><ul><li>Strategies: </li></ul><ul><li>Focus on school program for youth </li></ul><ul><li>Train peer educators </li></ul><ul><li>Develop training materials for adolescents </li></ul><ul><li>World Vision India </li></ul><ul><li>2003-2008 </li></ul><ul><li>Uttar Pradesh State (Target 1.2m) </li></ul><ul><li>Expanded Impact:$2.5 mil (FP $830,000) </li></ul><ul><li>Program Level of Effort </li></ul><ul><li>40% Immunization </li></ul><ul><li>30% FP/Birth Spacing </li></ul><ul><li>20% Breastfeeding </li></ul><ul><li>10% IMCI/Vitamin A </li></ul><ul><li>Strategies </li></ul><ul><li>Performance improvement AWW & ANM </li></ul><ul><li>Early registration of all pregnant women </li></ul><ul><li>Time and Targeted BCC for families </li></ul><ul><li>Improve block and village level planning and use of data </li></ul>
    13. 13. CSHGP Projects w/ 100% Flexible Fund Support <ul><li>ADRA/Nepal </li></ul><ul><li>2004-2009 </li></ul><ul><li>Eastern Region (target 500,000) </li></ul><ul><li>Expanded Impact for $2.5 million (FP) </li></ul><ul><li>Program Level of Effort </li></ul><ul><ul><li>100% Family Planning </li></ul></ul><ul><li>Strategies </li></ul><ul><li>BCC and Community Mobilization: training peer educators and FCHV, advocacy through religious leaders and decision makers </li></ul><ul><li>Training for FP Service Provision: public service providers (LAPM), VHW and CHW, FCHV refresher </li></ul><ul><li>System Strengthening: quality improvement through COPE and PDQ; strengthen referral system; strengthening contraceptive logistics management; improved M&E systems </li></ul><ul><li>Increasing Access to LAPMs: Mobile LAPM service provision </li></ul><ul><li>Save the Children/Mali </li></ul><ul><li>2004-2009 </li></ul><ul><li>Segou Region (target 184,000) </li></ul><ul><li>Expanded Impact for $2.5 million (FP) </li></ul><ul><li>Program Level of Effort </li></ul><ul><li>100% Family Planning </li></ul><ul><li>Program Strategies </li></ul><ul><li>Behavior Change: messages through individual and group; advocacy through religious leaders and decision-makers; radio </li></ul><ul><li>Training for FP Service Provision; health care providers, CBDs </li></ul><ul><li>System Strengthening: logistics management; improved M&E </li></ul><ul><li>Training; strengthening referral system for LAPMs; PDQ </li></ul><ul><li>Increasing Community Access: Establishing network of CBD and youth PE to sell contraceptives in villages w/o health centers </li></ul>
    14. 14. CSHGP Projects with a Portion of Family Planning Support <ul><li>Project Hope Uzbekistan </li></ul><ul><li>2003-2007 </li></ul><ul><li>Navoi, Uzbekistan (Targeted 94,000) </li></ul><ul><li>Cost XT $1,300,000 (FP $430,000) </li></ul><ul><li>Program Level of Effort </li></ul><ul><li>30% Maternal Child Health </li></ul><ul><li>30% Family Planning </li></ul><ul><li>10% Breastfeeding </li></ul><ul><li>10% Control of Diarrheal Disease </li></ul><ul><li>10% Pneumonia Case Mngt- </li></ul><ul><li>10% Nutrition </li></ul><ul><li>Strategies: </li></ul><ul><li>Target youth and adolescents with messages on about SRH </li></ul><ul><li>Train peer educators </li></ul><ul><li>Develop training materials for adolescent for use in schools </li></ul><ul><li>Scaled-up to national level </li></ul><ul><li>World Vision India </li></ul><ul><li>2003-2008 </li></ul><ul><li>Uttar Pradesh State (1.2m targeted) </li></ul><ul><li>Expanded Impact:$2.5 mil (FP $830,000) </li></ul><ul><li>Program Level of Effort </li></ul><ul><li>40% Immunization </li></ul><ul><li>30% FP/Birth Spacing </li></ul><ul><li>20% Breastfeeding </li></ul><ul><li>10% IMCI/Vitamin A </li></ul><ul><li>Strategies </li></ul><ul><li>Performance improvement AWW & ANM </li></ul><ul><li>Early registration of all pregnant women </li></ul><ul><li>Time and Targeted BCC for families </li></ul><ul><li>Improve block and village level planning and use of data </li></ul>
    15. 15. CSHGP Projects with 100% Family Planning Support <ul><li>ADRA/Nepal </li></ul><ul><li>2004-2009 </li></ul><ul><li>Eastern Region (targeting 500,000) </li></ul><ul><li>Expanded Impact for $2.5 million (FP) </li></ul><ul><li>Program Level of Effort </li></ul><ul><ul><li>100% Family Planning </li></ul></ul><ul><li>Strategies </li></ul><ul><li>BCC and Community Mobilization: training peer educators and FCHV, advocacy through religious leaders and decision makers </li></ul><ul><li>Training for FP Service Provision : public service providers (LAPM), VHW and CHW, FCHV refresher </li></ul><ul><li>System Strengthening: quality improvement through COPE and PDQ; strengthen referral system; strengthening contraceptive logistics management; improved M&E systems </li></ul><ul><li>Increasing Access to LAPMs : Mobile LAPM service provision </li></ul><ul><li>Save the Children/Mali </li></ul><ul><li>2004-2009 </li></ul><ul><li>Segou Region (targeting 184,000) </li></ul><ul><li>Expanded Impact for $2.5 million (FP) </li></ul><ul><li>Program Level of Effort </li></ul><ul><li>100% Family Planning </li></ul><ul><li>Program Strategies </li></ul><ul><li>BCC and Community Mobilization: individual and group messaging; advocacy w/ religious leaders and decision-makers; radio </li></ul><ul><li>Training for FP Service Provision ; health care providers, CBDs </li></ul><ul><li>System Strengthening : logistics management; improved M&E, strengthening referral system for LAPMs; PDQ </li></ul><ul><li>Increasing Access to FP : Establishing network of CBD and youth PE to sell contraceptives in villages w/o health centers </li></ul>
    16. 16. Birth Spacing Messages
    17. 17. Healthy Timing and Spacing of Pregnancies <ul><li>A child born three to five years after the birth of its sibling is about 2.5 times more likely to survive than children born at shorter intervals and less likely to be malnourished </li></ul><ul><li>Too young, too late, and too closely spaced result in high risk for the mother and child </li></ul>Sources: Conde-Agudelo, 2000: 2005-2006; DaVanzo, 2004; 2008; Razzaque, 2005; Rutstein, 2005. All studies adjusted for 10-15 confounding factors.
    18. 18. Birth Spacing Recommendations <ul><li>Wait 24 months before attempting the next pregnancy after a live birth (a birth-to-birth interval of 33 months) to reduce the risk of adverse: </li></ul><ul><ul><li>Maternal </li></ul></ul><ul><ul><li>Perinatal and </li></ul></ul><ul><ul><li>Infant outcomes </li></ul></ul><ul><li>Wait six months after a miscarriage or induced abortion to reduce the risks of adverse </li></ul><ul><ul><li>Maternal and </li></ul></ul><ul><ul><li>Perinatal outcomes </li></ul></ul>
    19. 19. Postpartum Family Planning An Essential Component of MCH Programs
    20. 20. Postpartum Need for FP <ul><li>99% of women postpartum want to delay or avoid the next pregnancy </li></ul><ul><li>A 36 month birth-to-birth interval improves health of mother and child </li></ul><ul><li>50% of births occur outside a hospital </li></ul><ul><li>70% of women receive no postpartum care </li></ul>Reaching postpartum women has the potential to provide FP information and services to over 90% of women of reproductive age!
    21. 21. Key Postpartum FP Messages <ul><li>Antenatal Period </li></ul><ul><li>LAM and immediate & exclusive BF </li></ul><ul><li>Reproductive intentions </li></ul><ul><li>Return to fertility </li></ul><ul><li>Pregnancy spacing for women who want another child </li></ul><ul><li>Contraceptive options including (LAPM – IUD, tubal ligation, and vasectomy) for women who have reached their desired family size. </li></ul><ul><li>Immediate Postpartum </li></ul><ul><li>(1 week) </li></ul><ul><li>All of the above + </li></ul><ul><li>LAM and Exclusive breastfeeding </li></ul><ul><li>Importance of postnatal care for the mother and the newborn </li></ul><ul><li>Post Natal Care Contact </li></ul><ul><li>(within 6 wks) </li></ul><ul><li>LAM and exclusive breastfeeding </li></ul><ul><li>Reproductive intentions </li></ul><ul><li>Return to sexual activity </li></ul><ul><li>Return to fertility </li></ul><ul><li>Pregnancy spacing for women wanting another child </li></ul><ul><li>Appropriate contraceptive options for women who do not want another child. </li></ul><ul><li>Importance of well baby care. </li></ul><ul><li>Child Health Contacts during </li></ul><ul><li>1 st year (immun., sick child, etc.) </li></ul><ul><li>All of the above + </li></ul><ul><li>Exclusive breastfeeding through first six months, then breastfeeding with complementary feeding </li></ul>
    22. 22. What are the Appropriate Post Partum Contraceptives Options?
    23. 23. World Vision’s Strategy Timed and Targeted Counseling: Getting the Right Messages to the Right People at the Right Time
    24. 24. World Vision’s Timed and Targeted Counseling Strategies and Results <ul><li>Provide a set of standard messages for counseling at designated timeframe </li></ul><ul><li>Utilize registers to track conception and birth </li></ul><ul><li>Identify and track pregnant women over time </li></ul>Train Community Volunteers NFHS: Uttar Pradesh India   1998/99 2005/06 1998/99 2005/06 Total Fertility Rate 4.1 3.8 2.9 2.7 Contraceptive Use 28% a 44% 48% 56% Unmet need for FP 25% b 22% 16% 13% Infant Mortality 89 c 73 68 57 a Among married women aged 15-49 b Among married women aged 15-49 who want to delay next pregnancy or want no more pregnancies c per 1,000 live births      
    25. 25. Increasing Community Access to Family Planning Bringing FP services to underserved and rural populations
    26. 26. Community-based Strategies for Increasing Community Access to FP <ul><li>Community-based Distribution Programs* (shorter term methods including DepoProvera) </li></ul><ul><ul><li>Community volunteers </li></ul></ul><ul><ul><li>Trained health workers </li></ul></ul><ul><li>Mobile Services for LAPMs* (implants, IUD, female and male sterilization) </li></ul><ul><li>Establishment of Depots </li></ul><ul><li>Pharmacy Sale and Administration </li></ul>
    27. 27. Community-based Distribution Networks <ul><li>Community health workers: </li></ul><ul><ul><li>Volunteers from public or private sector </li></ul></ul><ul><ul><li>Paid providers typically from the public sector </li></ul></ul><ul><li>Possible Roles </li></ul><ul><ul><li>Awareness and disseminating messages </li></ul></ul><ul><ul><li>Counseling on FP </li></ul></ul><ul><ul><li>Referrals (active and passive) </li></ul></ul><ul><ul><li>Provision of FP (condoms, pills, injectables*, SDM) </li></ul></ul>
    28. 28. Issues for Establishing Networks <ul><li>Selection Criteria </li></ul><ul><li>Training </li></ul><ul><li>Commodities and Logistics </li></ul><ul><li>Supervision and Reporting </li></ul><ul><li>Incentives/Motivation </li></ul><ul><li>Retention </li></ul><ul><li>Sustainability </li></ul>
    29. 29. The Rationale for Using Community Health Workers to Administer Injectable Contraception <ul><li>It is safe and effective </li></ul><ul><li>Expands access beyond health facilities to reach underserved populations (rural and urban) </li></ul><ul><li>Alleviates some of the burden on declining numbers of professional health care providers </li></ul><ul><li>Increasing access to injectable contraception has increased contraceptive prevalence rates at the national level in many countries </li></ul><ul><li>MDGs and country-specific FP and other health goals cannot be met without increasing access to FP </li></ul>
    30. 30. Provision of Injectables by Community Health Workers is Safe, Effective, Feasible <ul><li>Research and programmatic evidence from Africa, Asia, and Latin America: Provision of Depo-Provera by trained CHWs is extremely effective </li></ul><ul><li>June 2009 Technical Consultation at WHO: Evidence supports provision of injectables by trained CHWs </li></ul><ul><li>CHWs repeatedly demonstrate they: </li></ul><ul><ul><li>Provide injections safely and maintain supplies </li></ul></ul><ul><ul><li>Know when to refer to a clinic </li></ul></ul><ul><ul><li>Counsel about side effects </li></ul></ul><ul><ul><li>Administer injectables using a regular schedule </li></ul></ul><ul><ul><li>Provide services satisfactory to clientele </li></ul></ul>
    31. 31. Adding injectables to the Method Mix has Increased CPR in some African countries
    32. 32. Status of Paramedical Provision of Depo-Provera by CHWs in Africa 2004 TUNISIA MOROCCO SAHARA ALGERIA MAURITANIA MALI NIGER LIBYA CHAD EGYPT SUDAN ETHIOPIA DJIBOUTI ERITREA SOMALIA KENYA TANZANIA DEMOCRATIC CENTRAL RWANDA GABON EQUATORIAL ANGOLA CONGO NIGERIA BENIN DTVOIRE SIERRA SENEGAL GHANA THE GUINEA LIBERIA CAMEROON MALAWI ZAMBIA MOZAMBIQUE MADAGASCAR ZIMBABWE BOTSWANA SWAZILAND LESOTHO NAMIBIA ANGOLA WESTERN UGANDA OF THE CONGO REPUBLIC BURUNDI GUINEA REP. OF TOGO COTE BURKINA FASO GUINEA LEONE GAMBIA BISSAU SOUTH REPUBLIC AFRICAN THE AFRICA Pilot or limited program implementation with MOH approval; national policy restrictions remain in place
    33. 33. Countries are pilot testing CHW provision of injectables and instituting policy change National policies now permit scale-up. Scale-up in planning or implementation phase. Countries where pilots are being conducted or will be conducted by 2010 Potential for introduction of a demonstration project and/or policy change TUNISIA MOROCCO SAHARA ALGERIA MAURITANIA MALI NIGER LIBYA CHAD EGYPT SUDAN ETHIOPIA DJIBOUTI ERITREA SOMALIA KENYA TANZANIA DEMOCRATIC CENTRAL RWANDA GABON EQUATORIAL CONGO NIGERIA BENIN SIERRA LEONE SENEGAL GHANA THE GUINEA LIBERIA CAMEROON MALAWI ZAMBIA MOZAMBIQUE MADAGASCAR ZIMBABWE BOTSWANA SWAZILAND LESOTHO NAMIBIA ANGOLA WESTERN UGANDA OF THE CONGO REPUBLIC BURUNDI GUINEA REP. OF TOGO COTE D’VOIRE BURKINA FASO GUINEA GAMBIA BISSAU SOUTH REPUBLIC AFRICAN THE AFRICA
    34. 34. A Promising New Technology – Depo-SubQ in Uniject <ul><li>A new all-in-one single-use delivery system that combines </li></ul><ul><li>the needle and a pre-filled dose of Depo-Provera </li></ul><ul><li>formulated for subcutaneous injection (Depo-SubQ) into </li></ul><ul><li>one device. </li></ul><ul><li>Designed to give subcutaneous injections safely by all </li></ul><ul><li>trained providers including doctors, nurses, and CHWs. </li></ul><ul><li>Product may be available for purchase in 2011. However, cost of the commodity is still unknown. USAID has not committed to purchase Depo-SubQ in Uniject. </li></ul><ul><li>For now, programs are encouraged to move forward with the promotion of Depo-Provera delivered intramuscularly. </li></ul>
    35. 35. Abortion Prevention and Post Abortion Care An Opportunity for Integration through MCH Programs
    36. 36. Induced Abortions The Extent of the Problem <ul><li>205 million pregnancies worldwide: </li></ul><ul><ul><li>One third are unintended and 20% will end in abortion </li></ul></ul><ul><li>20 million unsafe abortions annually: </li></ul><ul><ul><li>Developing countries: 55% of abortions are unsafe </li></ul></ul><ul><ul><li>Developed regions: 8% are unsafe </li></ul></ul><ul><li>68,000/yr women die unnecessarily from unsafe abortions (13% of all maternal deaths): </li></ul><ul><ul><li>Africa: 650 deaths per 100,000 unsafe abortions </li></ul></ul><ul><ul><li>Developed regions: 10 deaths per 100,000 unsafe abortions </li></ul></ul>
    37. 37. Mobile Services <ul><li>Methods: implants, IUD insertions, male and female sterilizations, male circumcision </li></ul><ul><li>Community-level Tasks: scheduling services, preparing sites, inform client base, creating monitoring plan, and follow-up. </li></ul><ul><li>Mobile Team Tasks: appropriate team of trained providers, securing commodities, ensuring quality services and follow-up plan. </li></ul>FP services provided by a mobile team of trained providers in an area with limited or no FP services.
    38. 38. Community Actions to Establish Mobile Services <ul><li>Conduct needs assessment to determine demand for mobile services </li></ul><ul><li>Establish partnerships with local organizations that perform mobile services in your program area </li></ul><ul><li>Negotiate with public sector facilities to periodically bring services to a lower level facility </li></ul>
    39. 39. Abortions Result in Lost Lives <ul><li>Legal restriction do not affect abortion incidence: </li></ul><ul><ul><li>Africa abortion is illegal – abortion rate is 29 </li></ul></ul><ul><ul><li>Europe abortion is legal – abortion rate is 28 </li></ul></ul><ul><li>Causes of death due to unsafe abortions: </li></ul><ul><ul><li>Hemorrhage </li></ul></ul><ul><ul><li>Infection </li></ul></ul><ul><ul><li>poisoning from substances used to induce abortion </li></ul></ul><ul><li>Dangerous </li></ul><ul><li>Abortion Practices </li></ul><ul><li>Drinking turpentine, bleach or tea made with livestock manure </li></ul><ul><li>Inserting herbal preparations into the vagina or cervix </li></ul><ul><li>Placing foreign bodies, such as a stick, coat hanger or chicken bone, into the uterus </li></ul><ul><li>Jumping from the top of stairs or a roof </li></ul>
    40. 40. Abortion Prevention and PAC Life-Saving Community-based Actions <ul><li>Prevention: </li></ul><ul><li>Increase access to FP to address the unmet need for FP and reduce unintended pregnancies </li></ul><ul><li>Inform men and WRA of dangerous unsafe abortion practices </li></ul><ul><li>Provide messages to promote care-seeking behaviors for danger signs following an abortion </li></ul><ul><li>Post Abortion Care: </li></ul><ul><li>Advocate for availability of PAC at the community level (emergency treatment and FP) </li></ul><ul><li>Counsel patients to seek care immediately following abortions* </li></ul><ul><li>Mobilize transport to facilities for emergency care </li></ul><ul><li>Provide FP counseling and methods immediately following abortion </li></ul><ul><li>Counsel women wanting pregnancy to wait six months before becoming pregnant after an abortion </li></ul>
    41. 41. Danger Signs Following an Abortion <ul><li>Heavier than normal bleeding </li></ul><ul><li>Monthly bleeding </li></ul><ul><li>Fever </li></ul><ul><li>Dizziness or fainting </li></ul><ul><li>Severe stomach or abdominal pains </li></ul><ul><li>Bad smelling discharge from their vagina </li></ul>Immediately refer women to the clinic that has PAC services if they have:
    42. 42. http://info.k4health.org/PAC
    43. 43. Youth Programming at the Community Level Addressing Health Care Needs of Youth in MCH Programs
    44. 44. Why are Youth Important? <ul><li>1.5 billion youth aged 10-24 </li></ul><ul><ul><li>1.3 youth are living in developing countries </li></ul></ul><ul><li>Youth Bulge of Today </li></ul><ul><ul><li>The largest generation to transition to adulthood </li></ul></ul><ul><ul><li>Impact national security and civil conflict </li></ul></ul><ul><ul><li>Results in poverty, urban sprawl and slums </li></ul></ul><ul><li>Values and decisions are impacted by norms, expectations, peers, parents and other adults </li></ul>
    45. 45. Integrating Youth Issues into MCH Programs <ul><li>Clinic Services: </li></ul><ul><ul><li>Advocate for clinic services that meet the health care needs of youth </li></ul></ul><ul><li>CHW/Vs: </li></ul><ul><ul><li>Sensitize CHWs to serve youth </li></ul></ul><ul><ul><li>Disseminate messages on SRH </li></ul></ul><ul><li>Behavior Change Efforts </li></ul><ul><ul><li>Design custom messages for youth </li></ul></ul><ul><ul><li>Involve religious leaders and other adults to share accurate information and discuss RH/FP issues </li></ul></ul><ul><ul><li>Engage youth in community mobilization </li></ul></ul><ul><li>Systems: </li></ul><ul><ul><li>Include indicators for youth in monitoring systems to measure progress </li></ul></ul><ul><li>Health Care Needs </li></ul><ul><li>of Youth </li></ul><ul><li>Privacy </li></ul><ul><li>Confidentiality </li></ul><ul><li>Supportive health care providers </li></ul><ul><li>Range of quality services (FP/RH, MCH, PAC, STI, HIV VCT, treatment and care) </li></ul><ul><li>Customized messages on FP/RH (delay sexual debut and first pregnancy) </li></ul>

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