Epidemiology Disease of Major Importance Fall Trimester

Family Planning Contribution to Health amp How it Works

WHO definition

Family planning allows individuals and couples to anticipate and attain their desired number of children and the spacing and timing of their births

It is achieved through use of contraceptive methods and the treatment of involuntary infertility

A womanrsquos ability to space and limit her pregnancies has a direct impact on her health and well-being as well as on the outcome of each pregnancy Decreases mother infant amp child death rates

Can reduce abortion rates

Assists in prevention of AIDS

USAID How Contraceptive Use Impacts Mortality 2008

Better Birth Spacing Saves the Lives of

Children

Maternal Factors Associated with High Infant Mortality

Age of mother at birth too young or too old

Preceding birth interval too short Birth order too high Birth size smallbelow average Availability of care Access to care Education

Risk of death among under-five children with a

preceding birth interval of 36-41 months

compared to risk of death at other birth

intervals

317

126

105

316

143

116

281

100

151

82105

137

140

0

100

200

300

lt18 18-23 24-29 30-35 36-41 42-47 48-53 54-59 60+

Duration of preceding birth interval (months)

Rel

ativ

e ri

sk (p

erce

nt)

Neonatal Mortality Infant Mortality

Under-Five Mortality Perinatal Mortality

Source United States Agency for International Development (USAID) Bureau for Global Health Office of Population and Reproductive Health Washington

DC 20523-3600 December 2002 (WWWUSAIDGOV)

Positive Outcomes When

Pregnancies well timed

Children born 3 but less than 5 years apart compared to children born less than 2 years apart are

15 times more likely to survive first 7 days 22 times more likely to survive first 28 days 23 times more likely to survive first year 24 times more likely to survive to age 5 After A Miscarriage spacing lt 6 months more than

2x as likely to have low birth weight or preterm delivery compared to spacing of 18- 23

Closely spaced births or births to very young mothers increases the risk of death 2 frac12 to 3 fold compared to births spaced 3-5 years apart for the mothers their newborn children and the previously born child

70 6967 66

6462 61 61

59 58 5855

49 48

36

28

34

19

2724

2023

17

24

1618

15

6468

76

6164

2827

3336

27

45

2628

0

20

40

60

80Jo

rdan

Ug

an

da

Mad

hya P

rad

esh

Gu

ate

mala

Utt

ar

Pra

desh

Ph

ilip

pin

es

Nig

eri

a

Mo

rocco

Zam

bia

Eg

yp

t

Bo

livia

Ind

ia

Nep

al

Co

te d

Ivo

ire

Ken

ya

Tan

zan

ia

Peru

Gh

an

a

Ban

gla

desh

Ind

on

esia

Perc

en

t

lt36 months

lt24 months

Percent of Birth Intervals that are Short

Source United States Agency for International Development (USAID) Bureau for Global Health Office of Population and Reproductive Health Washington

DC 20523-3600 December 2002 (WWWUSAIDGOV)

Increased Contraceptive use impact on mortality

Deaths averted with Family Planning

If there had been no

change in contraceptive

prevalence there would have been 38m additional maternal

deaths in the two decades between 1985 and 2005

Source John Stover The Policy Project The Futures Group 2006

Family Planning as a priority in high HIV prevalence areas

For Will reduce pregnancies in known HIV+ women gt

decreased AIDS transmission Will reduce pregnancies in HIV+ women who have not

yet been diagnosed (90 still undiagnosed) Ongoing and regular Family planning ndash will reduce

pregnancy occurring during the first weeks of AIDS when viral load is highest

Birth Spacing allows HIV+ women to recover from previous pregnancies maximizing her health before the challenge of another pregnancy

Against Mixed evidence on increased HIV transmission to men

when on long acting hormone contraception Conclusion Recent WHO technical consultation concluded proven

benefits of FP outweighed the inconsistent potential risks of HIV transmission

Family Planning Use Impact on Abortion Rates

Classic relationship in post-Soviet countries

Mixed in places with falling fertility where there is very high unmet need for fertility control

Reaffirms need for additional FP access

Increased access to FP estimated to reduce induced abortions in the developing world by 70 (from 35 million to 11 million) also reducing deaths and post-abortion costs due to unsafe abortions International Family Planning Perspectives 2003 29(1)6-13

CPR

Coverage globally in 2010 ~28

Comparing effectiveness of methods More effective

Less effective

Less than 1 pregnancy per 100 women in one year

About 30 pregnancies per 100 women in one year

Injections Get repeat injections

on time

LAM (for 6 months) Breastfeed

often day and night

Pills Take a pill each day

Patch ring Keep in place

change on time

Condoms diaphragm Use correctly

every time you have sex

Fertility-awareness based methods

Abstain or use condoms on fertile

days Newest methods (Standard Days

Method and TwoDay Method) may be easier

to use

How to make your

method most effective

After procedure little or nothing

to do or remember

Vasectomy Use another method

for first 3 months

Withdrawal spermicide Use

correctly every time you have

sex

Injectables Pills LAM

Male Condoms

Female Condoms

Diaphragm

Spermicide

IUD Female Sterilization

Vasectomy

Patch Ring

Fertility-Awareness Based Methods

Withdrawal

Implants

Side Effects amp Obstacles Oral Contraceptives ndash Take every day IUDs ndash Medical procedure to insert Sterilization ndash Permanent Injectable ndash Menstrual disturbance Norplant ndash Cost Condom ndash Use every time Diaphragm ndash Use every time Natural family planning ndash precision in timing

Myth Family Planning methods are abortifacients IN THE PAST there was an incorrect understanding of the mechanisms of action that limited unified faith-based support for family planning TRUTH Family Planning methods prevent conception Most methods accepted by people of faith as contraceptive But incorrect understanding of EC amp IUD mechanism limited

acceptance

How DO EC and IUDs work

Emergency contraception prevent pregnancy

Effective only in the first few days following intercourse

before the ovum is released from the ovary and before the sperm fertilizes the ovum

Prevent ovulation change cervical mucous to inhibits entry of sperm to uterus disrupt sperm binding to the egg

Emergency contraceptive pills cannot interrupt an established pregnancy or harm a developing embryo

Hormonal amp Copper IUD prevent pregnancy by

Chemical change that damages sperm and egg before they can meet

Cervical mucous change that inhibits entry of sperm to uterus

Economic Benefits too Costs amp net health effects of contraceptive methods

Compared with use of no contraception Cost savings over 2 years

US$5907woman for tubal sterilization

US$9936 for vasectomy

Health gains 0088 QALYs for diaphragm

0147 QALYs for depot medroxyprogesterone acetate

Even modest increases in the use of the most effective methods result in financial savings and health gains

Sonnenberg FA Burkman RT Hagerty CG Speroff L Speroff T Contraception 2004 Jun69(6)447-59

WHO definition

Family planning allows individuals and couples to anticipate and attain their desired number of children and the spacing and timing of their births

It is achieved through use of contraceptive methods and the treatment of involuntary infertility

A womanrsquos ability to space and limit her pregnancies has a direct impact on her health and well-being as well as on the outcome of each pregnancy Decreases mother infant amp child death rates

Can reduce abortion rates

Assists in prevention of AIDS

USAID How Contraceptive Use Impacts Mortality 2008

Better Birth Spacing Saves the Lives of

Children

Maternal Factors Associated with High Infant Mortality

Age of mother at birth too young or too old

Preceding birth interval too short Birth order too high Birth size smallbelow average Availability of care Access to care Education

Risk of death among under-five children with a

preceding birth interval of 36-41 months

compared to risk of death at other birth

intervals

317

126

105

316

143

116

281

100

151

82105

137

140

0

100

200

300

lt18 18-23 24-29 30-35 36-41 42-47 48-53 54-59 60+

Duration of preceding birth interval (months)

Rel

ativ

e ri

sk (p

erce

nt)

Neonatal Mortality Infant Mortality

Under-Five Mortality Perinatal Mortality

Source United States Agency for International Development (USAID) Bureau for Global Health Office of Population and Reproductive Health Washington

DC 20523-3600 December 2002 (WWWUSAIDGOV)

Positive Outcomes When

Pregnancies well timed

Children born 3 but less than 5 years apart compared to children born less than 2 years apart are

15 times more likely to survive first 7 days 22 times more likely to survive first 28 days 23 times more likely to survive first year 24 times more likely to survive to age 5 After A Miscarriage spacing lt 6 months more than

2x as likely to have low birth weight or preterm delivery compared to spacing of 18- 23

Closely spaced births or births to very young mothers increases the risk of death 2 frac12 to 3 fold compared to births spaced 3-5 years apart for the mothers their newborn children and the previously born child

70 6967 66

6462 61 61

59 58 5855

49 48

36

28

34

19

2724

2023

17

24

1618

15

6468

76

6164

2827

3336

27

45

2628

0

20

40

60

80Jo

rdan

Ug

an

da

Mad

hya P

rad

esh

Gu

ate

mala

Utt

ar

Pra

desh

Ph

ilip

pin

es

Nig

eri

a

Mo

rocco

Zam

bia

Eg

yp

t

Bo

livia

Ind

ia

Nep

al

Co

te d

Ivo

ire

Ken

ya

Tan

zan

ia

Peru

Gh

an

a

Ban

gla

desh

Ind

on

esia

Perc

en

t

lt36 months

lt24 months

Percent of Birth Intervals that are Short

Source United States Agency for International Development (USAID) Bureau for Global Health Office of Population and Reproductive Health Washington

DC 20523-3600 December 2002 (WWWUSAIDGOV)

Increased Contraceptive use impact on mortality

Deaths averted with Family Planning

If there had been no

change in contraceptive

prevalence there would have been 38m additional maternal

deaths in the two decades between 1985 and 2005

Source John Stover The Policy Project The Futures Group 2006

Family Planning as a priority in high HIV prevalence areas

For Will reduce pregnancies in known HIV+ women gt

decreased AIDS transmission Will reduce pregnancies in HIV+ women who have not

yet been diagnosed (90 still undiagnosed) Ongoing and regular Family planning ndash will reduce

pregnancy occurring during the first weeks of AIDS when viral load is highest

Birth Spacing allows HIV+ women to recover from previous pregnancies maximizing her health before the challenge of another pregnancy

Against Mixed evidence on increased HIV transmission to men

when on long acting hormone contraception Conclusion Recent WHO technical consultation concluded proven

benefits of FP outweighed the inconsistent potential risks of HIV transmission

Family Planning Use Impact on Abortion Rates

Classic relationship in post-Soviet countries

Mixed in places with falling fertility where there is very high unmet need for fertility control

Reaffirms need for additional FP access

Increased access to FP estimated to reduce induced abortions in the developing world by 70 (from 35 million to 11 million) also reducing deaths and post-abortion costs due to unsafe abortions International Family Planning Perspectives 2003 29(1)6-13

CPR

Coverage globally in 2010 ~28

Comparing effectiveness of methods More effective

Less effective

Less than 1 pregnancy per 100 women in one year

About 30 pregnancies per 100 women in one year

Injections Get repeat injections

on time

LAM (for 6 months) Breastfeed

often day and night

Pills Take a pill each day

Patch ring Keep in place

change on time

Condoms diaphragm Use correctly

every time you have sex

Fertility-awareness based methods

Abstain or use condoms on fertile

days Newest methods (Standard Days

Method and TwoDay Method) may be easier

to use

How to make your

method most effective

After procedure little or nothing

to do or remember

Vasectomy Use another method

for first 3 months

Withdrawal spermicide Use

correctly every time you have

sex

Injectables Pills LAM

Male Condoms

Female Condoms

Diaphragm

Spermicide

IUD Female Sterilization

Vasectomy

Patch Ring

Fertility-Awareness Based Methods

Withdrawal

Implants

Side Effects amp Obstacles Oral Contraceptives ndash Take every day IUDs ndash Medical procedure to insert Sterilization ndash Permanent Injectable ndash Menstrual disturbance Norplant ndash Cost Condom ndash Use every time Diaphragm ndash Use every time Natural family planning ndash precision in timing

Myth Family Planning methods are abortifacients IN THE PAST there was an incorrect understanding of the mechanisms of action that limited unified faith-based support for family planning TRUTH Family Planning methods prevent conception Most methods accepted by people of faith as contraceptive But incorrect understanding of EC amp IUD mechanism limited

acceptance

How DO EC and IUDs work

Emergency contraception prevent pregnancy

Effective only in the first few days following intercourse

before the ovum is released from the ovary and before the sperm fertilizes the ovum

Prevent ovulation change cervical mucous to inhibits entry of sperm to uterus disrupt sperm binding to the egg

Emergency contraceptive pills cannot interrupt an established pregnancy or harm a developing embryo

Hormonal amp Copper IUD prevent pregnancy by

Chemical change that damages sperm and egg before they can meet

Cervical mucous change that inhibits entry of sperm to uterus

Economic Benefits too Costs amp net health effects of contraceptive methods

Compared with use of no contraception Cost savings over 2 years

US$5907woman for tubal sterilization

US$9936 for vasectomy

Health gains 0088 QALYs for diaphragm

0147 QALYs for depot medroxyprogesterone acetate

Even modest increases in the use of the most effective methods result in financial savings and health gains

Sonnenberg FA Burkman RT Hagerty CG Speroff L Speroff T Contraception 2004 Jun69(6)447-59

USAID How Contraceptive Use Impacts Mortality 2008

Better Birth Spacing Saves the Lives of

Children

Maternal Factors Associated with High Infant Mortality

Age of mother at birth too young or too old

Preceding birth interval too short Birth order too high Birth size smallbelow average Availability of care Access to care Education

Risk of death among under-five children with a

preceding birth interval of 36-41 months

compared to risk of death at other birth

intervals

317

126

105

316

143

116

281

100

151

82105

137

140

0

100

200

300

lt18 18-23 24-29 30-35 36-41 42-47 48-53 54-59 60+

Duration of preceding birth interval (months)

Rel

ativ

e ri

sk (p

erce

nt)

Neonatal Mortality Infant Mortality

Under-Five Mortality Perinatal Mortality

Source United States Agency for International Development (USAID) Bureau for Global Health Office of Population and Reproductive Health Washington

DC 20523-3600 December 2002 (WWWUSAIDGOV)

Positive Outcomes When

Pregnancies well timed

Children born 3 but less than 5 years apart compared to children born less than 2 years apart are

15 times more likely to survive first 7 days 22 times more likely to survive first 28 days 23 times more likely to survive first year 24 times more likely to survive to age 5 After A Miscarriage spacing lt 6 months more than

2x as likely to have low birth weight or preterm delivery compared to spacing of 18- 23

Closely spaced births or births to very young mothers increases the risk of death 2 frac12 to 3 fold compared to births spaced 3-5 years apart for the mothers their newborn children and the previously born child

70 6967 66

6462 61 61

59 58 5855

49 48

36

28

34

19

2724

2023

17

24

1618

15

6468

76

6164

2827

3336

27

45

2628

0

20

40

60

80Jo

rdan

Ug

an

da

Mad

hya P

rad

esh

Gu

ate

mala

Utt

ar

Pra

desh

Ph

ilip

pin

es

Nig

eri

a

Mo

rocco

Zam

bia

Eg

yp

t

Bo

livia

Ind

ia

Nep

al

Co

te d

Ivo

ire

Ken

ya

Tan

zan

ia

Peru

Gh

an

a

Ban

gla

desh

Ind

on

esia

Perc

en

t

lt36 months

lt24 months

Percent of Birth Intervals that are Short

Source United States Agency for International Development (USAID) Bureau for Global Health Office of Population and Reproductive Health Washington

DC 20523-3600 December 2002 (WWWUSAIDGOV)

Increased Contraceptive use impact on mortality

Deaths averted with Family Planning

If there had been no

change in contraceptive

prevalence there would have been 38m additional maternal

deaths in the two decades between 1985 and 2005

Source John Stover The Policy Project The Futures Group 2006

Family Planning as a priority in high HIV prevalence areas

For Will reduce pregnancies in known HIV+ women gt

decreased AIDS transmission Will reduce pregnancies in HIV+ women who have not

yet been diagnosed (90 still undiagnosed) Ongoing and regular Family planning ndash will reduce

pregnancy occurring during the first weeks of AIDS when viral load is highest

Birth Spacing allows HIV+ women to recover from previous pregnancies maximizing her health before the challenge of another pregnancy

Against Mixed evidence on increased HIV transmission to men

when on long acting hormone contraception Conclusion Recent WHO technical consultation concluded proven

benefits of FP outweighed the inconsistent potential risks of HIV transmission

Family Planning Use Impact on Abortion Rates

Classic relationship in post-Soviet countries

Mixed in places with falling fertility where there is very high unmet need for fertility control

Reaffirms need for additional FP access

Increased access to FP estimated to reduce induced abortions in the developing world by 70 (from 35 million to 11 million) also reducing deaths and post-abortion costs due to unsafe abortions International Family Planning Perspectives 2003 29(1)6-13

CPR

Coverage globally in 2010 ~28

Comparing effectiveness of methods More effective

Less effective

Less than 1 pregnancy per 100 women in one year

About 30 pregnancies per 100 women in one year

Injections Get repeat injections

on time

LAM (for 6 months) Breastfeed

often day and night

Pills Take a pill each day

Patch ring Keep in place

change on time

Condoms diaphragm Use correctly

every time you have sex

Fertility-awareness based methods

Abstain or use condoms on fertile

days Newest methods (Standard Days

Method and TwoDay Method) may be easier

to use

How to make your

method most effective

After procedure little or nothing

to do or remember

Vasectomy Use another method

for first 3 months

Withdrawal spermicide Use

correctly every time you have

sex

Injectables Pills LAM

Male Condoms

Female Condoms

Diaphragm

Spermicide

IUD Female Sterilization

Vasectomy

Patch Ring

Fertility-Awareness Based Methods

Withdrawal

Implants

Side Effects amp Obstacles Oral Contraceptives ndash Take every day IUDs ndash Medical procedure to insert Sterilization ndash Permanent Injectable ndash Menstrual disturbance Norplant ndash Cost Condom ndash Use every time Diaphragm ndash Use every time Natural family planning ndash precision in timing

Myth Family Planning methods are abortifacients IN THE PAST there was an incorrect understanding of the mechanisms of action that limited unified faith-based support for family planning TRUTH Family Planning methods prevent conception Most methods accepted by people of faith as contraceptive But incorrect understanding of EC amp IUD mechanism limited

acceptance

How DO EC and IUDs work

Emergency contraception prevent pregnancy

Effective only in the first few days following intercourse

before the ovum is released from the ovary and before the sperm fertilizes the ovum

Prevent ovulation change cervical mucous to inhibits entry of sperm to uterus disrupt sperm binding to the egg

Emergency contraceptive pills cannot interrupt an established pregnancy or harm a developing embryo

Hormonal amp Copper IUD prevent pregnancy by

Chemical change that damages sperm and egg before they can meet

Cervical mucous change that inhibits entry of sperm to uterus

Economic Benefits too Costs amp net health effects of contraceptive methods

Compared with use of no contraception Cost savings over 2 years

US$5907woman for tubal sterilization

US$9936 for vasectomy

Health gains 0088 QALYs for diaphragm

0147 QALYs for depot medroxyprogesterone acetate

Even modest increases in the use of the most effective methods result in financial savings and health gains

Sonnenberg FA Burkman RT Hagerty CG Speroff L Speroff T Contraception 2004 Jun69(6)447-59

Better Birth Spacing Saves the Lives of

Children

Maternal Factors Associated with High Infant Mortality

Age of mother at birth too young or too old

Preceding birth interval too short Birth order too high Birth size smallbelow average Availability of care Access to care Education

Risk of death among under-five children with a

preceding birth interval of 36-41 months

compared to risk of death at other birth

intervals

317

126

105

316

143

116

281

100

151

82105

137

140

0

100

200

300

lt18 18-23 24-29 30-35 36-41 42-47 48-53 54-59 60+

Duration of preceding birth interval (months)

Rel

ativ

e ri

sk (p

erce

nt)

Neonatal Mortality Infant Mortality

Under-Five Mortality Perinatal Mortality

Source United States Agency for International Development (USAID) Bureau for Global Health Office of Population and Reproductive Health Washington

DC 20523-3600 December 2002 (WWWUSAIDGOV)

Positive Outcomes When

Pregnancies well timed

Children born 3 but less than 5 years apart compared to children born less than 2 years apart are

15 times more likely to survive first 7 days 22 times more likely to survive first 28 days 23 times more likely to survive first year 24 times more likely to survive to age 5 After A Miscarriage spacing lt 6 months more than

2x as likely to have low birth weight or preterm delivery compared to spacing of 18- 23

Closely spaced births or births to very young mothers increases the risk of death 2 frac12 to 3 fold compared to births spaced 3-5 years apart for the mothers their newborn children and the previously born child

70 6967 66

6462 61 61

59 58 5855

49 48

36

28

34

19

2724

2023

17

24

1618

15

6468

76

6164

2827

3336

27

45

2628

0

20

40

60

80Jo

rdan

Ug

an

da

Mad

hya P

rad

esh

Gu

ate

mala

Utt

ar

Pra

desh

Ph

ilip

pin

es

Nig

eri

a

Mo

rocco

Zam

bia

Eg

yp

t

Bo

livia

Ind

ia

Nep

al

Co

te d

Ivo

ire

Ken

ya

Tan

zan

ia

Peru

Gh

an

a

Ban

gla

desh

Ind

on

esia

Perc

en

t

lt36 months

lt24 months

Percent of Birth Intervals that are Short

Source United States Agency for International Development (USAID) Bureau for Global Health Office of Population and Reproductive Health Washington

DC 20523-3600 December 2002 (WWWUSAIDGOV)

Increased Contraceptive use impact on mortality

Deaths averted with Family Planning

If there had been no

change in contraceptive

prevalence there would have been 38m additional maternal

deaths in the two decades between 1985 and 2005

Source John Stover The Policy Project The Futures Group 2006

Family Planning as a priority in high HIV prevalence areas

For Will reduce pregnancies in known HIV+ women gt

decreased AIDS transmission Will reduce pregnancies in HIV+ women who have not

yet been diagnosed (90 still undiagnosed) Ongoing and regular Family planning ndash will reduce

pregnancy occurring during the first weeks of AIDS when viral load is highest

Birth Spacing allows HIV+ women to recover from previous pregnancies maximizing her health before the challenge of another pregnancy

Against Mixed evidence on increased HIV transmission to men

when on long acting hormone contraception Conclusion Recent WHO technical consultation concluded proven

benefits of FP outweighed the inconsistent potential risks of HIV transmission

Family Planning Use Impact on Abortion Rates

Classic relationship in post-Soviet countries

Mixed in places with falling fertility where there is very high unmet need for fertility control

Reaffirms need for additional FP access

Increased access to FP estimated to reduce induced abortions in the developing world by 70 (from 35 million to 11 million) also reducing deaths and post-abortion costs due to unsafe abortions International Family Planning Perspectives 2003 29(1)6-13

CPR

Coverage globally in 2010 ~28

Comparing effectiveness of methods More effective

Less effective

Less than 1 pregnancy per 100 women in one year

About 30 pregnancies per 100 women in one year

Injections Get repeat injections

on time

LAM (for 6 months) Breastfeed

often day and night

Pills Take a pill each day

Patch ring Keep in place

change on time

Condoms diaphragm Use correctly

every time you have sex

Fertility-awareness based methods

Abstain or use condoms on fertile

days Newest methods (Standard Days

Method and TwoDay Method) may be easier

to use

How to make your

method most effective

After procedure little or nothing

to do or remember

Vasectomy Use another method

for first 3 months

Withdrawal spermicide Use

correctly every time you have

sex

Injectables Pills LAM

Male Condoms

Female Condoms

Diaphragm

Spermicide

IUD Female Sterilization

Vasectomy

Patch Ring

Fertility-Awareness Based Methods

Withdrawal

Implants

Side Effects amp Obstacles Oral Contraceptives ndash Take every day IUDs ndash Medical procedure to insert Sterilization ndash Permanent Injectable ndash Menstrual disturbance Norplant ndash Cost Condom ndash Use every time Diaphragm ndash Use every time Natural family planning ndash precision in timing

Myth Family Planning methods are abortifacients IN THE PAST there was an incorrect understanding of the mechanisms of action that limited unified faith-based support for family planning TRUTH Family Planning methods prevent conception Most methods accepted by people of faith as contraceptive But incorrect understanding of EC amp IUD mechanism limited

acceptance

How DO EC and IUDs work

Emergency contraception prevent pregnancy

Effective only in the first few days following intercourse

before the ovum is released from the ovary and before the sperm fertilizes the ovum

Prevent ovulation change cervical mucous to inhibits entry of sperm to uterus disrupt sperm binding to the egg

Emergency contraceptive pills cannot interrupt an established pregnancy or harm a developing embryo

Hormonal amp Copper IUD prevent pregnancy by

Chemical change that damages sperm and egg before they can meet

Cervical mucous change that inhibits entry of sperm to uterus

Economic Benefits too Costs amp net health effects of contraceptive methods

Compared with use of no contraception Cost savings over 2 years

US$5907woman for tubal sterilization

US$9936 for vasectomy

Health gains 0088 QALYs for diaphragm

0147 QALYs for depot medroxyprogesterone acetate

Even modest increases in the use of the most effective methods result in financial savings and health gains

Sonnenberg FA Burkman RT Hagerty CG Speroff L Speroff T Contraception 2004 Jun69(6)447-59

Maternal Factors Associated with High Infant Mortality

Age of mother at birth too young or too old

Preceding birth interval too short Birth order too high Birth size smallbelow average Availability of care Access to care Education

Risk of death among under-five children with a

preceding birth interval of 36-41 months

compared to risk of death at other birth

intervals

317

126

105

316

143

116

281

100

151

82105

137

140

0

100

200

300

lt18 18-23 24-29 30-35 36-41 42-47 48-53 54-59 60+

Duration of preceding birth interval (months)

Rel

ativ

e ri

sk (p

erce

nt)

Neonatal Mortality Infant Mortality

Under-Five Mortality Perinatal Mortality

Source United States Agency for International Development (USAID) Bureau for Global Health Office of Population and Reproductive Health Washington

DC 20523-3600 December 2002 (WWWUSAIDGOV)

Positive Outcomes When

Pregnancies well timed

Children born 3 but less than 5 years apart compared to children born less than 2 years apart are

15 times more likely to survive first 7 days 22 times more likely to survive first 28 days 23 times more likely to survive first year 24 times more likely to survive to age 5 After A Miscarriage spacing lt 6 months more than

2x as likely to have low birth weight or preterm delivery compared to spacing of 18- 23

Closely spaced births or births to very young mothers increases the risk of death 2 frac12 to 3 fold compared to births spaced 3-5 years apart for the mothers their newborn children and the previously born child

70 6967 66

6462 61 61

59 58 5855

49 48

36

28

34

19

2724

2023

17

24

1618

15

6468

76

6164

2827

3336

27

45

2628

0

20

40

60

80Jo

rdan

Ug

an

da

Mad

hya P

rad

esh

Gu

ate

mala

Utt

ar

Pra

desh

Ph

ilip

pin

es

Nig

eri

a

Mo

rocco

Zam

bia

Eg

yp

t

Bo

livia

Ind

ia

Nep

al

Co

te d

Ivo

ire

Ken

ya

Tan

zan

ia

Peru

Gh

an

a

Ban

gla

desh

Ind

on

esia

Perc

en

t

lt36 months

lt24 months

Percent of Birth Intervals that are Short

Source United States Agency for International Development (USAID) Bureau for Global Health Office of Population and Reproductive Health Washington

DC 20523-3600 December 2002 (WWWUSAIDGOV)

Increased Contraceptive use impact on mortality

Deaths averted with Family Planning

If there had been no

change in contraceptive

prevalence there would have been 38m additional maternal

deaths in the two decades between 1985 and 2005

Source John Stover The Policy Project The Futures Group 2006

Family Planning as a priority in high HIV prevalence areas

For Will reduce pregnancies in known HIV+ women gt

decreased AIDS transmission Will reduce pregnancies in HIV+ women who have not

yet been diagnosed (90 still undiagnosed) Ongoing and regular Family planning ndash will reduce

pregnancy occurring during the first weeks of AIDS when viral load is highest

Birth Spacing allows HIV+ women to recover from previous pregnancies maximizing her health before the challenge of another pregnancy

Against Mixed evidence on increased HIV transmission to men

when on long acting hormone contraception Conclusion Recent WHO technical consultation concluded proven

benefits of FP outweighed the inconsistent potential risks of HIV transmission

Family Planning Use Impact on Abortion Rates

Classic relationship in post-Soviet countries

Mixed in places with falling fertility where there is very high unmet need for fertility control

Reaffirms need for additional FP access

Increased access to FP estimated to reduce induced abortions in the developing world by 70 (from 35 million to 11 million) also reducing deaths and post-abortion costs due to unsafe abortions International Family Planning Perspectives 2003 29(1)6-13

CPR

Coverage globally in 2010 ~28

Comparing effectiveness of methods More effective

Less effective

Less than 1 pregnancy per 100 women in one year

About 30 pregnancies per 100 women in one year

Injections Get repeat injections

on time

LAM (for 6 months) Breastfeed

often day and night

Pills Take a pill each day

Patch ring Keep in place

change on time

Condoms diaphragm Use correctly

every time you have sex

Fertility-awareness based methods

Abstain or use condoms on fertile

days Newest methods (Standard Days

Method and TwoDay Method) may be easier

to use

How to make your

method most effective

After procedure little or nothing

to do or remember

Vasectomy Use another method

for first 3 months

Withdrawal spermicide Use

correctly every time you have

sex

Injectables Pills LAM

Male Condoms

Female Condoms

Diaphragm

Spermicide

IUD Female Sterilization

Vasectomy

Patch Ring

Fertility-Awareness Based Methods

Withdrawal

Implants

Side Effects amp Obstacles Oral Contraceptives ndash Take every day IUDs ndash Medical procedure to insert Sterilization ndash Permanent Injectable ndash Menstrual disturbance Norplant ndash Cost Condom ndash Use every time Diaphragm ndash Use every time Natural family planning ndash precision in timing

Myth Family Planning methods are abortifacients IN THE PAST there was an incorrect understanding of the mechanisms of action that limited unified faith-based support for family planning TRUTH Family Planning methods prevent conception Most methods accepted by people of faith as contraceptive But incorrect understanding of EC amp IUD mechanism limited

acceptance

How DO EC and IUDs work

Emergency contraception prevent pregnancy

Effective only in the first few days following intercourse

before the ovum is released from the ovary and before the sperm fertilizes the ovum

Prevent ovulation change cervical mucous to inhibits entry of sperm to uterus disrupt sperm binding to the egg

Emergency contraceptive pills cannot interrupt an established pregnancy or harm a developing embryo

Hormonal amp Copper IUD prevent pregnancy by

Chemical change that damages sperm and egg before they can meet

Cervical mucous change that inhibits entry of sperm to uterus

Economic Benefits too Costs amp net health effects of contraceptive methods

Compared with use of no contraception Cost savings over 2 years

US$5907woman for tubal sterilization

US$9936 for vasectomy

Health gains 0088 QALYs for diaphragm

0147 QALYs for depot medroxyprogesterone acetate

Even modest increases in the use of the most effective methods result in financial savings and health gains

Sonnenberg FA Burkman RT Hagerty CG Speroff L Speroff T Contraception 2004 Jun69(6)447-59

Risk of death among under-five children with a

preceding birth interval of 36-41 months

compared to risk of death at other birth

intervals

317

126

105

316

143

116

281

100

151

82105

137

140

0

100

200

300

lt18 18-23 24-29 30-35 36-41 42-47 48-53 54-59 60+

Duration of preceding birth interval (months)

Rel

ativ

e ri

sk (p

erce

nt)

Neonatal Mortality Infant Mortality

Under-Five Mortality Perinatal Mortality

Source United States Agency for International Development (USAID) Bureau for Global Health Office of Population and Reproductive Health Washington

DC 20523-3600 December 2002 (WWWUSAIDGOV)

Positive Outcomes When

Pregnancies well timed

Children born 3 but less than 5 years apart compared to children born less than 2 years apart are

15 times more likely to survive first 7 days 22 times more likely to survive first 28 days 23 times more likely to survive first year 24 times more likely to survive to age 5 After A Miscarriage spacing lt 6 months more than

2x as likely to have low birth weight or preterm delivery compared to spacing of 18- 23

Closely spaced births or births to very young mothers increases the risk of death 2 frac12 to 3 fold compared to births spaced 3-5 years apart for the mothers their newborn children and the previously born child

70 6967 66

6462 61 61

59 58 5855

49 48

36

28

34

19

2724

2023

17

24

1618

15

6468

76

6164

2827

3336

27

45

2628

0

20

40

60

80Jo

rdan

Ug

an

da

Mad

hya P

rad

esh

Gu

ate

mala

Utt

ar

Pra

desh

Ph

ilip

pin

es

Nig

eri

a

Mo

rocco

Zam

bia

Eg

yp

t

Bo

livia

Ind

ia

Nep

al

Co

te d

Ivo

ire

Ken

ya

Tan

zan

ia

Peru

Gh

an

a

Ban

gla

desh

Ind

on

esia

Perc

en

t

lt36 months

lt24 months

Percent of Birth Intervals that are Short

Source United States Agency for International Development (USAID) Bureau for Global Health Office of Population and Reproductive Health Washington

DC 20523-3600 December 2002 (WWWUSAIDGOV)

Increased Contraceptive use impact on mortality

Deaths averted with Family Planning

If there had been no

change in contraceptive

prevalence there would have been 38m additional maternal

deaths in the two decades between 1985 and 2005

Source John Stover The Policy Project The Futures Group 2006

Family Planning as a priority in high HIV prevalence areas

For Will reduce pregnancies in known HIV+ women gt

decreased AIDS transmission Will reduce pregnancies in HIV+ women who have not

yet been diagnosed (90 still undiagnosed) Ongoing and regular Family planning ndash will reduce

pregnancy occurring during the first weeks of AIDS when viral load is highest

Birth Spacing allows HIV+ women to recover from previous pregnancies maximizing her health before the challenge of another pregnancy

Against Mixed evidence on increased HIV transmission to men

when on long acting hormone contraception Conclusion Recent WHO technical consultation concluded proven

benefits of FP outweighed the inconsistent potential risks of HIV transmission

Family Planning Use Impact on Abortion Rates

Classic relationship in post-Soviet countries

Mixed in places with falling fertility where there is very high unmet need for fertility control

Reaffirms need for additional FP access

Increased access to FP estimated to reduce induced abortions in the developing world by 70 (from 35 million to 11 million) also reducing deaths and post-abortion costs due to unsafe abortions International Family Planning Perspectives 2003 29(1)6-13

CPR

Coverage globally in 2010 ~28

Comparing effectiveness of methods More effective

Less effective

Less than 1 pregnancy per 100 women in one year

About 30 pregnancies per 100 women in one year

Injections Get repeat injections

on time

LAM (for 6 months) Breastfeed

often day and night

Pills Take a pill each day

Patch ring Keep in place

change on time

Condoms diaphragm Use correctly

every time you have sex

Fertility-awareness based methods

Abstain or use condoms on fertile

days Newest methods (Standard Days

Method and TwoDay Method) may be easier

to use

How to make your

method most effective

After procedure little or nothing

to do or remember

Vasectomy Use another method

for first 3 months

Withdrawal spermicide Use

correctly every time you have

sex

Injectables Pills LAM

Male Condoms

Female Condoms

Diaphragm

Spermicide

IUD Female Sterilization

Vasectomy

Patch Ring

Fertility-Awareness Based Methods

Withdrawal

Implants

Side Effects amp Obstacles Oral Contraceptives ndash Take every day IUDs ndash Medical procedure to insert Sterilization ndash Permanent Injectable ndash Menstrual disturbance Norplant ndash Cost Condom ndash Use every time Diaphragm ndash Use every time Natural family planning ndash precision in timing

Myth Family Planning methods are abortifacients IN THE PAST there was an incorrect understanding of the mechanisms of action that limited unified faith-based support for family planning TRUTH Family Planning methods prevent conception Most methods accepted by people of faith as contraceptive But incorrect understanding of EC amp IUD mechanism limited

acceptance

How DO EC and IUDs work

Emergency contraception prevent pregnancy

Effective only in the first few days following intercourse

before the ovum is released from the ovary and before the sperm fertilizes the ovum

Prevent ovulation change cervical mucous to inhibits entry of sperm to uterus disrupt sperm binding to the egg

Emergency contraceptive pills cannot interrupt an established pregnancy or harm a developing embryo

Hormonal amp Copper IUD prevent pregnancy by

Chemical change that damages sperm and egg before they can meet

Cervical mucous change that inhibits entry of sperm to uterus

Economic Benefits too Costs amp net health effects of contraceptive methods

Compared with use of no contraception Cost savings over 2 years

US$5907woman for tubal sterilization

US$9936 for vasectomy

Health gains 0088 QALYs for diaphragm

0147 QALYs for depot medroxyprogesterone acetate

Even modest increases in the use of the most effective methods result in financial savings and health gains

Sonnenberg FA Burkman RT Hagerty CG Speroff L Speroff T Contraception 2004 Jun69(6)447-59

Positive Outcomes When

Pregnancies well timed

Children born 3 but less than 5 years apart compared to children born less than 2 years apart are

15 times more likely to survive first 7 days 22 times more likely to survive first 28 days 23 times more likely to survive first year 24 times more likely to survive to age 5 After A Miscarriage spacing lt 6 months more than

2x as likely to have low birth weight or preterm delivery compared to spacing of 18- 23

Closely spaced births or births to very young mothers increases the risk of death 2 frac12 to 3 fold compared to births spaced 3-5 years apart for the mothers their newborn children and the previously born child

70 6967 66

6462 61 61

59 58 5855

49 48

36

28

34

19

2724

2023

17

24

1618

15

6468

76

6164

2827

3336

27

45

2628

0

20

40

60

80Jo

rdan

Ug

an

da

Mad

hya P

rad

esh

Gu

ate

mala

Utt

ar

Pra

desh

Ph

ilip

pin

es

Nig

eri

a

Mo

rocco

Zam

bia

Eg

yp

t

Bo

livia

Ind

ia

Nep

al

Co

te d

Ivo

ire

Ken

ya

Tan

zan

ia

Peru

Gh

an

a

Ban

gla

desh

Ind

on

esia

Perc

en

t

lt36 months

lt24 months

Percent of Birth Intervals that are Short

Source United States Agency for International Development (USAID) Bureau for Global Health Office of Population and Reproductive Health Washington

DC 20523-3600 December 2002 (WWWUSAIDGOV)

Increased Contraceptive use impact on mortality

Deaths averted with Family Planning

If there had been no

change in contraceptive

prevalence there would have been 38m additional maternal

deaths in the two decades between 1985 and 2005

Source John Stover The Policy Project The Futures Group 2006

Family Planning as a priority in high HIV prevalence areas

For Will reduce pregnancies in known HIV+ women gt

decreased AIDS transmission Will reduce pregnancies in HIV+ women who have not

yet been diagnosed (90 still undiagnosed) Ongoing and regular Family planning ndash will reduce

pregnancy occurring during the first weeks of AIDS when viral load is highest

Birth Spacing allows HIV+ women to recover from previous pregnancies maximizing her health before the challenge of another pregnancy

Against Mixed evidence on increased HIV transmission to men

when on long acting hormone contraception Conclusion Recent WHO technical consultation concluded proven

benefits of FP outweighed the inconsistent potential risks of HIV transmission

Family Planning Use Impact on Abortion Rates

Classic relationship in post-Soviet countries

Mixed in places with falling fertility where there is very high unmet need for fertility control

Reaffirms need for additional FP access

Increased access to FP estimated to reduce induced abortions in the developing world by 70 (from 35 million to 11 million) also reducing deaths and post-abortion costs due to unsafe abortions International Family Planning Perspectives 2003 29(1)6-13

CPR

Coverage globally in 2010 ~28

Comparing effectiveness of methods More effective

Less effective

Less than 1 pregnancy per 100 women in one year

About 30 pregnancies per 100 women in one year

Injections Get repeat injections

on time

LAM (for 6 months) Breastfeed

often day and night

Pills Take a pill each day

Patch ring Keep in place

change on time

Condoms diaphragm Use correctly

every time you have sex

Fertility-awareness based methods

Abstain or use condoms on fertile

days Newest methods (Standard Days

Method and TwoDay Method) may be easier

to use

How to make your

method most effective

After procedure little or nothing

to do or remember

Vasectomy Use another method

for first 3 months

Withdrawal spermicide Use

correctly every time you have

sex

Injectables Pills LAM

Male Condoms

Female Condoms

Diaphragm

Spermicide

IUD Female Sterilization

Vasectomy

Patch Ring

Fertility-Awareness Based Methods

Withdrawal

Implants

Side Effects amp Obstacles Oral Contraceptives ndash Take every day IUDs ndash Medical procedure to insert Sterilization ndash Permanent Injectable ndash Menstrual disturbance Norplant ndash Cost Condom ndash Use every time Diaphragm ndash Use every time Natural family planning ndash precision in timing

Myth Family Planning methods are abortifacients IN THE PAST there was an incorrect understanding of the mechanisms of action that limited unified faith-based support for family planning TRUTH Family Planning methods prevent conception Most methods accepted by people of faith as contraceptive But incorrect understanding of EC amp IUD mechanism limited

acceptance

How DO EC and IUDs work

Emergency contraception prevent pregnancy

Effective only in the first few days following intercourse

before the ovum is released from the ovary and before the sperm fertilizes the ovum

Prevent ovulation change cervical mucous to inhibits entry of sperm to uterus disrupt sperm binding to the egg

Emergency contraceptive pills cannot interrupt an established pregnancy or harm a developing embryo

Hormonal amp Copper IUD prevent pregnancy by

Chemical change that damages sperm and egg before they can meet

Cervical mucous change that inhibits entry of sperm to uterus

Economic Benefits too Costs amp net health effects of contraceptive methods

Compared with use of no contraception Cost savings over 2 years

US$5907woman for tubal sterilization

US$9936 for vasectomy

Health gains 0088 QALYs for diaphragm

0147 QALYs for depot medroxyprogesterone acetate

Even modest increases in the use of the most effective methods result in financial savings and health gains

Sonnenberg FA Burkman RT Hagerty CG Speroff L Speroff T Contraception 2004 Jun69(6)447-59

70 6967 66

6462 61 61

59 58 5855

49 48

36

28

34

19

2724

2023

17

24

1618

15

6468

76

6164

2827

3336

27

45

2628

0

20

40

60

80Jo

rdan

Ug

an

da

Mad

hya P

rad

esh

Gu

ate

mala

Utt

ar

Pra

desh

Ph

ilip

pin

es

Nig

eri

a

Mo

rocco

Zam

bia

Eg

yp

t

Bo

livia

Ind

ia

Nep

al

Co

te d

Ivo

ire

Ken

ya

Tan

zan

ia

Peru

Gh

an

a

Ban

gla

desh

Ind

on

esia

Perc

en

t

lt36 months

lt24 months

Percent of Birth Intervals that are Short

Source United States Agency for International Development (USAID) Bureau for Global Health Office of Population and Reproductive Health Washington

DC 20523-3600 December 2002 (WWWUSAIDGOV)

Increased Contraceptive use impact on mortality

Deaths averted with Family Planning

If there had been no

change in contraceptive

prevalence there would have been 38m additional maternal

deaths in the two decades between 1985 and 2005

Source John Stover The Policy Project The Futures Group 2006

Family Planning as a priority in high HIV prevalence areas

For Will reduce pregnancies in known HIV+ women gt

decreased AIDS transmission Will reduce pregnancies in HIV+ women who have not

yet been diagnosed (90 still undiagnosed) Ongoing and regular Family planning ndash will reduce

pregnancy occurring during the first weeks of AIDS when viral load is highest

Birth Spacing allows HIV+ women to recover from previous pregnancies maximizing her health before the challenge of another pregnancy

Against Mixed evidence on increased HIV transmission to men

when on long acting hormone contraception Conclusion Recent WHO technical consultation concluded proven

benefits of FP outweighed the inconsistent potential risks of HIV transmission

Family Planning Use Impact on Abortion Rates

Classic relationship in post-Soviet countries

Mixed in places with falling fertility where there is very high unmet need for fertility control

Reaffirms need for additional FP access

Increased access to FP estimated to reduce induced abortions in the developing world by 70 (from 35 million to 11 million) also reducing deaths and post-abortion costs due to unsafe abortions International Family Planning Perspectives 2003 29(1)6-13

CPR

Coverage globally in 2010 ~28

Comparing effectiveness of methods More effective

Less effective

Less than 1 pregnancy per 100 women in one year

About 30 pregnancies per 100 women in one year

Injections Get repeat injections

on time

LAM (for 6 months) Breastfeed

often day and night

Pills Take a pill each day

Patch ring Keep in place

change on time

Condoms diaphragm Use correctly

every time you have sex

Fertility-awareness based methods

Abstain or use condoms on fertile

days Newest methods (Standard Days

Method and TwoDay Method) may be easier

to use

How to make your

method most effective

After procedure little or nothing

to do or remember

Vasectomy Use another method

for first 3 months

Withdrawal spermicide Use

correctly every time you have

sex

Injectables Pills LAM

Male Condoms

Female Condoms

Diaphragm

Spermicide

IUD Female Sterilization

Vasectomy

Patch Ring

Fertility-Awareness Based Methods

Withdrawal

Implants

Side Effects amp Obstacles Oral Contraceptives ndash Take every day IUDs ndash Medical procedure to insert Sterilization ndash Permanent Injectable ndash Menstrual disturbance Norplant ndash Cost Condom ndash Use every time Diaphragm ndash Use every time Natural family planning ndash precision in timing

Myth Family Planning methods are abortifacients IN THE PAST there was an incorrect understanding of the mechanisms of action that limited unified faith-based support for family planning TRUTH Family Planning methods prevent conception Most methods accepted by people of faith as contraceptive But incorrect understanding of EC amp IUD mechanism limited

acceptance

How DO EC and IUDs work

Emergency contraception prevent pregnancy

Effective only in the first few days following intercourse

before the ovum is released from the ovary and before the sperm fertilizes the ovum

Prevent ovulation change cervical mucous to inhibits entry of sperm to uterus disrupt sperm binding to the egg

Emergency contraceptive pills cannot interrupt an established pregnancy or harm a developing embryo

Hormonal amp Copper IUD prevent pregnancy by

Chemical change that damages sperm and egg before they can meet

Cervical mucous change that inhibits entry of sperm to uterus

Economic Benefits too Costs amp net health effects of contraceptive methods

Compared with use of no contraception Cost savings over 2 years

US$5907woman for tubal sterilization

US$9936 for vasectomy

Health gains 0088 QALYs for diaphragm

0147 QALYs for depot medroxyprogesterone acetate

Even modest increases in the use of the most effective methods result in financial savings and health gains

Sonnenberg FA Burkman RT Hagerty CG Speroff L Speroff T Contraception 2004 Jun69(6)447-59

Increased Contraceptive use impact on mortality

Deaths averted with Family Planning

If there had been no

change in contraceptive

prevalence there would have been 38m additional maternal

deaths in the two decades between 1985 and 2005

Source John Stover The Policy Project The Futures Group 2006

Family Planning as a priority in high HIV prevalence areas

For Will reduce pregnancies in known HIV+ women gt

decreased AIDS transmission Will reduce pregnancies in HIV+ women who have not

yet been diagnosed (90 still undiagnosed) Ongoing and regular Family planning ndash will reduce

pregnancy occurring during the first weeks of AIDS when viral load is highest

Birth Spacing allows HIV+ women to recover from previous pregnancies maximizing her health before the challenge of another pregnancy

Against Mixed evidence on increased HIV transmission to men

when on long acting hormone contraception Conclusion Recent WHO technical consultation concluded proven

benefits of FP outweighed the inconsistent potential risks of HIV transmission

Family Planning Use Impact on Abortion Rates

Classic relationship in post-Soviet countries

Mixed in places with falling fertility where there is very high unmet need for fertility control

Reaffirms need for additional FP access

Increased access to FP estimated to reduce induced abortions in the developing world by 70 (from 35 million to 11 million) also reducing deaths and post-abortion costs due to unsafe abortions International Family Planning Perspectives 2003 29(1)6-13

CPR

Coverage globally in 2010 ~28

Comparing effectiveness of methods More effective

Less effective

Less than 1 pregnancy per 100 women in one year

About 30 pregnancies per 100 women in one year

Injections Get repeat injections

on time

LAM (for 6 months) Breastfeed

often day and night

Pills Take a pill each day

Patch ring Keep in place

change on time

Condoms diaphragm Use correctly

every time you have sex

Fertility-awareness based methods

Abstain or use condoms on fertile

days Newest methods (Standard Days

Method and TwoDay Method) may be easier

to use

How to make your

method most effective

After procedure little or nothing

to do or remember

Vasectomy Use another method

for first 3 months

Withdrawal spermicide Use

correctly every time you have

sex

Injectables Pills LAM

Male Condoms

Female Condoms

Diaphragm

Spermicide

IUD Female Sterilization

Vasectomy

Patch Ring

Fertility-Awareness Based Methods

Withdrawal

Implants

Side Effects amp Obstacles Oral Contraceptives ndash Take every day IUDs ndash Medical procedure to insert Sterilization ndash Permanent Injectable ndash Menstrual disturbance Norplant ndash Cost Condom ndash Use every time Diaphragm ndash Use every time Natural family planning ndash precision in timing

Myth Family Planning methods are abortifacients IN THE PAST there was an incorrect understanding of the mechanisms of action that limited unified faith-based support for family planning TRUTH Family Planning methods prevent conception Most methods accepted by people of faith as contraceptive But incorrect understanding of EC amp IUD mechanism limited

acceptance

How DO EC and IUDs work

Emergency contraception prevent pregnancy

Effective only in the first few days following intercourse

before the ovum is released from the ovary and before the sperm fertilizes the ovum

Prevent ovulation change cervical mucous to inhibits entry of sperm to uterus disrupt sperm binding to the egg

Emergency contraceptive pills cannot interrupt an established pregnancy or harm a developing embryo

Hormonal amp Copper IUD prevent pregnancy by

Chemical change that damages sperm and egg before they can meet

Cervical mucous change that inhibits entry of sperm to uterus

Economic Benefits too Costs amp net health effects of contraceptive methods

Compared with use of no contraception Cost savings over 2 years

US$5907woman for tubal sterilization

US$9936 for vasectomy

Health gains 0088 QALYs for diaphragm

0147 QALYs for depot medroxyprogesterone acetate

Even modest increases in the use of the most effective methods result in financial savings and health gains

Sonnenberg FA Burkman RT Hagerty CG Speroff L Speroff T Contraception 2004 Jun69(6)447-59

Deaths averted with Family Planning

If there had been no

change in contraceptive

prevalence there would have been 38m additional maternal

deaths in the two decades between 1985 and 2005

Source John Stover The Policy Project The Futures Group 2006

Family Planning as a priority in high HIV prevalence areas

For Will reduce pregnancies in known HIV+ women gt

decreased AIDS transmission Will reduce pregnancies in HIV+ women who have not

yet been diagnosed (90 still undiagnosed) Ongoing and regular Family planning ndash will reduce

pregnancy occurring during the first weeks of AIDS when viral load is highest

Birth Spacing allows HIV+ women to recover from previous pregnancies maximizing her health before the challenge of another pregnancy

Against Mixed evidence on increased HIV transmission to men

when on long acting hormone contraception Conclusion Recent WHO technical consultation concluded proven

benefits of FP outweighed the inconsistent potential risks of HIV transmission

Family Planning Use Impact on Abortion Rates

Classic relationship in post-Soviet countries

Mixed in places with falling fertility where there is very high unmet need for fertility control

Reaffirms need for additional FP access

Increased access to FP estimated to reduce induced abortions in the developing world by 70 (from 35 million to 11 million) also reducing deaths and post-abortion costs due to unsafe abortions International Family Planning Perspectives 2003 29(1)6-13

CPR

Coverage globally in 2010 ~28

Comparing effectiveness of methods More effective

Less effective

Less than 1 pregnancy per 100 women in one year

About 30 pregnancies per 100 women in one year

Injections Get repeat injections

on time

LAM (for 6 months) Breastfeed

often day and night

Pills Take a pill each day

Patch ring Keep in place

change on time

Condoms diaphragm Use correctly

every time you have sex

Fertility-awareness based methods

Abstain or use condoms on fertile

days Newest methods (Standard Days

Method and TwoDay Method) may be easier

to use

How to make your

method most effective

After procedure little or nothing

to do or remember

Vasectomy Use another method

for first 3 months

Withdrawal spermicide Use

correctly every time you have

sex

Injectables Pills LAM

Male Condoms

Female Condoms

Diaphragm

Spermicide

IUD Female Sterilization

Vasectomy

Patch Ring

Fertility-Awareness Based Methods

Withdrawal

Implants

Side Effects amp Obstacles Oral Contraceptives ndash Take every day IUDs ndash Medical procedure to insert Sterilization ndash Permanent Injectable ndash Menstrual disturbance Norplant ndash Cost Condom ndash Use every time Diaphragm ndash Use every time Natural family planning ndash precision in timing

Myth Family Planning methods are abortifacients IN THE PAST there was an incorrect understanding of the mechanisms of action that limited unified faith-based support for family planning TRUTH Family Planning methods prevent conception Most methods accepted by people of faith as contraceptive But incorrect understanding of EC amp IUD mechanism limited

acceptance

How DO EC and IUDs work

Emergency contraception prevent pregnancy

Effective only in the first few days following intercourse

before the ovum is released from the ovary and before the sperm fertilizes the ovum

Prevent ovulation change cervical mucous to inhibits entry of sperm to uterus disrupt sperm binding to the egg

Emergency contraceptive pills cannot interrupt an established pregnancy or harm a developing embryo

Hormonal amp Copper IUD prevent pregnancy by

Chemical change that damages sperm and egg before they can meet

Cervical mucous change that inhibits entry of sperm to uterus

Economic Benefits too Costs amp net health effects of contraceptive methods

Compared with use of no contraception Cost savings over 2 years

US$5907woman for tubal sterilization

US$9936 for vasectomy

Health gains 0088 QALYs for diaphragm

0147 QALYs for depot medroxyprogesterone acetate

Even modest increases in the use of the most effective methods result in financial savings and health gains

Sonnenberg FA Burkman RT Hagerty CG Speroff L Speroff T Contraception 2004 Jun69(6)447-59

Family Planning as a priority in high HIV prevalence areas

For Will reduce pregnancies in known HIV+ women gt

decreased AIDS transmission Will reduce pregnancies in HIV+ women who have not

yet been diagnosed (90 still undiagnosed) Ongoing and regular Family planning ndash will reduce

pregnancy occurring during the first weeks of AIDS when viral load is highest

Birth Spacing allows HIV+ women to recover from previous pregnancies maximizing her health before the challenge of another pregnancy

Against Mixed evidence on increased HIV transmission to men

when on long acting hormone contraception Conclusion Recent WHO technical consultation concluded proven

benefits of FP outweighed the inconsistent potential risks of HIV transmission

Family Planning Use Impact on Abortion Rates

Classic relationship in post-Soviet countries

Mixed in places with falling fertility where there is very high unmet need for fertility control

Reaffirms need for additional FP access

Increased access to FP estimated to reduce induced abortions in the developing world by 70 (from 35 million to 11 million) also reducing deaths and post-abortion costs due to unsafe abortions International Family Planning Perspectives 2003 29(1)6-13

CPR

Coverage globally in 2010 ~28

Comparing effectiveness of methods More effective

Less effective

Less than 1 pregnancy per 100 women in one year

About 30 pregnancies per 100 women in one year

Injections Get repeat injections

on time

LAM (for 6 months) Breastfeed

often day and night

Pills Take a pill each day

Patch ring Keep in place

change on time

Condoms diaphragm Use correctly

every time you have sex

Fertility-awareness based methods

Abstain or use condoms on fertile

days Newest methods (Standard Days

Method and TwoDay Method) may be easier

to use

How to make your

method most effective

After procedure little or nothing

to do or remember

Vasectomy Use another method

for first 3 months

Withdrawal spermicide Use

correctly every time you have

sex

Injectables Pills LAM

Male Condoms

Female Condoms

Diaphragm

Spermicide

IUD Female Sterilization

Vasectomy

Patch Ring

Fertility-Awareness Based Methods

Withdrawal

Implants

Side Effects amp Obstacles Oral Contraceptives ndash Take every day IUDs ndash Medical procedure to insert Sterilization ndash Permanent Injectable ndash Menstrual disturbance Norplant ndash Cost Condom ndash Use every time Diaphragm ndash Use every time Natural family planning ndash precision in timing

Myth Family Planning methods are abortifacients IN THE PAST there was an incorrect understanding of the mechanisms of action that limited unified faith-based support for family planning TRUTH Family Planning methods prevent conception Most methods accepted by people of faith as contraceptive But incorrect understanding of EC amp IUD mechanism limited

acceptance

How DO EC and IUDs work

Emergency contraception prevent pregnancy

Effective only in the first few days following intercourse

before the ovum is released from the ovary and before the sperm fertilizes the ovum

Prevent ovulation change cervical mucous to inhibits entry of sperm to uterus disrupt sperm binding to the egg

Emergency contraceptive pills cannot interrupt an established pregnancy or harm a developing embryo

Hormonal amp Copper IUD prevent pregnancy by

Chemical change that damages sperm and egg before they can meet

Cervical mucous change that inhibits entry of sperm to uterus

Economic Benefits too Costs amp net health effects of contraceptive methods

Compared with use of no contraception Cost savings over 2 years

US$5907woman for tubal sterilization

US$9936 for vasectomy

Health gains 0088 QALYs for diaphragm

0147 QALYs for depot medroxyprogesterone acetate

Even modest increases in the use of the most effective methods result in financial savings and health gains

Sonnenberg FA Burkman RT Hagerty CG Speroff L Speroff T Contraception 2004 Jun69(6)447-59

Family Planning Use Impact on Abortion Rates

Classic relationship in post-Soviet countries

Mixed in places with falling fertility where there is very high unmet need for fertility control

Reaffirms need for additional FP access

Increased access to FP estimated to reduce induced abortions in the developing world by 70 (from 35 million to 11 million) also reducing deaths and post-abortion costs due to unsafe abortions International Family Planning Perspectives 2003 29(1)6-13

CPR

Coverage globally in 2010 ~28

Comparing effectiveness of methods More effective

Less effective

Less than 1 pregnancy per 100 women in one year

About 30 pregnancies per 100 women in one year

Injections Get repeat injections

on time

LAM (for 6 months) Breastfeed

often day and night

Pills Take a pill each day

Patch ring Keep in place

change on time

Condoms diaphragm Use correctly

every time you have sex

Fertility-awareness based methods

Abstain or use condoms on fertile

days Newest methods (Standard Days

Method and TwoDay Method) may be easier

to use

How to make your

method most effective

After procedure little or nothing

to do or remember

Vasectomy Use another method

for first 3 months

Withdrawal spermicide Use

correctly every time you have

sex

Injectables Pills LAM

Male Condoms

Female Condoms

Diaphragm

Spermicide

IUD Female Sterilization

Vasectomy

Patch Ring

Fertility-Awareness Based Methods

Withdrawal

Implants

Side Effects amp Obstacles Oral Contraceptives ndash Take every day IUDs ndash Medical procedure to insert Sterilization ndash Permanent Injectable ndash Menstrual disturbance Norplant ndash Cost Condom ndash Use every time Diaphragm ndash Use every time Natural family planning ndash precision in timing

Myth Family Planning methods are abortifacients IN THE PAST there was an incorrect understanding of the mechanisms of action that limited unified faith-based support for family planning TRUTH Family Planning methods prevent conception Most methods accepted by people of faith as contraceptive But incorrect understanding of EC amp IUD mechanism limited

acceptance

How DO EC and IUDs work

Emergency contraception prevent pregnancy

Effective only in the first few days following intercourse

before the ovum is released from the ovary and before the sperm fertilizes the ovum

Prevent ovulation change cervical mucous to inhibits entry of sperm to uterus disrupt sperm binding to the egg

Emergency contraceptive pills cannot interrupt an established pregnancy or harm a developing embryo

Hormonal amp Copper IUD prevent pregnancy by

Chemical change that damages sperm and egg before they can meet

Cervical mucous change that inhibits entry of sperm to uterus

Economic Benefits too Costs amp net health effects of contraceptive methods

Compared with use of no contraception Cost savings over 2 years

US$5907woman for tubal sterilization

US$9936 for vasectomy

Health gains 0088 QALYs for diaphragm

0147 QALYs for depot medroxyprogesterone acetate

Even modest increases in the use of the most effective methods result in financial savings and health gains

Sonnenberg FA Burkman RT Hagerty CG Speroff L Speroff T Contraception 2004 Jun69(6)447-59

CPR

Coverage globally in 2010 ~28

Comparing effectiveness of methods More effective

Less effective

Less than 1 pregnancy per 100 women in one year

About 30 pregnancies per 100 women in one year

Injections Get repeat injections

on time

LAM (for 6 months) Breastfeed

often day and night

Pills Take a pill each day

Patch ring Keep in place

change on time

Condoms diaphragm Use correctly

every time you have sex

Fertility-awareness based methods

Abstain or use condoms on fertile

days Newest methods (Standard Days

Method and TwoDay Method) may be easier

to use

How to make your

method most effective

After procedure little or nothing

to do or remember

Vasectomy Use another method

for first 3 months

Withdrawal spermicide Use

correctly every time you have

sex

Injectables Pills LAM

Male Condoms

Female Condoms

Diaphragm

Spermicide

IUD Female Sterilization

Vasectomy

Patch Ring

Fertility-Awareness Based Methods

Withdrawal

Implants

Side Effects amp Obstacles Oral Contraceptives ndash Take every day IUDs ndash Medical procedure to insert Sterilization ndash Permanent Injectable ndash Menstrual disturbance Norplant ndash Cost Condom ndash Use every time Diaphragm ndash Use every time Natural family planning ndash precision in timing

Myth Family Planning methods are abortifacients IN THE PAST there was an incorrect understanding of the mechanisms of action that limited unified faith-based support for family planning TRUTH Family Planning methods prevent conception Most methods accepted by people of faith as contraceptive But incorrect understanding of EC amp IUD mechanism limited

acceptance

How DO EC and IUDs work

Emergency contraception prevent pregnancy

Effective only in the first few days following intercourse

before the ovum is released from the ovary and before the sperm fertilizes the ovum

Prevent ovulation change cervical mucous to inhibits entry of sperm to uterus disrupt sperm binding to the egg

Emergency contraceptive pills cannot interrupt an established pregnancy or harm a developing embryo

Hormonal amp Copper IUD prevent pregnancy by

Chemical change that damages sperm and egg before they can meet

Cervical mucous change that inhibits entry of sperm to uterus

Economic Benefits too Costs amp net health effects of contraceptive methods

Compared with use of no contraception Cost savings over 2 years

US$5907woman for tubal sterilization

US$9936 for vasectomy

Health gains 0088 QALYs for diaphragm

0147 QALYs for depot medroxyprogesterone acetate

Even modest increases in the use of the most effective methods result in financial savings and health gains

Sonnenberg FA Burkman RT Hagerty CG Speroff L Speroff T Contraception 2004 Jun69(6)447-59

Comparing effectiveness of methods More effective

Less effective

Less than 1 pregnancy per 100 women in one year

About 30 pregnancies per 100 women in one year

Injections Get repeat injections

on time

LAM (for 6 months) Breastfeed

often day and night

Pills Take a pill each day

Patch ring Keep in place

change on time

Condoms diaphragm Use correctly

every time you have sex

Fertility-awareness based methods

Abstain or use condoms on fertile

days Newest methods (Standard Days

Method and TwoDay Method) may be easier

to use

How to make your

method most effective

After procedure little or nothing

to do or remember

Vasectomy Use another method

for first 3 months

Withdrawal spermicide Use

correctly every time you have

sex

Injectables Pills LAM

Male Condoms

Female Condoms

Diaphragm

Spermicide

IUD Female Sterilization

Vasectomy

Patch Ring

Fertility-Awareness Based Methods

Withdrawal

Implants

Side Effects amp Obstacles Oral Contraceptives ndash Take every day IUDs ndash Medical procedure to insert Sterilization ndash Permanent Injectable ndash Menstrual disturbance Norplant ndash Cost Condom ndash Use every time Diaphragm ndash Use every time Natural family planning ndash precision in timing

Myth Family Planning methods are abortifacients IN THE PAST there was an incorrect understanding of the mechanisms of action that limited unified faith-based support for family planning TRUTH Family Planning methods prevent conception Most methods accepted by people of faith as contraceptive But incorrect understanding of EC amp IUD mechanism limited

acceptance

How DO EC and IUDs work

Emergency contraception prevent pregnancy

Effective only in the first few days following intercourse

before the ovum is released from the ovary and before the sperm fertilizes the ovum

Prevent ovulation change cervical mucous to inhibits entry of sperm to uterus disrupt sperm binding to the egg

Emergency contraceptive pills cannot interrupt an established pregnancy or harm a developing embryo

Hormonal amp Copper IUD prevent pregnancy by

Chemical change that damages sperm and egg before they can meet

Cervical mucous change that inhibits entry of sperm to uterus

Economic Benefits too Costs amp net health effects of contraceptive methods

Compared with use of no contraception Cost savings over 2 years

US$5907woman for tubal sterilization

US$9936 for vasectomy

Health gains 0088 QALYs for diaphragm

0147 QALYs for depot medroxyprogesterone acetate

Even modest increases in the use of the most effective methods result in financial savings and health gains

Sonnenberg FA Burkman RT Hagerty CG Speroff L Speroff T Contraception 2004 Jun69(6)447-59

Side Effects amp Obstacles Oral Contraceptives ndash Take every day IUDs ndash Medical procedure to insert Sterilization ndash Permanent Injectable ndash Menstrual disturbance Norplant ndash Cost Condom ndash Use every time Diaphragm ndash Use every time Natural family planning ndash precision in timing

Myth Family Planning methods are abortifacients IN THE PAST there was an incorrect understanding of the mechanisms of action that limited unified faith-based support for family planning TRUTH Family Planning methods prevent conception Most methods accepted by people of faith as contraceptive But incorrect understanding of EC amp IUD mechanism limited

acceptance

How DO EC and IUDs work

Emergency contraception prevent pregnancy

Effective only in the first few days following intercourse

before the ovum is released from the ovary and before the sperm fertilizes the ovum

Prevent ovulation change cervical mucous to inhibits entry of sperm to uterus disrupt sperm binding to the egg

Emergency contraceptive pills cannot interrupt an established pregnancy or harm a developing embryo

Hormonal amp Copper IUD prevent pregnancy by

Chemical change that damages sperm and egg before they can meet

Cervical mucous change that inhibits entry of sperm to uterus

Economic Benefits too Costs amp net health effects of contraceptive methods

Compared with use of no contraception Cost savings over 2 years

US$5907woman for tubal sterilization

US$9936 for vasectomy

Health gains 0088 QALYs for diaphragm

0147 QALYs for depot medroxyprogesterone acetate

Even modest increases in the use of the most effective methods result in financial savings and health gains

Sonnenberg FA Burkman RT Hagerty CG Speroff L Speroff T Contraception 2004 Jun69(6)447-59

How DO EC and IUDs work

Emergency contraception prevent pregnancy

Effective only in the first few days following intercourse

before the ovum is released from the ovary and before the sperm fertilizes the ovum

Prevent ovulation change cervical mucous to inhibits entry of sperm to uterus disrupt sperm binding to the egg

Emergency contraceptive pills cannot interrupt an established pregnancy or harm a developing embryo

Hormonal amp Copper IUD prevent pregnancy by

Chemical change that damages sperm and egg before they can meet

Cervical mucous change that inhibits entry of sperm to uterus

Economic Benefits too Costs amp net health effects of contraceptive methods

Compared with use of no contraception Cost savings over 2 years

US$5907woman for tubal sterilization

US$9936 for vasectomy

Health gains 0088 QALYs for diaphragm

0147 QALYs for depot medroxyprogesterone acetate

Even modest increases in the use of the most effective methods result in financial savings and health gains

Sonnenberg FA Burkman RT Hagerty CG Speroff L Speroff T Contraception 2004 Jun69(6)447-59

Economic Benefits too Costs amp net health effects of contraceptive methods

Compared with use of no contraception Cost savings over 2 years

US$5907woman for tubal sterilization

US$9936 for vasectomy

Health gains 0088 QALYs for diaphragm

0147 QALYs for depot medroxyprogesterone acetate

Even modest increases in the use of the most effective methods result in financial savings and health gains

Sonnenberg FA Burkman RT Hagerty CG Speroff L Speroff T Contraception 2004 Jun69(6)447-59

Conclusion

Family planning is one of the most effective life saving interventions we have to reduce maternal and child mortality

Increased use of family planning can significantly reduce abortion rates

Unmet need for contraceptives is still at about 24 for Sub-Saharan Africa

Effective non-abortifacient methods including natural family planning methods exist that are acceptable to people of all faiths

Take Action

Get the word out

We promote family planning because we value women and children

Use the growing amp compelling evidence

Debunk the myths

People of all faiths can now unify in support of family planning to improve health and well-being of millions

Thank you

Unmet Family Planning Need 1st Year Postpartum (blue) amp All Women (purple)

0

10

20

30

40

50

60

70

80

B-desh Haiti Kenya Nigeria

1st Year PP

All Women

Source Borda M and W Winfrey Family Planning Needs

during the First Year Postpartum ACCESS-FP

Non-users 55 intend to use--Their preferred methods for future (Kenya DHS

08-09)

Injectables 52

Unsure 13

Pill 12

Female sterilization 8

Implants 8

Male condom 2

IUD 2

Periodic abstinence 2

Female condom 03

Contraceptive use in USA among women at risk of unintended pregnancy by religious affiliation (Natl Surv

Fam Grwth 2006-08 n=7356 women)

Protestant

Contraceptive Method All Women Catholic Mainline Evangelical No Relig Affil

Highly Effective 69 68 73 74 62

Sterilization 33 32 34 41 26

Pill amp other hormonal 31 31 35 28 30

Intrauterine device 5 5 4 4 6

Condom 14 15 13 10 17

Natural FP 1 2 1 1 1

Other 5 4 4 6 7

None 11 11 10 9 14

of women sexually active but not pregnant post-partum or trying to become pregnant

Christian Connections for International Health at Center for Bioethics amp Human Dignity 13 July 2012

The 2 classic female hormones (progesterone and estrogen) vary throughout the cycle

Cervical mucus is amenable to sperm penetration only mid-cycle when estrogen peaks and before progesterone rises

Any contraceptive that has progestin in it will make cervical mucus hostile to sperm

IUDS

Hormonal IUDs - progestin levonorgestrel Prevention of pregnancy due to subsequent thickening of cervical mucus which prevents the passage of sperm inhibition of sperm mobility and inhibition of endometrial growth

Copper IUD ndash endometrium releases white blood cells enzymes and prostaglandins and these reactions of the endometrium appear to prevent sperm from reaching the fallopian tubes In addition release copper ions into the the uterus enhancing the debilitating effect on sperm

Hormonal contraceptive methods have at least 2 major mechanisms of action

Inhibitingdisrupting ovulation

Thickening cervical mucus

Other

Population growth

RH bulge to come

Health in Afghanistan

Maternal Mortality Rates VA is 7100000 Puerto Rico 18100000 2001 was 1600100000 NE Corner Badakshan

province 6400100000 Now (2010)

337100000

Key Findings

bull Fewer Women die during Pregnancy and Childbirth

bull More Children survive to their Fifth Birthday

bull Women are having fewer children

bull More Women Use Life Saving Care

USAID and State Family Planning and Reproductive Health Budgets - FY2009

- FY 2011

FY 2009 Enacted

FY 2010 653(a) Initial

FY 2011 Request

Congressional EarmarkDirective

$545000 $648457

-

Family Planning and Reproductive Health

$572401 $666590

$715740

Delta EarmarkDirective vs Programmed

$27401 $18133

-

FY09 included $50m as a USG contribution to UNFPA FY10 includes $55m as a USG contribution to UNFPA FY11 includes $50m as a USG contribution to UNFPA

Funding comparisons

Equity for the Moms and Babies

We cannot be complacent

Impact of FP on abortion rates

Rising contraceptive use results in reduced abortion incidence in settings where fertility itself is constant

The parallel rise in abortion and contraception in some countries occurred because increased contraceptive use alone was unable to meet the growing need for fertility regulation in situations where fertility was falling rapidly

Resources Jim Shelton FP Myths Mary Ellen Stanton MH

National Family Planning and Reproductive

Health Association ndash httpwwwnfprhaorgmainindexcfm

WHO Family Planning Site - httpwwwwhointtopicsfamily_planningen

K4Health (knowledge for Health)project Hopkins Family Planning Guidebook for providers amp Wall chart

CEDPA womenrsquos empowerment amp RH PATH new technology amp coverage expansion FHIhttpwwwfhiorgenindexhtm

Take Action

Get the word out

We promote family planning because we value women and children

Use the growing amp compelling evidence

Debunk the myths

People of all faiths can now unify in support of family planning to improve health and well-being of millions

Thank you

Unmet Family Planning Need 1st Year Postpartum (blue) amp All Women (purple)

0

10

20

30

40

50

60

70

80

B-desh Haiti Kenya Nigeria

1st Year PP

All Women

Source Borda M and W Winfrey Family Planning Needs

during the First Year Postpartum ACCESS-FP

Non-users 55 intend to use--Their preferred methods for future (Kenya DHS

08-09)

Injectables 52

Unsure 13

Pill 12

Female sterilization 8

Implants 8

Male condom 2

IUD 2

Periodic abstinence 2

Female condom 03

Contraceptive use in USA among women at risk of unintended pregnancy by religious affiliation (Natl Surv

Fam Grwth 2006-08 n=7356 women)

Protestant

Contraceptive Method All Women Catholic Mainline Evangelical No Relig Affil

Highly Effective 69 68 73 74 62

Sterilization 33 32 34 41 26

Pill amp other hormonal 31 31 35 28 30

Intrauterine device 5 5 4 4 6

Condom 14 15 13 10 17

Natural FP 1 2 1 1 1

Other 5 4 4 6 7

None 11 11 10 9 14

of women sexually active but not pregnant post-partum or trying to become pregnant

Christian Connections for International Health at Center for Bioethics amp Human Dignity 13 July 2012

The 2 classic female hormones (progesterone and estrogen) vary throughout the cycle

Cervical mucus is amenable to sperm penetration only mid-cycle when estrogen peaks and before progesterone rises

Any contraceptive that has progestin in it will make cervical mucus hostile to sperm

IUDS

Hormonal IUDs - progestin levonorgestrel Prevention of pregnancy due to subsequent thickening of cervical mucus which prevents the passage of sperm inhibition of sperm mobility and inhibition of endometrial growth

Copper IUD ndash endometrium releases white blood cells enzymes and prostaglandins and these reactions of the endometrium appear to prevent sperm from reaching the fallopian tubes In addition release copper ions into the the uterus enhancing the debilitating effect on sperm

Hormonal contraceptive methods have at least 2 major mechanisms of action

Inhibitingdisrupting ovulation

Thickening cervical mucus

Other

Population growth

RH bulge to come

Health in Afghanistan

Maternal Mortality Rates VA is 7100000 Puerto Rico 18100000 2001 was 1600100000 NE Corner Badakshan

province 6400100000 Now (2010)

337100000

Key Findings

bull Fewer Women die during Pregnancy and Childbirth

bull More Children survive to their Fifth Birthday

bull Women are having fewer children

bull More Women Use Life Saving Care

USAID and State Family Planning and Reproductive Health Budgets - FY2009

- FY 2011

FY 2009 Enacted

FY 2010 653(a) Initial

FY 2011 Request

Congressional EarmarkDirective

$545000 $648457

-

Family Planning and Reproductive Health

$572401 $666590

$715740

Delta EarmarkDirective vs Programmed

$27401 $18133

-

FY09 included $50m as a USG contribution to UNFPA FY10 includes $55m as a USG contribution to UNFPA FY11 includes $50m as a USG contribution to UNFPA

Funding comparisons

Equity for the Moms and Babies

We cannot be complacent

Impact of FP on abortion rates

Rising contraceptive use results in reduced abortion incidence in settings where fertility itself is constant

The parallel rise in abortion and contraception in some countries occurred because increased contraceptive use alone was unable to meet the growing need for fertility regulation in situations where fertility was falling rapidly

Resources Jim Shelton FP Myths Mary Ellen Stanton MH

National Family Planning and Reproductive

Health Association ndash httpwwwnfprhaorgmainindexcfm

WHO Family Planning Site - httpwwwwhointtopicsfamily_planningen

K4Health (knowledge for Health)project Hopkins Family Planning Guidebook for providers amp Wall chart

CEDPA womenrsquos empowerment amp RH PATH new technology amp coverage expansion FHIhttpwwwfhiorgenindexhtm

Thank you

Unmet Family Planning Need 1st Year Postpartum (blue) amp All Women (purple)

0

10

20

30

40

50

60

70

80

B-desh Haiti Kenya Nigeria

1st Year PP

All Women

Source Borda M and W Winfrey Family Planning Needs

during the First Year Postpartum ACCESS-FP

Non-users 55 intend to use--Their preferred methods for future (Kenya DHS

08-09)

Injectables 52

Unsure 13

Pill 12

Female sterilization 8

Implants 8

Male condom 2

IUD 2

Periodic abstinence 2

Female condom 03

Contraceptive use in USA among women at risk of unintended pregnancy by religious affiliation (Natl Surv

Fam Grwth 2006-08 n=7356 women)

Protestant

Contraceptive Method All Women Catholic Mainline Evangelical No Relig Affil

Highly Effective 69 68 73 74 62

Sterilization 33 32 34 41 26

Pill amp other hormonal 31 31 35 28 30

Intrauterine device 5 5 4 4 6

Condom 14 15 13 10 17

Natural FP 1 2 1 1 1

Other 5 4 4 6 7

None 11 11 10 9 14

of women sexually active but not pregnant post-partum or trying to become pregnant

Christian Connections for International Health at Center for Bioethics amp Human Dignity 13 July 2012

The 2 classic female hormones (progesterone and estrogen) vary throughout the cycle

Cervical mucus is amenable to sperm penetration only mid-cycle when estrogen peaks and before progesterone rises

Any contraceptive that has progestin in it will make cervical mucus hostile to sperm

IUDS

Hormonal IUDs - progestin levonorgestrel Prevention of pregnancy due to subsequent thickening of cervical mucus which prevents the passage of sperm inhibition of sperm mobility and inhibition of endometrial growth

Copper IUD ndash endometrium releases white blood cells enzymes and prostaglandins and these reactions of the endometrium appear to prevent sperm from reaching the fallopian tubes In addition release copper ions into the the uterus enhancing the debilitating effect on sperm

Hormonal contraceptive methods have at least 2 major mechanisms of action

Inhibitingdisrupting ovulation

Thickening cervical mucus

Other

Population growth

RH bulge to come

Health in Afghanistan

Maternal Mortality Rates VA is 7100000 Puerto Rico 18100000 2001 was 1600100000 NE Corner Badakshan

province 6400100000 Now (2010)

337100000

Key Findings

bull Fewer Women die during Pregnancy and Childbirth

bull More Children survive to their Fifth Birthday

bull Women are having fewer children

bull More Women Use Life Saving Care

USAID and State Family Planning and Reproductive Health Budgets - FY2009

- FY 2011

FY 2009 Enacted

FY 2010 653(a) Initial

FY 2011 Request

Congressional EarmarkDirective

$545000 $648457

-

Family Planning and Reproductive Health

$572401 $666590

$715740

Delta EarmarkDirective vs Programmed

$27401 $18133

-

FY09 included $50m as a USG contribution to UNFPA FY10 includes $55m as a USG contribution to UNFPA FY11 includes $50m as a USG contribution to UNFPA

Funding comparisons

Equity for the Moms and Babies

We cannot be complacent

Impact of FP on abortion rates

Rising contraceptive use results in reduced abortion incidence in settings where fertility itself is constant

The parallel rise in abortion and contraception in some countries occurred because increased contraceptive use alone was unable to meet the growing need for fertility regulation in situations where fertility was falling rapidly

Resources Jim Shelton FP Myths Mary Ellen Stanton MH

National Family Planning and Reproductive

Health Association ndash httpwwwnfprhaorgmainindexcfm

WHO Family Planning Site - httpwwwwhointtopicsfamily_planningen

K4Health (knowledge for Health)project Hopkins Family Planning Guidebook for providers amp Wall chart

CEDPA womenrsquos empowerment amp RH PATH new technology amp coverage expansion FHIhttpwwwfhiorgenindexhtm

Unmet Family Planning Need 1st Year Postpartum (blue) amp All Women (purple)

0

10

20

30

40

50

60

70

80

B-desh Haiti Kenya Nigeria

1st Year PP

All Women

Source Borda M and W Winfrey Family Planning Needs

during the First Year Postpartum ACCESS-FP

Non-users 55 intend to use--Their preferred methods for future (Kenya DHS

08-09)

Injectables 52

Unsure 13

Pill 12

Female sterilization 8

Implants 8

Male condom 2

IUD 2

Periodic abstinence 2

Female condom 03

Contraceptive use in USA among women at risk of unintended pregnancy by religious affiliation (Natl Surv

Fam Grwth 2006-08 n=7356 women)

Protestant

Contraceptive Method All Women Catholic Mainline Evangelical No Relig Affil

Highly Effective 69 68 73 74 62

Sterilization 33 32 34 41 26

Pill amp other hormonal 31 31 35 28 30

Intrauterine device 5 5 4 4 6

Condom 14 15 13 10 17

Natural FP 1 2 1 1 1

Other 5 4 4 6 7

None 11 11 10 9 14

of women sexually active but not pregnant post-partum or trying to become pregnant

Christian Connections for International Health at Center for Bioethics amp Human Dignity 13 July 2012

The 2 classic female hormones (progesterone and estrogen) vary throughout the cycle

Cervical mucus is amenable to sperm penetration only mid-cycle when estrogen peaks and before progesterone rises

Any contraceptive that has progestin in it will make cervical mucus hostile to sperm

IUDS

Hormonal IUDs - progestin levonorgestrel Prevention of pregnancy due to subsequent thickening of cervical mucus which prevents the passage of sperm inhibition of sperm mobility and inhibition of endometrial growth

Copper IUD ndash endometrium releases white blood cells enzymes and prostaglandins and these reactions of the endometrium appear to prevent sperm from reaching the fallopian tubes In addition release copper ions into the the uterus enhancing the debilitating effect on sperm

Hormonal contraceptive methods have at least 2 major mechanisms of action

Inhibitingdisrupting ovulation

Thickening cervical mucus

Other

Population growth

RH bulge to come

Health in Afghanistan

Maternal Mortality Rates VA is 7100000 Puerto Rico 18100000 2001 was 1600100000 NE Corner Badakshan

province 6400100000 Now (2010)

337100000

Key Findings

bull Fewer Women die during Pregnancy and Childbirth

bull More Children survive to their Fifth Birthday

bull Women are having fewer children

bull More Women Use Life Saving Care

USAID and State Family Planning and Reproductive Health Budgets - FY2009

- FY 2011

FY 2009 Enacted

FY 2010 653(a) Initial

FY 2011 Request

Congressional EarmarkDirective

$545000 $648457

-

Family Planning and Reproductive Health

$572401 $666590

$715740

Delta EarmarkDirective vs Programmed

$27401 $18133

-

FY09 included $50m as a USG contribution to UNFPA FY10 includes $55m as a USG contribution to UNFPA FY11 includes $50m as a USG contribution to UNFPA

Funding comparisons

Equity for the Moms and Babies

We cannot be complacent

Impact of FP on abortion rates

Rising contraceptive use results in reduced abortion incidence in settings where fertility itself is constant

The parallel rise in abortion and contraception in some countries occurred because increased contraceptive use alone was unable to meet the growing need for fertility regulation in situations where fertility was falling rapidly

Resources Jim Shelton FP Myths Mary Ellen Stanton MH

National Family Planning and Reproductive

Health Association ndash httpwwwnfprhaorgmainindexcfm

WHO Family Planning Site - httpwwwwhointtopicsfamily_planningen

K4Health (knowledge for Health)project Hopkins Family Planning Guidebook for providers amp Wall chart

CEDPA womenrsquos empowerment amp RH PATH new technology amp coverage expansion FHIhttpwwwfhiorgenindexhtm

Non-users 55 intend to use--Their preferred methods for future (Kenya DHS

08-09)

Injectables 52

Unsure 13

Pill 12

Female sterilization 8

Implants 8

Male condom 2

IUD 2

Periodic abstinence 2

Female condom 03

Contraceptive use in USA among women at risk of unintended pregnancy by religious affiliation (Natl Surv

Fam Grwth 2006-08 n=7356 women)

Protestant

Contraceptive Method All Women Catholic Mainline Evangelical No Relig Affil

Highly Effective 69 68 73 74 62

Sterilization 33 32 34 41 26

Pill amp other hormonal 31 31 35 28 30

Intrauterine device 5 5 4 4 6

Condom 14 15 13 10 17

Natural FP 1 2 1 1 1

Other 5 4 4 6 7

None 11 11 10 9 14

of women sexually active but not pregnant post-partum or trying to become pregnant

Christian Connections for International Health at Center for Bioethics amp Human Dignity 13 July 2012

The 2 classic female hormones (progesterone and estrogen) vary throughout the cycle

Cervical mucus is amenable to sperm penetration only mid-cycle when estrogen peaks and before progesterone rises

Any contraceptive that has progestin in it will make cervical mucus hostile to sperm

IUDS

Hormonal IUDs - progestin levonorgestrel Prevention of pregnancy due to subsequent thickening of cervical mucus which prevents the passage of sperm inhibition of sperm mobility and inhibition of endometrial growth

Copper IUD ndash endometrium releases white blood cells enzymes and prostaglandins and these reactions of the endometrium appear to prevent sperm from reaching the fallopian tubes In addition release copper ions into the the uterus enhancing the debilitating effect on sperm

Hormonal contraceptive methods have at least 2 major mechanisms of action

Inhibitingdisrupting ovulation

Thickening cervical mucus

Other

Population growth

RH bulge to come

Health in Afghanistan

Maternal Mortality Rates VA is 7100000 Puerto Rico 18100000 2001 was 1600100000 NE Corner Badakshan

province 6400100000 Now (2010)

337100000

Key Findings

bull Fewer Women die during Pregnancy and Childbirth

bull More Children survive to their Fifth Birthday

bull Women are having fewer children

bull More Women Use Life Saving Care

USAID and State Family Planning and Reproductive Health Budgets - FY2009

- FY 2011

FY 2009 Enacted

FY 2010 653(a) Initial

FY 2011 Request

Congressional EarmarkDirective

$545000 $648457

-

Family Planning and Reproductive Health

$572401 $666590

$715740

Delta EarmarkDirective vs Programmed

$27401 $18133

-

FY09 included $50m as a USG contribution to UNFPA FY10 includes $55m as a USG contribution to UNFPA FY11 includes $50m as a USG contribution to UNFPA

Funding comparisons

Equity for the Moms and Babies

We cannot be complacent

Impact of FP on abortion rates

Rising contraceptive use results in reduced abortion incidence in settings where fertility itself is constant

The parallel rise in abortion and contraception in some countries occurred because increased contraceptive use alone was unable to meet the growing need for fertility regulation in situations where fertility was falling rapidly

Resources Jim Shelton FP Myths Mary Ellen Stanton MH

National Family Planning and Reproductive

Health Association ndash httpwwwnfprhaorgmainindexcfm

WHO Family Planning Site - httpwwwwhointtopicsfamily_planningen

K4Health (knowledge for Health)project Hopkins Family Planning Guidebook for providers amp Wall chart

CEDPA womenrsquos empowerment amp RH PATH new technology amp coverage expansion FHIhttpwwwfhiorgenindexhtm

Contraceptive use in USA among women at risk of unintended pregnancy by religious affiliation (Natl Surv

Fam Grwth 2006-08 n=7356 women)

Protestant

Contraceptive Method All Women Catholic Mainline Evangelical No Relig Affil

Highly Effective 69 68 73 74 62

Sterilization 33 32 34 41 26

Pill amp other hormonal 31 31 35 28 30

Intrauterine device 5 5 4 4 6

Condom 14 15 13 10 17

Natural FP 1 2 1 1 1

Other 5 4 4 6 7

None 11 11 10 9 14

of women sexually active but not pregnant post-partum or trying to become pregnant

Christian Connections for International Health at Center for Bioethics amp Human Dignity 13 July 2012

The 2 classic female hormones (progesterone and estrogen) vary throughout the cycle

Cervical mucus is amenable to sperm penetration only mid-cycle when estrogen peaks and before progesterone rises

Any contraceptive that has progestin in it will make cervical mucus hostile to sperm

IUDS

Hormonal IUDs - progestin levonorgestrel Prevention of pregnancy due to subsequent thickening of cervical mucus which prevents the passage of sperm inhibition of sperm mobility and inhibition of endometrial growth

Copper IUD ndash endometrium releases white blood cells enzymes and prostaglandins and these reactions of the endometrium appear to prevent sperm from reaching the fallopian tubes In addition release copper ions into the the uterus enhancing the debilitating effect on sperm

Hormonal contraceptive methods have at least 2 major mechanisms of action

Inhibitingdisrupting ovulation

Thickening cervical mucus

Other

Population growth

RH bulge to come

Health in Afghanistan

Maternal Mortality Rates VA is 7100000 Puerto Rico 18100000 2001 was 1600100000 NE Corner Badakshan

province 6400100000 Now (2010)

337100000

Key Findings

bull Fewer Women die during Pregnancy and Childbirth

bull More Children survive to their Fifth Birthday

bull Women are having fewer children

bull More Women Use Life Saving Care

USAID and State Family Planning and Reproductive Health Budgets - FY2009

- FY 2011

FY 2009 Enacted

FY 2010 653(a) Initial

FY 2011 Request

Congressional EarmarkDirective

$545000 $648457

-

Family Planning and Reproductive Health

$572401 $666590

$715740

Delta EarmarkDirective vs Programmed

$27401 $18133

-

FY09 included $50m as a USG contribution to UNFPA FY10 includes $55m as a USG contribution to UNFPA FY11 includes $50m as a USG contribution to UNFPA

Funding comparisons

Equity for the Moms and Babies

We cannot be complacent

Impact of FP on abortion rates

Rising contraceptive use results in reduced abortion incidence in settings where fertility itself is constant

The parallel rise in abortion and contraception in some countries occurred because increased contraceptive use alone was unable to meet the growing need for fertility regulation in situations where fertility was falling rapidly

Resources Jim Shelton FP Myths Mary Ellen Stanton MH

National Family Planning and Reproductive

Health Association ndash httpwwwnfprhaorgmainindexcfm

WHO Family Planning Site - httpwwwwhointtopicsfamily_planningen

K4Health (knowledge for Health)project Hopkins Family Planning Guidebook for providers amp Wall chart

CEDPA womenrsquos empowerment amp RH PATH new technology amp coverage expansion FHIhttpwwwfhiorgenindexhtm

The 2 classic female hormones (progesterone and estrogen) vary throughout the cycle

Cervical mucus is amenable to sperm penetration only mid-cycle when estrogen peaks and before progesterone rises

Any contraceptive that has progestin in it will make cervical mucus hostile to sperm

IUDS

Hormonal IUDs - progestin levonorgestrel Prevention of pregnancy due to subsequent thickening of cervical mucus which prevents the passage of sperm inhibition of sperm mobility and inhibition of endometrial growth

Copper IUD ndash endometrium releases white blood cells enzymes and prostaglandins and these reactions of the endometrium appear to prevent sperm from reaching the fallopian tubes In addition release copper ions into the the uterus enhancing the debilitating effect on sperm

Hormonal contraceptive methods have at least 2 major mechanisms of action

Inhibitingdisrupting ovulation

Thickening cervical mucus

Other

Population growth

RH bulge to come

Health in Afghanistan

Maternal Mortality Rates VA is 7100000 Puerto Rico 18100000 2001 was 1600100000 NE Corner Badakshan

province 6400100000 Now (2010)

337100000

Key Findings

bull Fewer Women die during Pregnancy and Childbirth

bull More Children survive to their Fifth Birthday

bull Women are having fewer children

bull More Women Use Life Saving Care

USAID and State Family Planning and Reproductive Health Budgets - FY2009

- FY 2011

FY 2009 Enacted

FY 2010 653(a) Initial

FY 2011 Request

Congressional EarmarkDirective

$545000 $648457

-

Family Planning and Reproductive Health

$572401 $666590

$715740

Delta EarmarkDirective vs Programmed

$27401 $18133

-

FY09 included $50m as a USG contribution to UNFPA FY10 includes $55m as a USG contribution to UNFPA FY11 includes $50m as a USG contribution to UNFPA

Funding comparisons

Equity for the Moms and Babies

We cannot be complacent

Impact of FP on abortion rates

Rising contraceptive use results in reduced abortion incidence in settings where fertility itself is constant

The parallel rise in abortion and contraception in some countries occurred because increased contraceptive use alone was unable to meet the growing need for fertility regulation in situations where fertility was falling rapidly

Resources Jim Shelton FP Myths Mary Ellen Stanton MH

National Family Planning and Reproductive

Health Association ndash httpwwwnfprhaorgmainindexcfm

WHO Family Planning Site - httpwwwwhointtopicsfamily_planningen

K4Health (knowledge for Health)project Hopkins Family Planning Guidebook for providers amp Wall chart

CEDPA womenrsquos empowerment amp RH PATH new technology amp coverage expansion FHIhttpwwwfhiorgenindexhtm

IUDS

Hormonal IUDs - progestin levonorgestrel Prevention of pregnancy due to subsequent thickening of cervical mucus which prevents the passage of sperm inhibition of sperm mobility and inhibition of endometrial growth

Copper IUD ndash endometrium releases white blood cells enzymes and prostaglandins and these reactions of the endometrium appear to prevent sperm from reaching the fallopian tubes In addition release copper ions into the the uterus enhancing the debilitating effect on sperm

Hormonal contraceptive methods have at least 2 major mechanisms of action

Inhibitingdisrupting ovulation

Thickening cervical mucus

Other

Population growth

RH bulge to come

Health in Afghanistan

Maternal Mortality Rates VA is 7100000 Puerto Rico 18100000 2001 was 1600100000 NE Corner Badakshan

province 6400100000 Now (2010)

337100000

Key Findings

bull Fewer Women die during Pregnancy and Childbirth

bull More Children survive to their Fifth Birthday

bull Women are having fewer children

bull More Women Use Life Saving Care

USAID and State Family Planning and Reproductive Health Budgets - FY2009

- FY 2011

FY 2009 Enacted

FY 2010 653(a) Initial

FY 2011 Request

Congressional EarmarkDirective

$545000 $648457

-

Family Planning and Reproductive Health

$572401 $666590

$715740

Delta EarmarkDirective vs Programmed

$27401 $18133

-

FY09 included $50m as a USG contribution to UNFPA FY10 includes $55m as a USG contribution to UNFPA FY11 includes $50m as a USG contribution to UNFPA

Funding comparisons

Equity for the Moms and Babies

We cannot be complacent

Impact of FP on abortion rates

Rising contraceptive use results in reduced abortion incidence in settings where fertility itself is constant

The parallel rise in abortion and contraception in some countries occurred because increased contraceptive use alone was unable to meet the growing need for fertility regulation in situations where fertility was falling rapidly

Resources Jim Shelton FP Myths Mary Ellen Stanton MH

National Family Planning and Reproductive

Health Association ndash httpwwwnfprhaorgmainindexcfm

WHO Family Planning Site - httpwwwwhointtopicsfamily_planningen

K4Health (knowledge for Health)project Hopkins Family Planning Guidebook for providers amp Wall chart

CEDPA womenrsquos empowerment amp RH PATH new technology amp coverage expansion FHIhttpwwwfhiorgenindexhtm

Hormonal contraceptive methods have at least 2 major mechanisms of action

Inhibitingdisrupting ovulation

Thickening cervical mucus

Other

Population growth

RH bulge to come

Health in Afghanistan

Maternal Mortality Rates VA is 7100000 Puerto Rico 18100000 2001 was 1600100000 NE Corner Badakshan

province 6400100000 Now (2010)

337100000

Key Findings

bull Fewer Women die during Pregnancy and Childbirth

bull More Children survive to their Fifth Birthday

bull Women are having fewer children

bull More Women Use Life Saving Care

USAID and State Family Planning and Reproductive Health Budgets - FY2009

- FY 2011

FY 2009 Enacted

FY 2010 653(a) Initial

FY 2011 Request

Congressional EarmarkDirective

$545000 $648457

-

Family Planning and Reproductive Health

$572401 $666590

$715740

Delta EarmarkDirective vs Programmed

$27401 $18133

-

FY09 included $50m as a USG contribution to UNFPA FY10 includes $55m as a USG contribution to UNFPA FY11 includes $50m as a USG contribution to UNFPA

Funding comparisons

Equity for the Moms and Babies

We cannot be complacent

Impact of FP on abortion rates

Rising contraceptive use results in reduced abortion incidence in settings where fertility itself is constant

The parallel rise in abortion and contraception in some countries occurred because increased contraceptive use alone was unable to meet the growing need for fertility regulation in situations where fertility was falling rapidly

Resources Jim Shelton FP Myths Mary Ellen Stanton MH

National Family Planning and Reproductive

Health Association ndash httpwwwnfprhaorgmainindexcfm

WHO Family Planning Site - httpwwwwhointtopicsfamily_planningen

K4Health (knowledge for Health)project Hopkins Family Planning Guidebook for providers amp Wall chart

CEDPA womenrsquos empowerment amp RH PATH new technology amp coverage expansion FHIhttpwwwfhiorgenindexhtm

Population growth

RH bulge to come

Health in Afghanistan

Maternal Mortality Rates VA is 7100000 Puerto Rico 18100000 2001 was 1600100000 NE Corner Badakshan

province 6400100000 Now (2010)

337100000

Key Findings

bull Fewer Women die during Pregnancy and Childbirth

bull More Children survive to their Fifth Birthday

bull Women are having fewer children

bull More Women Use Life Saving Care

USAID and State Family Planning and Reproductive Health Budgets - FY2009

- FY 2011

FY 2009 Enacted

FY 2010 653(a) Initial

FY 2011 Request

Congressional EarmarkDirective

$545000 $648457

-

Family Planning and Reproductive Health

$572401 $666590

$715740

Delta EarmarkDirective vs Programmed

$27401 $18133

-

FY09 included $50m as a USG contribution to UNFPA FY10 includes $55m as a USG contribution to UNFPA FY11 includes $50m as a USG contribution to UNFPA

Funding comparisons

Equity for the Moms and Babies

We cannot be complacent

Impact of FP on abortion rates

Rising contraceptive use results in reduced abortion incidence in settings where fertility itself is constant

The parallel rise in abortion and contraception in some countries occurred because increased contraceptive use alone was unable to meet the growing need for fertility regulation in situations where fertility was falling rapidly

Resources Jim Shelton FP Myths Mary Ellen Stanton MH

National Family Planning and Reproductive

Health Association ndash httpwwwnfprhaorgmainindexcfm

WHO Family Planning Site - httpwwwwhointtopicsfamily_planningen

K4Health (knowledge for Health)project Hopkins Family Planning Guidebook for providers amp Wall chart

CEDPA womenrsquos empowerment amp RH PATH new technology amp coverage expansion FHIhttpwwwfhiorgenindexhtm

RH bulge to come

Health in Afghanistan

Maternal Mortality Rates VA is 7100000 Puerto Rico 18100000 2001 was 1600100000 NE Corner Badakshan

province 6400100000 Now (2010)

337100000

Key Findings

bull Fewer Women die during Pregnancy and Childbirth

bull More Children survive to their Fifth Birthday

bull Women are having fewer children

bull More Women Use Life Saving Care

USAID and State Family Planning and Reproductive Health Budgets - FY2009

- FY 2011

FY 2009 Enacted

FY 2010 653(a) Initial

FY 2011 Request

Congressional EarmarkDirective

$545000 $648457

-

Family Planning and Reproductive Health

$572401 $666590

$715740

Delta EarmarkDirective vs Programmed

$27401 $18133

-

FY09 included $50m as a USG contribution to UNFPA FY10 includes $55m as a USG contribution to UNFPA FY11 includes $50m as a USG contribution to UNFPA

Funding comparisons

Equity for the Moms and Babies

We cannot be complacent

Impact of FP on abortion rates

Rising contraceptive use results in reduced abortion incidence in settings where fertility itself is constant

The parallel rise in abortion and contraception in some countries occurred because increased contraceptive use alone was unable to meet the growing need for fertility regulation in situations where fertility was falling rapidly

Resources Jim Shelton FP Myths Mary Ellen Stanton MH

National Family Planning and Reproductive

Health Association ndash httpwwwnfprhaorgmainindexcfm

WHO Family Planning Site - httpwwwwhointtopicsfamily_planningen

K4Health (knowledge for Health)project Hopkins Family Planning Guidebook for providers amp Wall chart

CEDPA womenrsquos empowerment amp RH PATH new technology amp coverage expansion FHIhttpwwwfhiorgenindexhtm

Health in Afghanistan

Maternal Mortality Rates VA is 7100000 Puerto Rico 18100000 2001 was 1600100000 NE Corner Badakshan

province 6400100000 Now (2010)

337100000

Key Findings

bull Fewer Women die during Pregnancy and Childbirth

bull More Children survive to their Fifth Birthday

bull Women are having fewer children

bull More Women Use Life Saving Care

USAID and State Family Planning and Reproductive Health Budgets - FY2009

- FY 2011

FY 2009 Enacted

FY 2010 653(a) Initial

FY 2011 Request

Congressional EarmarkDirective

$545000 $648457

-

Family Planning and Reproductive Health

$572401 $666590

$715740

Delta EarmarkDirective vs Programmed

$27401 $18133

-

FY09 included $50m as a USG contribution to UNFPA FY10 includes $55m as a USG contribution to UNFPA FY11 includes $50m as a USG contribution to UNFPA

Funding comparisons

Equity for the Moms and Babies

We cannot be complacent

Impact of FP on abortion rates

Rising contraceptive use results in reduced abortion incidence in settings where fertility itself is constant

The parallel rise in abortion and contraception in some countries occurred because increased contraceptive use alone was unable to meet the growing need for fertility regulation in situations where fertility was falling rapidly

Resources Jim Shelton FP Myths Mary Ellen Stanton MH

National Family Planning and Reproductive

Health Association ndash httpwwwnfprhaorgmainindexcfm

WHO Family Planning Site - httpwwwwhointtopicsfamily_planningen

K4Health (knowledge for Health)project Hopkins Family Planning Guidebook for providers amp Wall chart

CEDPA womenrsquos empowerment amp RH PATH new technology amp coverage expansion FHIhttpwwwfhiorgenindexhtm

USAID and State Family Planning and Reproductive Health Budgets - FY2009

- FY 2011

FY 2009 Enacted

FY 2010 653(a) Initial

FY 2011 Request

Congressional EarmarkDirective

$545000 $648457

-

Family Planning and Reproductive Health

$572401 $666590

$715740

Delta EarmarkDirective vs Programmed

$27401 $18133

-

FY09 included $50m as a USG contribution to UNFPA FY10 includes $55m as a USG contribution to UNFPA FY11 includes $50m as a USG contribution to UNFPA

Funding comparisons

Equity for the Moms and Babies

We cannot be complacent

Impact of FP on abortion rates

Rising contraceptive use results in reduced abortion incidence in settings where fertility itself is constant

The parallel rise in abortion and contraception in some countries occurred because increased contraceptive use alone was unable to meet the growing need for fertility regulation in situations where fertility was falling rapidly

Resources Jim Shelton FP Myths Mary Ellen Stanton MH

National Family Planning and Reproductive

Health Association ndash httpwwwnfprhaorgmainindexcfm

WHO Family Planning Site - httpwwwwhointtopicsfamily_planningen

K4Health (knowledge for Health)project Hopkins Family Planning Guidebook for providers amp Wall chart

CEDPA womenrsquos empowerment amp RH PATH new technology amp coverage expansion FHIhttpwwwfhiorgenindexhtm

Funding comparisons

Equity for the Moms and Babies

We cannot be complacent

Impact of FP on abortion rates

Rising contraceptive use results in reduced abortion incidence in settings where fertility itself is constant

The parallel rise in abortion and contraception in some countries occurred because increased contraceptive use alone was unable to meet the growing need for fertility regulation in situations where fertility was falling rapidly

Resources Jim Shelton FP Myths Mary Ellen Stanton MH

National Family Planning and Reproductive

Health Association ndash httpwwwnfprhaorgmainindexcfm

WHO Family Planning Site - httpwwwwhointtopicsfamily_planningen

K4Health (knowledge for Health)project Hopkins Family Planning Guidebook for providers amp Wall chart

CEDPA womenrsquos empowerment amp RH PATH new technology amp coverage expansion FHIhttpwwwfhiorgenindexhtm

Equity for the Moms and Babies

We cannot be complacent

Impact of FP on abortion rates

Rising contraceptive use results in reduced abortion incidence in settings where fertility itself is constant

The parallel rise in abortion and contraception in some countries occurred because increased contraceptive use alone was unable to meet the growing need for fertility regulation in situations where fertility was falling rapidly

Resources Jim Shelton FP Myths Mary Ellen Stanton MH

National Family Planning and Reproductive

Health Association ndash httpwwwnfprhaorgmainindexcfm

WHO Family Planning Site - httpwwwwhointtopicsfamily_planningen

K4Health (knowledge for Health)project Hopkins Family Planning Guidebook for providers amp Wall chart

CEDPA womenrsquos empowerment amp RH PATH new technology amp coverage expansion FHIhttpwwwfhiorgenindexhtm

Impact of FP on abortion rates

Rising contraceptive use results in reduced abortion incidence in settings where fertility itself is constant

The parallel rise in abortion and contraception in some countries occurred because increased contraceptive use alone was unable to meet the growing need for fertility regulation in situations where fertility was falling rapidly

Resources Jim Shelton FP Myths Mary Ellen Stanton MH

National Family Planning and Reproductive

Health Association ndash httpwwwnfprhaorgmainindexcfm

WHO Family Planning Site - httpwwwwhointtopicsfamily_planningen

K4Health (knowledge for Health)project Hopkins Family Planning Guidebook for providers amp Wall chart

CEDPA womenrsquos empowerment amp RH PATH new technology amp coverage expansion FHIhttpwwwfhiorgenindexhtm

Resources Jim Shelton FP Myths Mary Ellen Stanton MH

National Family Planning and Reproductive

Health Association ndash httpwwwnfprhaorgmainindexcfm

WHO Family Planning Site - httpwwwwhointtopicsfamily_planningen

K4Health (knowledge for Health)project Hopkins Family Planning Guidebook for providers amp Wall chart

CEDPA womenrsquos empowerment amp RH PATH new technology amp coverage expansion FHIhttpwwwfhiorgenindexhtm