Transcript Investing in Family Planning: the Case for LAPMs and Reality

Workshop on Investing in
Family Planning
The Case for LAPMs
A family planning forecasting tool
for evidence based advocacy and
planning
John M. Pile, Roy Jacobstein, Jan Kumar,
Alyson Smith, Jane Wickstrom
The ACQUIRE Project
Kampala, Uganda
January 29-31, 2007
The number of women of reproductive
age is large and growing.
Projected Women of Reproductive Age
Uganda
300
280
260
240
220
200
180
160
140
120
100
80
60
40
20
0
284
20
18
16
252
223
197
179.3
Millions
Millions
Projected Women of Reproductive Age,
Sub-Saharan Africa
2006
2010
2015
Year
2020
2025
14
12
10
8
6
4
2
0
14
11
9
6
2006
7
2010
2015
Year
2020
2025
Demand for
family planning is high, yet….

Globally ~716 million women use FP

In Sub-Saharan Africa ~26 million women use
FP

In Uganda ~ 1 million women use FP
Significant unmet need
for family planning

Globally over 120 million women have unmet
need for FP

In Sub-Saharan Africa ~30 million women have
an unmet need for FP.

In Uganda ~ 1.8 million have unmet need
Family planning saves lives—addressing
unmet need in Uganda
Meeting the unmet need for family planning by 2015 would
result in an estimated

4.6 million fewer unintended pregnancies

1.2 million fewer abortions

2.8 million fewer unintended births

~17,000 maternal lives saved

~1.1 million children lives saved
Family Planning and the Millennium
Development Goals
Reducing unmet need for FP can help countries to
meet the MD Goals by reducing the cost of meeting
the MD Goals.
Liz Gilbert, the David & Lucile
Packard Foundation
Chamberlain Diala, JHU/CCP
Chamberlain Diala, JHU/CCP
Focus on 5 of 8 Millennium Development
Goals:

Achieve universal primary education

Reduce child mortality

Improve maternal health

Ensure environmental sustainability

Combat HIV/AIDS, malaria and other diseases
Social Sector Cost Savings and Family
Planning Costs in Uganda
450
400
US$ (million)
350
300
250
200
Total Savings: $408 M
Malaria, $13 M
Maternal Health,
$126 M
Water & Sanitation,
$59 M
Immunization,
$52 M
150
100
50
Total Costs: $97 M
Education,
$158 M
0
Source: Moreland and Talbird 2006.
Family Planning,
$97 M
Family planning can have a significant and costeffective impact in HIV/AIDS prevention efforts
Number of HIV-positive births averted
Number of HIV-positive births averted by each
strategy, given US$ 20,000 in program costs
35
30
30
23
25
20
15
10
5
0
Contraceptive strategy
Traditional PMTCT Strategy
Benefits of PMTCT Services and Family Planning
Added to PMTCT Services in 14 High-Prevalence
Countries in 2007
180,000
160,000
140,000
120,000
100,000
80,000
60,000
FP
FP
40,000
20,000
PMTCT
0
FP
PMTCT
Child infections averted
Child deaths averted
Unintended pregnancies
averted to HIV+ women
FP
32,000
55,000
155,000
PMTCT
39,000
20,000
Source: USAID. Adding Family Planning to PMTCT Sites Increases PMTCT Benefits. Global Health Issue Brief. July 2006.
The Case for LAPMs
IUCDs
Implants
Minilap
Vasectomy
The case for LAPMs:
LAPMs address the full range of women’s and couples’
needs

LAPMs are an important and attractive method option
for women and men who wish
– to delay a first birth,
– to space births, and
– to limit family size once they decide that they want to have no
more children.

LAPMs are equally suitable for
– young and older women,
– women who have been pregnant and those who have not,
– people living with HIV,
– as well as postpartum and post-abortion women
The case for LAPMs:
LAPMs are especially effective
Pregnancy Rates by Method
The case for LAPMs:
LAPMs have lower discontinuation rates than shortacting methods
% Women and men using FP methods at one year
Periodic abstinence
51%
Condoms
53%
Injectables
56%
OC pills
68%
IUD
78%
Implants
84%
Tubal ligation
100%
Vasectomy
100%
Source: 2003 Kenya DHS
The case for LAPMs:
LAPMs are cost effective
Commodity Cost (US$) to Health Care System Per Year of
Protection, by Method
IUD
$0.16
Vasectomy
$0.55
Female Sterilization
$1.01
Pills
$3.60
Implanon
$9.87
Jadelle
$6.00
Norplant
$6.80
Depo Provera
$3.86
Condoms
$4.20
0
2
4
6
8
10
12
US$
Source: UNFPA 2005. Achieving the ICPD Goals: Reproductive Health Commodity Requirements 2000-2015.
Assumes IUD Norplant and Jadelle used for 3.5 years; Implanon for 2.5 years; and female sterilization and vasectomy for 10 years.
Comparison of Annual Contraceptive Commodity
Costs for Short- and Long-acting Contraceptives
Over 1 to 5 Years
25
20
Condoms
Pills
Depo
IUCD
Jadelle
Implanon
Norplant
15
US$
10
5
0
At First
Visit
After 1
Year
After 2
Years
After 3
years
After 4
years
After 5
years
Source: UNFPA 2005. Achieving the ICPD Goals: Reproductive Health Commodity Requirements 2000-2015.
.
LAPMs
Needed, Wanted and Crucial

The health and cost benefits of investing in family
planning are well known, well documented and
substantial.

LAPMs have clear advantages among methods of family
planning to both clients and health systems.
LAPMs
Needed, Wanted and Crucial

The unmet need for family planning in Uganda is great—
1 million Ugandan couples have an unmet need to space,
700,000 have an unmet need to limit.

An investment of less than $100 million to address this
unmet need will avert more than 1.1 million maternal
and child deaths, 4.6 million unintended pregnancies
and is more than offset by the resulting savings in
achieving millennium development goals of universal
primary education and environmental sustainability.
Call to Action

In the absence of widespread availability and use of
LAPMs, a country’s fertility will generally stay high, and
national development will be low and slow.

Despite other compelling public health and development
challenges Uganda faces, the need to make LAPM
services more widely available, accessible and used is
pressing and should be given even higher priority.