August 2018 News Review

Access to Contraception

Guaranteeing accessing Contraceptive Commodities – condoms, implants, IUDs, or pills – is a complicated task with many variables. Funding, administrative approvals, supply chain management, provider and end-user training and counselling, communication and reducing stigma all have an influence on reducing the unmet need for contraception.

The most important aspect is giving women and girls, and secondarily their partners, control of their reproductive health.

The consensus also is that “Modern contraceptive methods are key to development” (Tanzania Daily News), a “Key to Achieving the SDGs” (Modern Ghana), which “spurs economic growth.” (Business Day Nigeria).

That unmet need for women in some parts of Africa can be dire. One study showed that almost 90% of (DR) Congolese women are unable to access any modern method of contraception. Which can have consequences in places like Angola, where 50 percent of pregnancies happen before the age of 18.

How to plug that gap? In Ethiopia, Marie Stopes International introduced a digital family planning counselling application. Another Ethiopian study showed that greater macroeconomic issues of poverty and overall ante-natal and post-natal care are predictors of use of postpartum contraception. Education levels are determinants as well, as described in articles from Ghana, Nigeria, and South Africa, where one project is using “indigenous education systems” to boost family planning knowledge.

Reducing stigma and myths: Cultural and religious “misconceptions” hinder use in Nigeria. In Kenya, most Catholics approve of condom use but there are still “taboos” including the simple act of talking to children about birth control. Family planning is boosted as a human right (Ghana), use of condoms is cool (Kenya), and one Zimbabwean newspaper is compelled to run an article that states: No, distributing condoms in prisons does not promote homosexuality.

Meeting the future gap will require new business models, social franchising, online financing tools, better data analysis and other innovations.

The Reproductive Health Supplies Coalition looks at the global contraceptive commodity gap: “The results of this analysis suggest that by 2020, there will be 493 million users of contraception in the 135 low- and middle-income countries. Meeting their contraceptive consumption needs over the next three years will require $8.45 billion. Out of pocket expenditures will account for the vast majority of that financing.”

A similar study by Guttmacher looks only at adolescent contraceptive use into the future. Under the best scenario, “the number of modern method users would reach 27.1 million in 2030, and the proportion of adolescent women whose need for modern contraception would be met would rise to 79%. Contraceptive services for the 7.1 million modern method users in 2030 would cost an estimated $365 million under an assumption of increased LARC use. In 2030, an estimated 10 million unintended pregnancies would be averted under this accelerated growth scenario.”

In the US, improvements in contraceptive use—including increases in use of long-acting reversible contraception and withdrawal in combination with another method—appear to be driving recent declines in adolescent birth and pregnancy rates.

Two new commodities were approved by the US Food and Drug Administration: the Annovera vaginal ring that can be effective for one year, and a controversial “digital birth control” app, similar to one that had its advertising banned in the UK, which has a 6.5% failure rate. Amid much talk about the need for contraceptive pills for men, with three “promising new methods” in advanced development, Uganda’s Daily Monitor asks its readers, “Would you use it?”

The Need for Preservice Family Planning Training for Doctors, Nurses and Midwives

CIRHT is dedicated to preservice training in contraception and comprehensive abortion care to improve the lives of girls and women and reduce maternal mortality and morbidity. One study in Global Health: Science and Practice looked at adaptation of that training in Tanzania and Uganda:

“Adaptation of an evidence-based global family planning training resource in Tanzania and Uganda resulted in substantive changes to the curricula of the reproductive health preservice course unit that will support nurses and midwives to provide quality, rights-based family planning services.”

An essay in The New York Times puts it simply: Want to Protect the Right to Abortion? Train More People to Perform Them.

Research Highlights

Two studies by colleagues at the University of Michigan also address the theme of access to contraception.

Michelle Moniz was the lead author on research that showed the clear link between Medicaid expansion in Michigan as part of Obamacare and women’s access to birth control and family planning services. “Our findings suggest that the expansion provided an important service for populations with a high unmet need for family planning care. Unmet reproductive health needs can lead to unintended pregnancy, which has a higher risk of adverse health outcomes and is expensive to the health care system.”

Justine Wu looked at stereotypes of women with intellectual and developmental disabilities (IDD), who are “less likely to receive effective reversible contraception… pervasive stereotypes about women with disabilities negatively affect the way health care providers counsel women about their reproductive and contraceptive options and how women perceive their own sexual and reproductive agency.”

Algeria

Dr Yacine Terkmane : «Non, l’avortement n’a pas été légalisé en Algérie», Algerie Monde, 16 Aug 2018

Nécessité de mettre en œuvre et suivre la stratégie nationale de planification familiale (spécialistes), Algerie Press Service, 31 Jul 2018

Angola

Le dialogue et l’autonomisation des femmes aident à réduire les grossesses précoces, ANGOP, 17 Aug 2018

Cinquante pour cent des Angolaises ont conçu avant 18 ans, ANGOP, 15 Aug 2018

Burkina Faso

Santé de la mère et de l’enfant : La fondation Buffett propose son soutien au président du Faso, Sidwaya, 26 Aug 2018

Droit à la santé de la reproduction, Sidwaya, 22 Aug 2018

DRC

In #DRCongo almost 90% of Congolese women are unable to access any modern method of contraception., Marie Stopes International, 14 Aug 2018

Promotion des droits des femmes en Afrique. Protocole de Maputo : la vulgarisation lancée !, La Prosperite, 2 Aug 2018