Status and role of family planning in the context of the Zika epidemic in the LAC region - USAID ASSIST Project
←
→
Page content transcription
If your browser does not render page correctly, please read the page content below
Status and role of family planning in the context of
the Zika epidemic in the LAC region
Mark Hathaway, MD, MPH
Asesora Técnico de PF
International Workshop on Strengthening Health Services to Fight Zika
Santo Domingo, Republica Dominicana, Noviembre 28 a 30 de 2017
Presentation Outline
• Explain Maternal Child Survival Program (MCSP)
• Describe the many family planning (FP) opportunities
• Explain how the Zika crisis can be switched to an opportunity
• Show the vast unmet need for family planning
• Provide information on tools for improving FP uptake (LARC
LRP, MEC, MOA chart, etc)
• Describe some of the mechanisms of action of FP methods
2
USAID’s flagship
Maternal and Child
Survival Program
Vision Statement
Self-reliant countries equipped with
the analytical tools and effective
systems enabling them to be on track
to end preventable child and maternal
deaths
Credit: Kate Holt / MCHIP
Technical Areas
▪ Maternal & Newborn
Health
▪ Child Health &
Immunization
▪ Family Planning
▪ Nutrition
▪ Malaria
▪ Water, Sanitation, &
Hygiene (WASH)
▪ HIV/TB
Cross-Cutting Issues ▪ Quality ▪ Innovation ▪ Partnerships (private sector, civil society, etc.) ▪ Gender ▪ Equity ▪ Measurement and Analytics ▪ Behavior Change Communication ▪ Digital Health ▪ Community Approaches ▪ WASH ▪ Health Systems Strengthening ▪ Zika
From Household to Hospital Care
Credit: Juozas Cernius/MCHIP Credit: Karen Kasmauski/MCHIP
Household Community
Credit: Karen Kasmauski/MCHIP
Credit: MCHIP
Referral Clinics/Hospitals
Family Planning… An Opportunity
• Regardless of local status of Zika transmission
• Promote capacity-building, high-quality FP service delivery
• Provide comprehensive and updated evidence-based
counseling on all options and methods
• Prevention of pregnancy for women who do
not want to be pregnant is a primary strategy
to reduce Zika-related birth defects.
Optimizing Contact Points
and Methods to Deliver PPFP
throughout the first 2 years postpartum
PNC Pharmacy
Pre- ANC Birth visits / drug
pregnancy visits • home • home Immunization Measles shop
adolescents 1-4+ • facility • facility visits immuniz. visits
Introduction of
complementary foods,
return to fertility
Care of Pregnant Women
• Schedule/encourage ANC
visits according to national
standards
• Include discussion of family
planning methods and
document method prior to
labor (≤ 36 weeks)
Adolescents
Postpartum Family Planning (PPFP) • PPFP counseling and method use allows women and families to prevent an unplanned pregnancy • In the context of Zika, this prevents potential birth defects in unplanned pregnancies • Planned pregnancies allow women to actively prevent Zika exposure before and during pregnancies
Milliones de Mujeres Carecen de Servicios Esenciales Fuente: UNFPA. Planificación Familiar: Clave para el Desarrollo Sostenible. 10 Julio 2017
Numero Estimado de Embarazos No Intencionales
Por falta de Uso de Metodos Anticonceptivos
Fuente: UNFPA. Planificación Familiar: Clave para el Desarrollo Sostenible. 10 Julio 2017Tasas totales de aborto y de prevalencia del uso de Anticonceptivos Modernos en 59 países
Mortalidad Materna
Satisfacer la necesidad insatisfecha de servicios
de anticoncepcion moderna y de atencion a la
salud maternal salvaria la vide de mujeres
Fuente: UNFPAPor cada dolar adicional gastado en servicios
de anticoncepcion por encima del nivel actual, el
costo de la atencion relacionada con el
embarazo se reduciria en $2.30.Costos/Beneficios Fuente: UNFPA. Planificación Familiar: Clave para el Desarrollo Sostenible. 10 Julio 2017
Family Planning Counseling • Discussion of all available methods, including: • Efficacy (see WHO tiered chart, next slide) • Mechanism of action • Procedure/instructions for use • Non-contraceptive benefits • Potential side effects, risks • Eligibility for chosen method • Follow up plans
Tier 1 Tier 2 Tier 3
Family Planning Counseling
• Several counseling job aides exist to help
with FP counseling, including:
• WHO Medical Eligibility Criteria (2015)
• Selected Practice Recommendations (2013)
• Locally developed FP counseling flip charts
• LARC LRP de MCSPModule 1: Module 3:
Module 2:
Introduction to Medical Eligibility &
FP Counseling
LARC Client Assessment
Module 6:
Module 5:
Module 4: Copper
Infection Prevention
Quality of Care Intrauterine Device
for LARC Methods
(Cu-T 380-A)
Module 7: Module 9:
Module 8:
Hormonal Postabortion
Postpartum
Intrauterine Device
Intrauterine Device Intrauterine Device
(LNG-IUS)
Module 10:
Implementation
Contraceptive
Guide
ImplantsEstructura de los Modulos ▪ Duracion varia de 5-10 horas ▪ Mas tiempo para practicar con modelos o con pacientes ▪ Incorpora actividades en ves de presentaciones
Acceso a Planificación Familiar
pos-Evento Obstétrico
▪ Movimiento global con vision de
FP2020 y liderazgo de Jhpiego
▪ Miembros del comité ejecutivo global:
FP2020, USAID, BMGF, OMS, FNUAP,
Gates Institute a JHU y Advance
Family Planning, DFID, Packard
Foundation and Jhpiego.
▪ El contrasto entre DIU posparto y
Implantes pospartoPost-Partum IUD Insertion Practice
Laerdal Mama-U Model
http://www.laerdalglobalheal
th.com/doc/2580/Mama-UImportance of Fundal Placement STRONGLY recommend ultrasound guidance, especially for training
Equipment
• Post-placental:
✓ Graves speculum
✓ Betadine and
cotton/sponges
✓ Forceps
✓Long curved Kelly
32cm, Miltex #302505
✓+/- ring forceps for
cervix
✓ Scissors
• Postpartum:
✓ Bed that breaks away
✓ Light sourceAumento del Uso de DIUPP en India
18%
16% Inicio de Tarea
14% Compartida de
inserción de DIUPP
12%
Aceptores de
10%
DIUPP
8%
6%
4%
2%
Total deliveries: 2,917,919; Total insertion: 237,667
0% (Jan-11 to Apr-14)
2011 2012 Mes 2013 2014 30Definition of Pregnancy:
…When implantation occurs!!
• All scientific organizations (including WHO) use this
definition.
• Using the scientific definition we can dispel myths
and misperceptions, demonstrating that none of
these family planning methods cause an
abortion.
* All contraceptive methods prevent fertilization of
the egg by the sperm. *How Contraception Works: Mechanisms of Action
Incapacitates Sperm
All contraceptives prevent
• Copper IUD † fertilization of the egg by the sperm Ovary
Fallopian Tube
Prevents Ovulation (release of egg Uterus
from the ovary)
• Hormonal Contraceptives (Combined)
• Combined Oral Contraceptives (COCs) Thickens Cervical Mucus
• Emergency Contraceptive Pills • Hormonal Contraceptives (Progestin-only)*
• Combined Hormonal Vaginal Rings • Hormonal IUDs
• Hormonal Contraceptives (Progestin-only)* • Implants
• Implants • Injectables
• Injectables Cervix • Progestin-only Pills (POPs)
• Progestin-only Pills (POPs) • Progestin-only Vaginal Rings
• Progestin-only Vaginal Rings
• Lactation Amenorrhea Method (LAM)
Blocks Sperm
Vagina • Male Condoms
• Female Condoms
* Progestin-only hormonal methods have more than one mechanism of action.
† The Copper IUD works by preventing fertilization but in very rare instances, if used as Emergency Contraception, it may prevent implantation of a fertilized egg.“Same day” contraception
bHCG
Production
(Urine)
Start of End of Ovulation End of
Menses Menses CycleContraceptive Implant
Improve Application of Recommendations
• Add value to the wheel by offering guidance
how to initiate contraception (jacket=SPR)
o Counseling
o Nuances of different non-permanent
methods
o Special timing: Postpartum, post-abortion,
and post-coital contraception (EC)
o Method effectiveness chartSimplified & Integrated MEC+SPR Tool
Features:
• Clipboard size
• 3-fold jacket design
• Detachable wheel
inside the jacket
• New color schemeMEC Wheel Front
Features:
• Revised medical
conditions &
characteristics
• Added male and
female sterilization
• Revised order of
contraceptive
methods
• Added tiers to
contraceptive
methodsMEC Wheel Back
Features:
• Top lists conditions/
• characteristics
which are
recommendation
categories 1 & 2
that are not on
front of the wheel.
Also includes men
& vasectomy
recommendations
• Fewer Explanations
and explanations
simplifiedFamily Planning can Accelerate the Achievement
of all 17 SDGsMuchas gracias!
For more information, please visit
www.mcsprogram.org
This presentation was made possible by the generous support of the American people through the
United States Agency for International Development (USAID), under the terms of the Cooperative
Agreement AID-OAA-A-14-00028. The contents are the responsibility of the authors and do not
necessarily reflect the views of USAID or the United States Government.
facebook.com/MCSPglobal twitter.com/MCSPglobalYou can also read
