3. Epidemiology of Contraceptive
• Usage varies in many parts of the world;
• Increase in Asia & Latin America
• Low in sub Saharan Africa
• Globally, slight increase in modern contraceptive
usage from 54% in 1990 to 57% in 2012
• Malaysia, the family contraceptive prevalence rate
was at 51.9% (2004), overall achievement low
despite vigorous effort
Factors related to increase use of contraceptive.
• Greater availability of reliable contraceptive methods.
• Continuous effort to promote the use of family planning
• Greater access to the contraceptive
4. The Un-met Need
• Annually, 6 million to 27 million
unintended pregnancies occur among
people practicing contraception.
• 120-150 million , couples do not use
contraceptive
Unmet Need for spacing childbearing
-proportion of currently married women who want
to posphone their next birth for 2 years or more
but not using an effective Family Planning
Un-met need for limiting childbearing
- Proportion of currently married women who do
not want any more children but are not using an
effective family planning method
5. Health Concerns and Opposition to Family Planning Are Leading
Reasons That Women Do Not Use Modern Contraception, Even
Though They Want to Avoid Becoming Pregnant
Source: Jacqueline E. Darroch, Gilda Sedgh, and Haley Ball, Contraceptive Technologies: Responding to Women's Needs (New York:
Guttmacher Institute, 2011).
6. Contraceptive Prevalence Rates (CPR) - Malaysia
5.3
34.4
51.4 53 54.5
51.9
1966 1974 1984 1988 1994 2004
Source – Malaysia Population Family Survey 2004, LPPKN
Modern method =
34%
The proportion of women of reproductive age (married) who are currently using a
contraceptive method
7. Status Of Family Planning Practices
60
50
40
30
20
10
0
1974 -2004
1974 1984
1994
2004
36
52.2 54.8
51.9
26.3
30.3
30.2
34.4
any method modern method
60
50
40
30
20
10
0
any method modern method
50.1 50.4
57.8
53
30.1
37.4
44.4 42.3
Sabah Sarawak
1989 2004 1980 2004
Peninsular
1989 -2004
9. Lifetime Risk for Maternal Mortality & Percentage
of Modern Contraceptive Usage
Country Lifetime Risk for
Maternal Mortality
( 1 in number stated)
Percent of women
using modern
contraception
Bangladesh 1 : 59 43%
Chad 1 : 11 2%
Malawi 1 : 7 26%
Pakistan 1 : 31 20%
Australia 1 : 5,800 72%
Malaysia 1 : 660 42%
10. Family Planning As An Indicator Towards Achieving
Mdg Goals
Maternal Deaths By Practice Of FP : Malaysia 2006 - 2011
Family
Planning
2009 2010 2011
n % n % n %
Ever User 38 24.7 29 19.9 40 30.8
None user 114 74.0 86 58.9 65 50.0
Don't know 2 1.3 31 21.2 25 19.2
Total 154 100.0 146 100.0 130 100.0
11. Family Planning As An Indicator
Towards Achieving MDG Goals
Family Planning Usage Among Reported Maternal Death , Malaysia 2006-2008
Family
Planning
2006 2007 2008
n % n % n %
Ever use 30 23.6 25 18.4 24 18.3
None user 68 53.5 86 63.2 82 62.6
Don’t know 29 22.9 25 18.4 27 19.1
Total 127 100.0 136 100.0 133 100.0
Data source : report on the CEMD in Malaysia 2006-2008
12. Contraceptive in Sarawak.
To begin with:
• 1966, provision of services by Sarawak Family Planning
Association (SFPA) with support of International Planned
Parenthood Federation (IPPF)
• 1977, The National Family Planning Programme extended to
Sarawak , incorporate the activity into MCH programme
Objectives :
To promotes the health of the mothers and
children ; encourage spacing of the childbirth
Millennium years:
Continuation of the traditional services in MCH
2008 clinic near SFPA Facilities initiated the service
2012 – expansion of services in the hospital
2013 – all health clinic & hospital involved
Sarawak NPFDB –
started 2002
National population and Family Federation board
13. Main Agencies Providing FP In Sarawak –
MOH, FHRAM
120
100
80
60
40
20
0
1970 1980 1990 2000 2010
MOH
FRHAM
New Acceptor for FP Sarawak
15. New Approach of Family Planning Services
• Emphasis services to the target groups ( High Risk Client)
• Emphasis on effectiveness to improve provision of a quality
services ( timing, method )
• Monitor the work process more effective and quality
( good model of care) using qualitative indicators .
General Objective:
Reduce morbidity and mortality among children and mothers due to
pregnancy and / complications of pregnancy through family planning
practices
Specific Objective:
• Determine a basic level of effective family planning
practices among high-risk customers .
• Ensuring effective family planning practices and continued
for at least 2 years
16. Indicators
Quantitative Indicator;
Percentage of high risk clients whom are registered in the programme
practice family planning method code 1 in the current year
( Code 1 = method of contraception with a Pearl index < 9)
Qualitative Indicator:
Percentage of high risk client whom practice effective family planning
methods ( code 1 ) continuously for 2 years
( Code 1 = method of contraception with a Pearl index < 9 )
17. MODEL OF GOOD CARE
6 Critical Steps
• Registration Of Clients
• Identification Of Risk Groups
Pregnancy
• Counseling Process
• Use Of The Guidelines Of WHO -
WHO Medical Eligibility Criteria For
Starting Contraceptive Methods "
• Detection & Tindaksusul Dropout
Cases
• Management Of Contraceptive
Supplies And Data
18. Amalan Perancang Keluarga Yang Berkesan di Kalangan
Pelanggan Berisiko : INDIKATOR PENGGUNAAN 2011-2013p
NEGERI 2011 (Julai – Dis) 2012 2013
Bil. Kes
Berisiko
Pencapaian
%
Bil. Kes
Berisiko
Pencapaian
%
Bil. Kes
Berisiko
Pencapaian
%
Perlis 611 73.15 1,050 79.70 1,173 75.45
Kedah 4,661 81.98 9,156 84.39 8,996 84.2
Pulau Pinang 1,823 57.49 4,063 76.00 3,527 77.06
Perak 10,243 50.79 19,143 55.20 7,804 64.57
WP Kuala Lumpur 775 57.16 2,545 65.3 2,545 65.3
WP Putrajaya 125 80.00 213 89.7 123 92.68
Selangor 5,873 64.16 13,107 60.00 12,364 72.57
Negeri Sembilan 1,781 55.59 3,149 67.2 6,343 72.46
Melaka 1,098 68.49 2,702 72.0 3,530 74.16
Johor 6,602 56.76 12,077 71.17 13,988 75.53
Pahang 2,803 81.16 6,322 84.4 5,326 87.40
Terengganu 2,542 60.54 6,103 64.53 7,341 65.60
Kelantan 4,733 56.22 10,512 67.6 8,275 83.34
WP Labuan 217 59.45 493 86.21 357 97.20
Sabah 6,480 61.42 21,335 76.20 8,673 80.99
Sarawak 8,287 80.31 17,064 78.45 16,141 83.01
MALAYSIA 58,654 64.03 129,034 70.78 106,506 76.87
19. Amalan Perancang Keluarga Yang Berkesan di Kalangan Pelanggan Berisiko
: INDIKATOR KUALITI KOHORT 2011(QAP/ PK/ 22)
Negeri
Bil. Kes berisiko yang
didaftar (QAP/PK/20)
Bilangan yang mengamal mengikut
jenis kaedah
Bilangan Kes Amal
Pindah Masuk
(Kod 1 & Kod 2
Jumlah pindah keluar
Bil. Kes berhenti
amal
Berjaya amal
% Berjaya amal
Kod 1
Kod 2
Kod 3
Yang tidak amal
Kod 1
Kod 2
Perlis 477 405 3 14 65 0 46 62 1 311 83
Kedah 4694 3837 352 134 373 45 231 583 40 3135 69.5
P. Pinang 1823 1048 410 176 189 27 0 54 23 1090 68.5
Perak 7804 5039 841 1701 223 0 24 0 0 5376 69.0
WPKL &
275 191 20 53 11 1 31 30 6 166 67.8
Putrajaya
Selangor 8331 5041 943 1968 345 110 450 650 170 3518 44.0
N Sembilan 1739 1083 188 319 149 3 104 56 7 1423 86.8
Melaka 573 417 52 59 45 7 28 64 12 349 63.2
Johor 3110 1692 209 275 934 57 162 216 30 2071 68.9
Pahang 5218 4651 143 147 239 34 191 222 16 4289 85.3
Terengganu 1236 825 101 125 185 2 70 156 17 690 59.1
Kelantan 4875 3361 147 456 911 69 348 444 21 2923 63.6
WP Labuan 217 129 11 11 66 0 27 16 2 100 52.6
Sabah 8163 5091 372 854 1846 55 728 1062 110 3698 49.4
Sarawak 8539 6871 460 304 904 170 651 953 85 5500 68.2
Malaysia 57074 39681 4252 6596 6485 580 3091 4568 540 34639 60.7
20. UPDATES : FAMILY PLANNING SERVICES
Actions
• Monitoring of state performance based on pre determined targets by Family Health
Development Division (FHDD). -
• Family planning services in hospital
• initiation of FP for post natal and post abortion patients (hosp with specialist : 82.4%,
hosp without specialist : 60%)
• Dedicated ‘expert family planning team ‘ in hospitals
• Reactivate national family planning training by KKM
• Reactivate family planning promotion –
• Production of pamphlets/booklets in 2011 & distributed to clinics and hospitals
• Production of video documentary (topics : Kaedah Perancang keluarga, kaedah implan)
in 2013- Uploaded to MyHealth, youtube & distribution of VCDs to clinics and hospitals
• Introduction of quality indicator on effective family planning amongst high risk women
• Wider range of contraceptives
• More choice of contraceptives procured via central contract
• Inclusion of Low dose Ethinylestradiol and Etonogestrel Implant in the MOH drug
formulary since 2011
• Unresolved issue : Downgrade of Etonogestrel Implant from List A* to List AKK
Editor's Notes
The definition of un-met need
MOH dominating the services after millennium years.
Method most accepted by the Sarawakian are pills and injection.. However the other method such as IUCD and implanon usage are slighty increased for the past 2 years…
Mainly because of increase accessibility to the services through:
Provision of the services by hospital
Increase no of medical office in the health clinic.
