Status and role of family planning in the context of
the Zika epidemic in the LAC region
Mark Hathaway, MD, MPH
Asesora Técnico de PF
International Workshop on Strengthening Health Services to Fight Zika
Santo Domingo, Republica Dominicana, Noviembre 28 a 30 de 2017
Presentation Outline
• Explain Maternal Child Survival Program (MCSP)
• Describe the many family planning (FP) opportunities
• Explain how the Zika crisis can be switched to an opportunity
• Show the vast unmet need for family planning
• Provide information on tools for improving FP uptake (LARC
LRP, MEC, MOA chart, etc)
• Describe some of the mechanisms of action of FP methods
2
Vision StatementSelf-reliant countries equipped with
the analytical tools and effective systems enabling them to be on track to end preventable child and maternal
deaths
USAID’s flagship
Maternal and Child
Survival Program
Credit: Kate Holt / MCHIP
▪ Maternal & Newborn
Health
▪ Child Health &
Immunization
▪ Family Planning
▪ Nutrition
▪ Malaria
▪ Water, Sanitation, &
Hygiene (WASH)
▪ HIV/TB
Technical Areas
Cross-Cutting Issues
▪ Quality
▪ Innovation
▪ Partnerships (private sector, civil society, etc.)
▪ Gender
▪ Equity
▪ Measurement and Analytics
▪ Behavior Change Communication
▪ Digital Health
▪ Community Approaches
▪ WASH
▪ Health Systems Strengthening
▪ Zika
From Household to Hospital Care
Household
Clinics/Hospitals
Community
Referral
Credit: Juozas Cernius/MCHIP Credit: Karen Kasmauski/MCHIP
Credit: MCHIPCredit: Karen Kasmauski/MCHIP
Family Planning… An Opportunity
• Regardless of local status of Zika transmission• Promote capacity-building, high-quality FP service delivery
• Provide comprehensive and updated evidence-based
counseling on all options and methods
• Prevention of pregnancy for women who do
not want to be pregnant is a primary strategy
to reduce Zika-related birth defects.
Pre-pregnancy
adolescents
ANC visits 1-4+
Birth
• home
• facility
PNC visits
• home
• facility
Immunization visits
Introduction of complementary foods,
return to fertility
Measles immuniz.
Pharmacy/ drug shop visits
Optimizing Contact Points
and Methods to Deliver PPFP
throughout the first 2 years postpartum
Care of Pregnant Women
• Schedule/encourage ANC
visits according to national
standards
• Include discussion of family
planning methods and
document method prior to
labor (≤ 36 weeks)
Adolescents
Postpartum Family Planning (PPFP)
• PPFP counseling and method use allows
women and families to prevent an unplanned
pregnancy
• In the context of Zika, this prevents potential
birth defects in unplanned pregnancies
• Planned pregnancies allow women to actively
prevent Zika exposure before and during
pregnancies
Milliones de Mujeres
Carecen de Servicios Esenciales
Fuente: UNFPA. Planificación Familiar: Clave para el Desarrollo Sostenible. 10 Julio 2017
Numero Estimado de Embarazos No Intencionales
Por falta de Uso de Metodos Anticonceptivos
Fuente: UNFPA. Planificación Familiar: Clave para el Desarrollo Sostenible. 10 Julio 2017
Tasas totales de aborto y de prevalencia del uso
de Anticonceptivos Modernos en 59 países
Mortalidad Materna
Satisfacer la necesidad insatisfecha de servicios
de anticoncepcion moderna y de atencion a la
salud maternal salvaria la vide de mujeres
Fuente: UNFPA
Por cada dolar adicional gastado en servicios
de anticoncepcion por encima del nivel actual, el
costo de la atencion relacionada con el
embarazo se reduciria en $2.30.
Costos/Beneficios
Fuente: UNFPA. Planificación Familiar: Clave para el Desarrollo Sostenible. 10 Julio 2017
Family Planning Counseling
• Discussion of all available methods, including:
• Efficacy (see WHO tiered chart, next slide)
• Mechanism of action
• Procedure/instructions for use
• Non-contraceptive benefits
• Potential side effects, risks
• Eligibility for chosen method
• Follow up plans
Tier 1
Tier 2
Tier 3
Family Planning Counseling
• Several counseling job aides exist to help
with FP counseling, including:
• WHO Medical Eligibility Criteria (2015)
• Selected Practice Recommendations (2013)
• Locally developed FP counseling flip charts
• LARC LRP de MCSP
Module 1: Introduction to
LARC
Module 2: FP Counseling
Module 3: Medical Eligibility & Client Assessment
Module 4: Quality of Care
Module 5: Infection Prevention for LARC Methods
Module 6: Copper
Intrauterine Device (Cu-T 380-A)
Module 7: Hormonal
Intrauterine Device (LNG-IUS)
Module 8: Postpartum
Intrauterine Device
Module 9: Postabortion
Intrauterine Device
Module 10: Contraceptive
Implants
Implementation Guide
Estructura de los Modulos
▪ Duracion varia de 5-10
horas
▪ Mas tiempo para
practicar con modelos
o con pacientes
▪ Incorpora actividades
en ves de
presentaciones
Acceso a Planificación Familiar pos-Evento Obstétrico
▪ Movimiento global con vision de FP2020 y liderazgo de Jhpiego
▪ Miembros del comité ejecutivo global: FP2020, USAID, BMGF, OMS, FNUAP, Gates Institute a JHU y AdvanceFamily Planning, DFID, Packard Foundation and Jhpiego.
▪ El contrasto entre DIU posparto y Implantes posparto
Post-Partum IUD Insertion Practice
Laerdal Mama-U Modelhttp://www.laerdalglobalheal
th.com/doc/2580/Mama-U
Importance of Fundal Placement
STRONGLY recommend ultrasound guidance, especially for training
Equipment• Post-placental:
✓ Graves speculum
✓ Betadine and
cotton/sponges
✓ Forceps
✓Long curved Kelly
32cm, Miltex #302505
✓+/- ring forceps for
cervix
✓ Scissors
• Postpartum:
✓ Bed that breaks away
✓ Light source
Aumento del Uso de DIUPP en India
18%
16%
14%
12%
10%
8%
6%
4%
2%
0%
Mes2011 2012 2013 2014
Ace
pto
res
de
D
IUP
P
Inicio de Tarea Compartida de
inserción de DIUPP
30
Total deliveries: 2,917,919; Total insertion: 237,667(Jan-11 to Apr-14)
Definition of Pregnancy:
• All scientific organizations (including WHO) use this
definition.
• Using the scientific definition we can dispel myths
and misperceptions, demonstrating that none of
these family planning methods cause an
abortion.
…When implantation occurs!!
* All contraceptive methods prevent fertilization of
the egg by the sperm. *
How Contraception Works: Mechanisms of ActionAll contraceptives prevent
fertilization of the egg by the sperm
Fallopian Tube
Vagina
Uterus
* Progestin-only hormonal methods have more than one mechanism of action.
† The Copper IUD works by preventing fertilization but in very rare instances, if used as Emergency Contraception, it may prevent implantation of a fertilized egg.
Ovary
Prevents Ovulation (release of egg
from the ovary)• Hormonal Contraceptives (Combined)
• Combined Oral Contraceptives (COCs)
• Emergency Contraceptive Pills
• Combined Hormonal Vaginal Rings
• Hormonal Contraceptives (Progestin-only)*
• Implants
• Injectables
• Progestin-only Pills (POPs)
• Progestin-only Vaginal Rings
• Lactation Amenorrhea Method (LAM)
Blocks Sperm• Male Condoms
• Female Condoms
Thickens Cervical Mucus• Hormonal Contraceptives (Progestin-only)*
• Hormonal IUDs
• Implants
• Injectables
• Progestin-only Pills (POPs)
• Progestin-only Vaginal Rings
Incapacitates Sperm• Copper IUD †
Cervix
“Same day” contraception
OvulationEnd of
MensesStart of
Menses
End of
Cycle
bHCG
Production
(Urine)
Contraceptive Implant
Improve Application of Recommendations
• Add value to the wheel by offering guidance
how to initiate contraception (jacket=SPR)
o Counseling
o Nuances of different non-permanent
methods
o Special timing: Postpartum, post-abortion,
and post-coital contraception (EC)
o Method effectiveness chart
Simplified & Integrated MEC+SPR Tool
Features:
• Clipboard size
• 3-fold jacket design
• Detachable wheel
inside the jacket
• New color scheme
MEC Wheel Front
Features:
• Revised medical
conditions &
characteristics
• Added male and
female sterilization
• Revised order of
contraceptive
methods
• Added tiers to
contraceptive
methods
MEC Wheel Back
Features:
• Top lists conditions/
• characteristics
which are
recommendation
categories 1 & 2
that are not on
front of the wheel.
Also includes men
& vasectomy
recommendations
• Fewer Explanations
and explanations
simplified
Family Planning can Accelerate the Achievement
of all 17 SDGs
Muchas gracias!
For more information, please visit
www.mcsprogram.org
This presentation was made possible by the generous support of the American people through the
United States Agency for International Development (USAID), under the terms of the Cooperative
Agreement AID-OAA-A-14-00028. The contents are the responsibility of the authors and do not
necessarily reflect the views of USAID or the United States Government.
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