Transcript Slide 1

Family
Planning
Symposium sur la mortalité
maternelle, Dakar 12/10
Luc de Bernis
Conseiller Santé maternelle
UNFPA
The Population issue:
The World Bank analysis
Sub-Saharan Africa faces huge challenges to
integrate into the world economy, increase its rate
of economic growth, and lift its men and women
out of poverty. To achieve these goals, Africa must
inter alia improve its governance, build its human
capital, improve the health of its citizens, trigger an
education revolution, manage the rapid pace of
urbanization, increase its agricultural productivity,
protect its environment, and adapt to global climate
change. The rapid growth of the sub-Saharan
population is exacerbating all these challenges,
making more difficult the achievement of the
Millennium Development Goals (MDGs).
The Human rights approach
In 1994 in Cairo, at the International Conference on
Population and Development
179 countries agreed that:
“…Reproductive rights embrace certain human
rights that are already recognized... These rights
rest on the recognition of the basic rights of all
couples and individuals to decide freely and
responsibly the number, spacing and timing of
their children and to have the information, and
means to do so, and the right to attain the
highest standard of sexual and reproductive
health... their right to make decisions concerning
reproduction free of discrimination, coercion, and
violence…” – Para 7.3, ICPD
Poverty, Gender, Health, Environment:
FP is central for achieving all MDGs
MDG1: Eradicate extreme poverty and hunger.
Poverty/income, Employment/decent work, hunger
MDG 2: Achieve universal primary education
MDG 3: Promote gender equality and empower
women
MDG 7: Environmental sustainability
+ MDG 4, 5 and 6
MDG5: Improve Maternal Health
(… to ensure every pregnancy is wanted and
every birth is safe!)
Two targets:
• Reduce the Maternal mortality ratio by three
quarter, between 1990 and 2015
• Achieve, by 2015, universal access to
Reproductive health
MDG 5B
Universal access to Reproductive health
Five indicators
• Adolescent birth rate
• Antenatal care coverage (at least one
visit and at least four visits)
• Unmet needs for Family planning
• Contraceptive prevalence rate
Strategies for MMR (and MNR) reduction
(London consensus – 2010)
• Family planning (FP)
• Skilled birth attendance (SBA)
• Emergency obstetric and neonatal care (EmONC)
• Community-based interventions: FP, …
• Health center: FP, ANC, Basic EmONC
• Referral hospital: FP, Comprehensive EmONC,
specialised neonatal care
Health system strengthening and Community
involvement
Avantages médicaux des services de santé sexuelle et reproductive
Condom masculin
Condom Féminin
Contraceptifs Oraux (Pilules)
Injectables (+ seringues/aiguilles)
Dispositifs intra- utérins (DIU)
Implants
Spermicides
Méthodes des Jours Fixes
Family Planning services
Why is FP uptake has stalled?
Services
Governance, supervision
Human resources
Supplies and choice of methods
HMIS
Constellation of services
Access, affordability
9
Demand
Community empowerment and
ownership
Empowerment of women and girls
and male involvement
Information, Perceptions, Beliefs
Satisfaction with services
Policies,
Laws, legislation,
National priorities, plans and
budgets
Current situation (SSA)
• Sub-Saharan Africa (SSA) hosts 25 of the 28 high
fertility countries of the world, defined by a total
fertility rate (TFR) higher than 5 children per woman.
• Due to decline of mortality rates (despite HIV
epidemic), and high fertility rate, since the 1960s,
sub-Saharan Africa’s population has grown at the rate
of 2.5 percent per year, implying a doubling time of
the population of 28 years.
• the rate of increase of the contraceptive prevalence
rate (CPR) is estimated at only 0.5 percentage point
per year (better in Southern Africa, Madagascar,
Malawi, Ethiopia, Rwanda).
Unmet needs for FP
• In the least developed countries, 6/10 women who do
not want to get pregnant are not using contraception.
• This unmet need is highest among the disadvantaged
individuals who are also most likely to suffer adverse
consequences from unprotected sex.
•
• When faced with an unintended pregnancy, women
with few resources often have an unwanted birth or
seek an unsafe abortion, resulting in high rates of
maternal mortality and morbidity among this
population group.
•
• These same women also lack protection from sexually
transmitted infections, including HIV.
Total Fertility Rate, Contraceptive Prevalence and
Unmet Need in Developing Countries and Least
Developed Countries
Each year, …
• 42 million women seek an abortion – an
estimated 20 millions of those abortions are not
safe, resulting in nearly 67,000 deaths annually.
• modern contraceptives help prevent 2.7 million
infant deaths and the loss of 60 million years of
healthy life through birth spacing and reducing
unwanted pregnancies.
• FP is instrumental in lowering HIV transmission
and mother-to-child transmission of HIV (dual
protection)
Relation between Maternal Mortality
Rate and use of Family Planning services
Meeting unmet need for family planning and maternal
and newborn health care would save women’s lives.
550
Maternal deaths (in 000s), 2008
410
240
160
Current levels
of care
Expanded family
planning use only
Expanded
maternal and
newborn care only
Expanded family planning
and maternal
and newborn care
Equity
• Among underserved groups is the adolescents’
one: new generations begin their sexually active
years being often excluded from reproductive
health services. They enter adulthood with
inadequate information on sexuality and RH
and few skills to protect their health and rights.
• Adolescent friendly services (and not
Adolescent health services)
• SRH education at school
Equity (2)
FP services too often fail to reach:
• the poor, those living in remote areas and urban
slums, and people with less education
• indigenous people,
• individuals with disabilities,
• people living with HIV,
• internally displaced people, and
• migrant workers
As a result, socio-economic disparities in SRH
indicators are among the largest of any health
indicators.
Experts meeting on FP and Equity
New York, June 2009
Recommendations for research:
5. Support research, both technically and financially,
to assess the barriers disadvantaged groups face
and measure programme impact on reducing
inequities in family planning access and use.
7. Identify priority needs for research, monitoring,
and translating research into programmes and
policies conducive to reducing inequities in access
to reproductive health services at the country
level.
New Developments
• Recent analytical work on the East Asia situation
has demonstrated that demographic changes, in
particular rapid declines in fertility, have brought
about a “demographic dividend” caused by more
favorable dependency ratios and a relatively
larger share of the labor force.
• Second, the human rights agenda, that includes
access to RH and family planning services, has
also gained prominence in recent years
Source: WB Africa Region. Outline of a strategic plan for Population and Reproductive
health. March 2010
Some references
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Reducing unmet need for family planning: Evidence-based strategies and approaches.
Outlook 2008; 25(1).
Bongaarts J, Sinding SW. A response to critics of family planning programs. International
Perspectives on Sexual and Reproductive Health, 2009; 35(1):39-44
James Gribble et Joan Haffey. La Santé reproductive en Afrique Sub-saharienne. 2009
Population Reference Bureau
Rapport 2010 sur les OMD.
http://www.un.org/fr/millenniumgoals/report2010.shtml
How universal is access to reproductive health?
http://www.unfpa.org/public/home/publications/pid/6532
State of the World Population 2010. http://www.unfpa.org/swp/
Eight lives. Stories of RH. http://www.unfpa.org/public/home/publications/pid/6641
Guengant, J.-P. & J.F. May. (2007). Impact of the Proximate Determinants on the Future
Course of Fertility in Sub-Saharan Africa. Population Bulletin of the United Nations. Nos.
46/47 2002: 71-95.
Birdsall, N., Kelley, A.C., & Sinding, S.W. (Eds). (2001). Population Matters: demographic
change, economic growth, and poverty in the developing world. New York, NY: Oxford
University Press.