Dr. j melgar family planning and development


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Dr. j melgar family planning and development

  1. 1. Global Rationales & Actual Benefits of Family Planning Junice L.Demeterio-Melgar Training of Medical Educators in Family Planning Silliman University, May 2010
  2. 2. Some early FP technology pig intestine condoms Crododile dung pessary weasel’s testicles Oral mercury Gold/silver diaphragm lemon Ian Fortey, Cracked.com
  3. 3. 4 Pre Sept 1994 Rationales <ul><li>Population control </li></ul><ul><ul><li>Government FP programs </li></ul></ul><ul><li>Birth control </li></ul><ul><li>Contraception </li></ul><ul><li>Responsible parenthood </li></ul>
  4. 4. Pop theory: too many people consume resources, destroy environment
  5. 5. World Pop in 2010: over 7 B
  6. 6. Thomas Malthus 1766-1834 <ul><li>“ population increases geometrically while subsistence increases in arithmetic ratio” </li></ul><ul><li>http://www.economyprofessor.com/economictheories/malthusian-population-theory .php </li></ul>“ Overpopulation is not simply population density but the numbers of people in an area relative to its resources and the capacity of the environment to sustain human activities”. Paul Ehrlich 1932-present
  7. 7. Women’s Reproductive Rights: pregnancy can be unwelcome
  8. 8. Margaret Sanger 1979-1966 <ul><li>&quot;no woman can call herself free who doesn't own and control her own body.“ </li></ul>http://www.nurses.info/personalities_margaret_sanger.htm feminist writer ( Married Love, Wise Parenthood ) Marie Stopes 1880-1958
  9. 9. Women’ right to FP (CEDAW 12.1 &General Recommendation No. 21 <ul><li>Article 16 (1) (e) </li></ul><ul><li>21. Women are entitled to decide on the no. and spacing of their children </li></ul><ul><li>22. Women need information and services on sexuality and contraception </li></ul><ul><li>23. Ensuring women’s right to FP results in family wellbeing, environmental protection and sustainable economic & social development. </li></ul>
  10. 10. Religious doctrine: all births are blessings
  11. 11. Pope Paul VI, 1897-1978 <ul><li>-Marriage & conjugal love are naturally ordained toward procreation and education of children. Every marital act must be open to the procreation of human life. </li></ul><ul><li>-Prohibited: abortion, temporary or permanent sterilization, contraception, includig emergency contraception </li></ul><ul><li>- Allowed: rhythm </li></ul>Humanae Vitae (1968)
  12. 12. Humanae Vitae cont’d… <ul><ul><li>Dangers of artificial contraception: </li></ul></ul><ul><ul><li>1. Lowers moral standards, inc. marital infidelity </li></ul></ul><ul><ul><li>2. Causes men to disrespect women </li></ul></ul><ul><ul><li>3. Allows State to dictate on couples’ private decisions </li></ul></ul><ul><ul><ul><ul><ul><li>http://www.vatican.va/holy_father/paul_vi/encyclicals/documents/hf_p-vi_enc_25071968_humanae-vitae_en.html </li></ul></ul></ul></ul></ul>
  13. 13. Medical science: FP as necessary Health service to women
  14. 14. WHO, USFDA, FIGO, ACOG, Williams… <ul><li>Pregnancy is established when a fertilized egg implants on the uterine lining. USFDA, AMA, ACOG, FIGO, Williams Obstetrics 22 nd ed. </li></ul><ul><li>Contraception prevents pregnancy mainly through preventing ovulation and fertilization. WHO Expert Opinion on House Bill 4643 On Abortive Substances and Devices in the Philippines, 2006 </li></ul><ul><li>Contraceptives are not abortifacients. </li></ul><ul><li>WHO Expert Opinion on House Bill 4643 On Abortive Substances and Devices in the Philippines, 2006 </li></ul>
  15. 15. Abortion is different from contraception <ul><li>Abortion is the termination of pregnancy, before the fetus develops sufficiently to survive – i.e. prior to 20 weeks gestation or less than 500g birthweight. </li></ul><ul><li>Williams Obstetrics 22 nd ed. </li></ul><ul><li>Medical abortion drugs: mifepristone, misoprostol; </li></ul><ul><li>Surgical methods: transcervical procedures, eg vacuum aspiration, dilatation and curettage, and dilatation and evacuation. </li></ul><ul><li>WHO Expert Opinion on House Bill 4643 On Abortive Substances and Devices in the Philippines, 2006 </li></ul>
  16. 16. Contraceptives very safe <ul><li>OCP nonsmoker, per 100T users: 1.5 </li></ul><ul><ul><ul><li>Per year: 1:67,000 </li></ul></ul></ul><ul><li>OCP heavy smoker, per 100T: 59 </li></ul><ul><ul><li>Per year: 1:1,700 </li></ul></ul><ul><ul><li>-IUD (per year), per 100T users 0.01 </li></ul></ul><ul><ul><li>Per year: 1:10,000 </li></ul></ul><ul><li>Barriers, per 100T per 100T users 0.0 </li></ul><ul><li> Per year: 0 </li></ul><ul><li>FAB, per 100T users: 0.0 </li></ul><ul><li> Per year: 0 </li></ul><ul><li>Female sterilization, per 100T users 2.6 </li></ul><ul><li> Per year: 1:38,000 </li></ul><ul><li>Male sterilization, per 100T users 0.1 </li></ul><ul><li> Per year : 1:1,000,000 </li></ul><ul><li> </li></ul>Contraceptive Technnology 17 th ed, 1998
  17. 17. … compared to <ul><li>Risk of death from pregnancy & childbirth in Asia </li></ul><ul><ul><li>Per 100T livebirths 390 </li></ul></ul><ul><ul><li>Lifetime risk: 1:65 </li></ul></ul><ul><li>Other risks of death in US </li></ul><ul><ul><li>Motorcycling, per 100T users: 100 </li></ul></ul><ul><ul><ul><li>Per year: 1:1,000 </li></ul></ul></ul><ul><ul><li>Automobile driving, per 100T users: 16 </li></ul></ul><ul><ul><ul><li>Per year: 1:6,000 </li></ul></ul></ul><ul><ul><li>Continuing the pregnancy, per 100T LB: 10 </li></ul></ul><ul><ul><ul><li>Lifetime risk: 1:10,000 </li></ul></ul></ul>Contraceptive Technnology 17 th ed, 1998
  18. 18. NORPLANT VASECTOMY INJECTABLE FSTERILIZN TCu380AIUD POPbreastfeeding LAM6mos OCP CONDOM DIAPH+SPERMCID FAB FCONDOMS SPERMCID NO METHOD 0-1: Always very effective 2-9: Effective as common- Ly used. Very effective when used correctly & consistently. 10-30: Only somewhat effective as commonly used. Effective when used correctly & consistently (0-1) (2-9) (10-30) Pregnancies per 100 Women in 1 st 12 mos Use Modern Contraceptives: Very Effective WHO, USAID, Bloomberfg, Family Planning A Global Handbook , 2007 COR CON USE TYP USE .1 .15 .3 .5 .8 1 2 6-8 14 20 20 21 26 85 .1 .1 .3 .5 .6 .5 .5 .1 3 6 1-9 5 6 85
  19. 19. Contraceptives: in WHO Core List of Essential Medicines Minimum medicine needs for a basic health care system, listing the most efficacious, safe and cost-effective medicines for priority conditions. Priority conditions are selected on the basis of current and estimated future public health relevance, and potential for safe and cost-effective treatment. http://www.who.int/medicines/publications/essentialmedicines/en/
  20. 20. Women Population Church Medical ICPD POA 1994 The Reproductive Health Consensus
  21. 21. ICPD POA major Goals ( 1.12) <ul><ul><li>sustained econ growth in the context of sustainable development </li></ul></ul><ul><ul><li>education, especially for girls </li></ul></ul><ul><ul><li>gender equity and equality </li></ul></ul><ul><ul><li>infant, child and maternal mortality reduction </li></ul></ul><ul><ul><li>provision of universal access to RH services, FP & sexual health. </li></ul></ul>
  22. 22. Reproductive Health <ul><li>state of health in all matters relating to the reproductive system,its functions and processes </li></ul><ul><li>Implies: </li></ul><ul><li>satisfying & safe sex life </li></ul><ul><li>capability to reproduce </li></ul><ul><li>freedom to decide if, when, and how often to reproduce </li></ul><ul><ul><li>right to FP </li></ul></ul><ul><li>access to health services that will enable women to survive pregnancy & child birth, and for infants to be born healthy </li></ul><ul><li>right to sexual health </li></ul><ul><li>Intl Conf. on Pop. & Devt. Programme of Action Ch 7 Para. 2 </li></ul>
  23. 23. <ul><ul><li>FP counselling, IEC & services; </li></ul></ul><ul><ul><li>Maternal & child health </li></ul></ul><ul><ul><li>Infertility prevention & treatment of infertility </li></ul></ul><ul><ul><li>Abortion per para. 8.25, including prevention & management of consequences </li></ul></ul><ul><ul><li>RTIs, STIs & other conditions - prevention & treatment </li></ul></ul><ul><ul><li>Sexuality & responsible parenthood IE & counselling </li></ul></ul><ul><ul><li>Referrals for complicated cases </li></ul></ul><ul><ul><li>Active discouragement of harmful practices, such as FGM, </li></ul></ul>ICPD 7.6 RH services as part of Primary Health Care
  24. 24. <ul><li>No promo of abortion as FP </li></ul><ul><li>Address public health impact </li></ul><ul><li>Prevention of unwanted pregnancy </li></ul><ul><li>Compassionate counselling of women with unwanted pregnancies </li></ul><ul><li>Abortion policy change must be done according to national legislative processes </li></ul><ul><li>In circumstances where abortion is not against the law, such abortion should be safe. In all cases, women should have access to quality services for the management of complications arising from abortion. </li></ul><ul><li>Post-abortion counselling, education and family-planning services to avoid repeat abortions. </li></ul>Abortion – according to ICPD POA 8.25
  25. 25. Goal: enable couples and individuals to decide freely and responsibly no.& spacing of their children Ensure informed free choice, is essential to long-term success of FP programs. Coercion, incentives and disincentives, targets & quotas have not worked Governmental goals for FP should be defined in terms of UNMET NEED for information and services. ICPD POA 7.12 FP Program principles
  26. 26. Bruce-Jain Framework of Quality FP Care (1990) <ul><li>Choice of contraceptive methods </li></ul><ul><li>Full & accurate information </li></ul><ul><li>Technical competence </li></ul><ul><li>Interpersonal communication </li></ul><ul><li>Continuity of care and follow up </li></ul><ul><li>Appropriate constellation of services </li></ul><ul><ul><ul><ul><ul><li>Creel et al, Overview of Quality of Care in Reproductive Health: Definitions and Measurements of Quality of Care , PRB & PopCouncil 2002 </li></ul></ul></ul></ul></ul>
  27. 27. FP Benefits <ul><li>Saves women’s, men’s & children’s lives </li></ul><ul><li>Improves women’s & family’s productivity </li></ul><ul><li>Generates public health savings </li></ul><ul><li>Reduces population pressure on scarce resources </li></ul><ul><ul><ul><ul><ul><li>Guttmacher Institute and UNFPA, Adding it Up: The Costs and Benefits of Investing in Family Planning </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>and Maternal and Newborn Health , 2009; Population Reference Bureau, Family Planning Saves Lives , 2009 </li></ul></ul></ul></ul></ul>
  28. 28. Comparative Cost-Effectiveness of FP Intervention Cost $ per DALY saved Insecticide-treated bednets 3-20 Malaria prevntn for pregnant women 29 TB treatment (epidemic sitns) 6-60 Modern contraceptive methods 62 ARV treatment India 150 ARV treatment Sub-Saharan Africa 252-547 BCG vaccination of children 48-203 Oral rehydration therapy 1,268 Cholera immunization 3,516 Guttmacher Institute and UNFPA, Adding it Up: The Costs and Benefits of Investing in Family Planning and Maternal and Newborn Health, 2009