Description of available contraceptive methods in Sudan

ByDr. Sami Mahmoud AbdelkhairDr. Waled Amen Mohammed

Geneva Foundation for Medical Education and Research GFMER Sudan 2012

Forum No: ( 3 )

Name of presentersName Position Institution

Sami Mahmoud Abdelkhair Consultant Obstetrician & Gynae. RHC

Waled Amen Mohammed Head, Community Health Nursing UMST

Name Position Institution

Sami Mahmoud Abdelkhair Consultant Obstetrician & Gynae. RHC

Waled Amen Mohammed Head, Community Health Nursing UMST

Name of contributors

Contents of the presentation

• Introduction• Definitions• History• Methods of contraception.• Recommendations• Conclusions• Références

Introduction • Family planning is an important strategy in

promoting maternal and child health. • It improves health through adequate spacing of

birth and avoiding pregnancy at high-risk maternal ages and high parities ,(Umbeli, 2010).

• The total fertility rate for the Sudan has fallen from 5.4 children per woman to 4.6 in the period 1995-2000 and is estimated at the same rate in 2006 (SHHS, 2006).

Definitions• What is Contraception ? Contraception is

the intentional prevention of pregnancy during sexual intercourse. Birth control is the device and/or practice to decrease the risk of conceiving, or bearing, offspring. With the wide assortment of birth control options available, it is possible for a woman to use several different contraceptive methods at various stages throughout her fertile years.

History of Family planning in Sudan

• Family planning services were initiated in 1965 when the Sudan Family Planning Association was founded. The first thing in 1964 by pioneers such as Prof. Alatabani (Director) and Prof.Awatif A. Osman ( General Secretary).

History of Family planning in Sudan

• In 1975, the Ministry of Health established the maternal and child health and family planning project followed by the Sudan Fertility Control Association in 1976. • Family planning services were integrated

into the Primary Health Care System in 1985.

Methods of Contraception

• Block the sperm from reaching the egg • Kill or damage sperm • Keep eggs from being released each month • Change the lining of the uterus so the

fertilized egg does not attach to it • Thicken the mucus in the cervix so sperm can

not easily pass through it

IDEAL CONTRACEPTIVE

•Effective•Safe•No C/I•cheap

•Available •One time

method•Acceptable• reversible

Availability of contraceptive methods in Sudan

• Barrier Methods:1. Male condom: is now available as a

counter-drug in many private pharmacies.It is not available in the PHC facilities or even in

HIV management centers.There is a lot of religious & political dilemmas

about male condom use in Sudan

2. Other types of barrier methods are not available like :

• Female Condoms • Spermicidal Sponge Diaphragm• Cervical cap

Availability of contraceptive methods in Sudan

• Spermicides often are used in suppositories, foam, cream, jelly, and film (thin sheets that contain spermicide) to kill sperm or make them inactive.

• All forms of Spermicides are not available in Sudan now , however they were used 5 years ago by Sudan Family planning Association.

Availability of contraceptive methods in Sudan

• Hormonal birth control :comes in several forms, pill, skin patch, vaginal ring, injection, hormonal IUD and implant.

• Only three types are available1. Birth control pills2. Injection of depot medroxyprogesterone

acetate (DMPA) 3. Implant

Availability of contraceptive methods in Sudan

Birth control pills

• Birth control pills are two types1. Progesrtone only pills (POP) like Exulton &

Cerazette tabs2. Combined oral contraceptives (COC) like Microgynon, Marvelon & cilest.Both types are available in Sudan but not for

free for patients.

Applicator

implants• Adopted by FMH in 2010• Now used mainly in Khartoum state.• UNFPA has sponsored it at the level PHC

facilities.• It cost 80 SDG for the patients.• The insertion cost will reach 200 SDG.

(DKT International, 2012)

Intra-Uterine Device IUD• small, T-shaped, plastic device that is inserted

and left inside the uterus to prevent pregnancy. There are two types : the hormonal IUD (Mirena) and the copper IUD.

• The IUD does not protect against STDs.•

Emergency Contraception

• There are two types of emergency contraception :

1. Plan B 2. the IUD• There is no Plan B available in Sudan.• IUD is very rarely used as emergency

contraceptives.

IUD supply

• DKT company is the main supplier for IUD in the country.

• Hospital , health centers as well as SFPA are buying the IUD from DKT for 5 SDG , but actually the patient had the service for 40 SDG.

(DKT International, 2012)

Surgery for Contraception

1. TUBAL LIGATION2. VASECTOMY

Tubal ligation• Done by three methods:1. During C/S ( Done frequently in Grand-

multipara with many scars).2. With mini-lapratomy3. During Laparoscopy with special clips

THESE CLIPS ARE NOT AVAILABLE IN SUDAN.

Vasectomy

Vasectomy Is not practicedIn Sudan For Religious

reasons

Utilization of Family planning Methods in Sudan

• The percentage of women using modern methods of contraception in Sudan rose, for example, from four percent in 1977-1978 to six percent in 1989 and seven percent in 1992-1993.

• The utilization rate remains low at 9 % in 2005 which is among the lowest in the world. (WHO, 2007).

• Millennium Development Goals (MDGs) report 2012 stated that the prevalence rate is still the same in Sudan at 9%. (UNDP-Sudan, 2012).

Uses of Contraceptive methods (Ibnouf, 2007).

Pills IUD Injections

47.7

10.27.5

Percent

Uses of Natural methods (Ibnouf, 2007)

Breast feeding Rhythm Withdrawal Condom

33

16.1

3.61

Percent

Uses of Contraceptive methods (SHHS, 2010).

Female sterilization

Male sterilization

IUD

Injectables

Implants

Pill

Male condom

Female condom

Diaphragm/foam/jelly

Lactational amenorrhoea method (LAM)

Periodic abstinence/Rhythm

Withdrawal

Other

.3

.0

.5

.9

.0

6.3

.1

.0

.0

.3

.3

.0

.2

Recommendations

• More liberal Condom provision• Emergency contraception• Female condoms• Spermicidal.• Improve laparoscopy service

Conclusion• Fertility rate in Sudan is still high mainly in rural

settings. The utilization of contraceptive methods is low especially modern ones. The most frequently used methods are oral contraceptive pills followed by intrauterine devices and injections.

• The access to contraceptive methods in Sudan is �available for years. Some study reflects lacking knowledge about the methods for controlling birth.

• The most common challenges for women to utilize contraceptive methods are culture, religion, taboos, urban-rural availability of services and men dominant in decision making.

ReferencesTaha Family planning practice in Central Sudan. Khartoum: Department of Community Medicine, College of Medicine, University of Juba, Sudan; 2010 [cited 2012 Aug]. Available from: Family Planning- Dictionary.com.WHO. Contraceptive methods 2007.UNDP-Sudan. Status of Millennium Development Goals in Sudan. Report. New York: UN; 2012 July.Federal Ministry of Health. Sudan Household Health Survey. Sudan; 2006.Ibnouf AH, Maarse JAM, Borne VD. Utilization of family planning services by married Sudanese women of reproductive age. Eastern Mediterranean Health Journal. 2007; 13(6).Bulatao RA. 2007 [updated 2007; cited Aug 2012]; Available from: www.who.org.Umbeli T, Mukhtar A and. Abusalab. M.A. Unmet needs for family planning in DarAssalam, Sudan. Health Journal. 2005 4 May; 11:4.DKT International. Ensuring the right for all to quality family planning options since 2005; 2007