Transcript Document

How Using Family
Planning to Time and
Space Pregnancies
Reduces Mortality
Adrienne Allison,
December 12, 2012
Family Planning to Time and Space Pregnancy
Using family planning to time
and space pregnancies is
the single most effective
way to save lives and
improve the health and
well-being infants, children
and mothers.
UNFPA, 2012
Outline of Presentation
1.Impact of FP Use on Infant, Child and
Maternal Mortality
2.Impact of FP Use on Child Health
3. Family Planning Methods
Impact of Birth Interval on
Neonatal Mortality
3.00
Adj. Relative Odds Ratio
2.72
2.50
2.00
1.67
1.50
1.27
1.21
1.00
1.03
36-47 ref
41-47
1.00
0.92
0.93
48-53
54-59
1.08
0.50
0.00
<18
Rutstein 2005
18-23
24-29
30-35
Neonatal mortality by birth-to-birth interval (17 DHS surveys)
60+
Impact of Birth-to-Pregnancy Interval on
Infant Mortality
Deaths per 1,000 infants under age one
Effect of Birth Interval on Infant Mortality
100
Less than 2 years
94.2
2-3 years
87.1
82.6
80
63.9
55.6
60
48
50.1
45.8
52.8
50.8
43.2
39.7
35.4
40
19.2
20
0
Turkmenistan Kyrgyz Rep. Kazakhstan
2000
1997
1999
Armenia
2000
Georgia
1999
Uzbekistan
1996
Romania
1999
Birth to Pregnancy Intervals and Relative
Risk of Adverse Maternal, Perinatal and
Pregnancy Outcomes
Risk (odds ratio)
3.6
Miscarriage
Low Birth Weight
Maternal Death
Pre-term Birth
3.2
2.8
2.4
2
1.6
1.2
0.8
0.4
0
<6
6 to 11 12 to 17 18 to 23 24 to 29 30 to 35 36 to 47 48 to 59
Pregnancy Interval (months)
Sources: Conde-Agudelo 2005 and DaVanzo et al
2007
Stover J J Ross, 2009
Age of Mother
Parity
Spacing
Impact of Short Interpregnancy
Intervals
•
Infants: increased risk of neonatal and perinatal mortality, low birth
weight, preterm delivery
•
Children: mortality for children born 2 to 4 years apart is 75 per 1000
live births; for those born less than 2 years apart, it rises to 134 per
1000
•
Mothers: higher risk of mortality, pre-eclampsia, ruptured membranes,
anemia, high blood pressure
•
Infants whose mothers die are 3 to 10 times more likely to die before
age one, compared to infants whose mothers live
Rutstein, DHS, 2005
•
Adolescent girls: pregnancy– related complications are the leading
cause of mortality
Girls age 15 to 19 are twice as likely to die as women age 20 – 24
Girls under 15 are 5 times more likely to die than those 20 - 24
Infants of teenage girls are almost twice as likely to die as those born
to women age 20 – 29
SAVE, 2007, Guttmacher 2002
•
•
•
Longer Birth Intervals Decrease
Stunting and Underweight
Stunting
Underw eight
Percent of relative risk
160
146
140
140
120
129
120128
122
100
112
120111
100
95
100
93
80
92
97
82
78
79
60
<18
18-23 24-29 30-35 36-41 42-47 48-53 54-59
60+
Duration of preceding birth intervals (months)
Source for figure: Rustein, Shea, Effects of Birth Interval on Mortality and Health: Multivariate Cross-Country
Analysis, MACRO International, Presentation at USAID, July 2000; Rutstein 2005; Dewey and Cohen, 2004.
The Need for Family Planning
The risk:
• Women who do not breastfed may become
pregnant again as 25 days after giving birth
• Without the protection of FP, 85% of sexually
active women will become pregnant within the
first year
(USAID 2007)
Women Do Not Use Family Planning
because of:
•
•
•
•
•
Lack of knowledge about FP methods
No easy access to health /FP services
Low quality health / FP services
Fears about side effects
Opposition from husbands, mothers-inlaw
• Cultural values
Contraceptive Methods
• Most effective: Implants, IUD, Female
Sterilization, Vasectomy
• More effective: Injectables, LAM, Pills
• Less effective: Male Condoms, Female
Condoms, Fertility Awareness Methods (FAM)
• Least effective: Withdrawal, Spermicides
Female Sterilization
• Ideally done within 48 hours after delivery
• May be performed immediately following delivery or
during C/section
• If not performed within 1 week of delivery, delay for
4-6 weeks
• Highly effective, 99.5% comparable to vasectomy,
implants, IUDs
• Follow local protocols for counseling clients and
obtaining informed consent in advance
• Discuss during prenatal care
Male Sterilization: Vasectomy
• A safe, convenient, highly effective and simple form
of contraception that is provided under local
anesthesia in an out-patient setting
• Vasectomy is safer, simpler, less expensive and
equally effective as female sterilization (tubal
ligation)
• Highly effective in preventing pregnancy (99.6 to
99.8% effective)
• Not effective until after 3 months- requires a backup contraceptive method during the first 12 weeks
after a vasectomy
IUDs
• Can be inserted postpartum (immediately
up to 48 hours after delivery) or after 4 to
6 weeks;
• Highly effective
• Effective immediately
• Long-term method (up to 12 years with
Copper T 380A)
• Do not interfere with intercourse
• Do not affect breastfeeding,
• Few side effects
19
Combined Oral Contraception (COC)
• Start 3 weeks after delivery if not breastfeeding, 6
months after delivery if breastfeeding
• Highly effective when taken daily (0.1 – 0.5
pregnancies per 100 women during the first year of
use)
• No pelvic exam or lab tests required to initiate use
• Can start even if menses has notreturned, but will
need to use condoms or abstain for the first week of
use
• Does not interfere with intercourse
• Client can stop use
• Can be provided by trained non-medical staff
Progestin-only contraceptives
(pills, injectables, implants)
• No effect on breastfeeding, milk production or
infant growth and development after infant is 6
weeks
• WHO recommends a delay of 6 weeks after
childbirth before starting progestin-only methods
to avoid newborn exposure to progestin
• If woman is using LAM, progestin-only is a good
method to transition to at 6 months or when LAM
criteria are no longer met (exclusive breastfeeding
and menses not returned
21
Condoms
•
When used consistently and correctly, male and
female condoms are highly effective against
pregnancy (97%) and STIs/HIV
•
Can be used after childbirth (as soon as
intercourse is resumed)
22
Lactational Amenorrhea Method
(LAM)
• Protects from pregnancy if menses have not
returned
• If Infant is less than six months old
• If mother is exclusively breastfeeding on demand (no
more than 4 hours between feeds during the day; no
more than 6 hours between feeds at night)
• Bonus effect - Immediate and exclusive
breastfeeding for 6 months can reduce infant
mortality by about 50%
Emergency Contraception
• Provides protection for up to 120 hours after
unprotected intercourse, but should be taken
immediately as effectiveness declines over 5 days
• If a woman is already pregnant, EC does not affect her
pregnancy – she will remain pregnant
• Levonorgestrel, a progestogen hormone, works by
stopping or disrupting ovulation, and may also prevent
the egg and sperm from meeting
• After EC a mother needs immediate long term
protection from pregnancy through a FP method
Comparing effectiveness of methods
Most effective
Generally
2 or fewer
pregnancies
per 100
women in
one year
How to make your
method most effective
Implants
Female
Sterilization
Vasectomy
Injectables
Pill
s
IUD
One-time procedures. Nothing to
do or remember.
Need repeat injections
every 1 to 3 months
Must take a pill each day
Must follow LAM instructions
About 15
pregnancies
per 100
women in
one year
LAM
Male
Condoms
Diaphragm
Least effective
Must use every time
you have sex
Must use every time you have
sex; requires partner’s
cooperation.
Female
Condom
About 30
pregnancies
per 100
women in one
year
Must use every time you have sex;
requires partner’s cooperation.
Fertility
Awareness-Based
Methods
Spermicides
Must abstain or use condoms on
fertile days; requires partner’s
cooperation.
Must use every time
you have sex
Benefits of Using Family Planning
Healthy newborns, infants, children, and women, and
happy, stable families and communities.