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Access to medicines for women

and children

ACCESS TO ESSENTIAL MATERNAL AND

REPRODUCTIVE DRUGS: WHERE ARE WE?

Dr. Raffaela Schiavon

Ipas Mexico

Index

Maternal and Reproductive Health Indicators

(MDG 5):

• Maternal Mortality Rate

• Contraceptive Prevalence/Unmet Needs

• Mexico as a case study.

Access and procurement of RMNH commodities:

• Model Lists of Essential Medicines (MLEMs)

and interventions

• EC and misoprostol as case studies

Maternal Mortality Ratio 1990-2013

http://www.who.int/gho/maternal_health/mortality/maternal/en/index1.html

Contraceptive Use/Unmet needs

In 2014, there are 1,556 million women of reproductive

age; 877 million want to avoid pregnancy (36% to stop

and 21% to delay childbearing).

Contraceptive Use/Unmet needs Every year, there are 123 million desired and 87 million undesired pregnancies. Most of them are due to non-use or under-use of modern contraceptives. Reducing the number of unintended pregnancies could avert 60% of maternal deaths and 57% of child deaths (WHO, 2014).

Undesired/ Pregnant Women

Undesired/Non-pregnant Women (n,%)

Pooled 12,874 (100%) 111, 301 (100%)

Modern Methods 11.3% 50.5%

Traditional Methods 10.3% 20.9%

No Method 78.4% 28.6%

Bellizzi S et al. Hum. Reprod. 2015;humrep.deu348

Modern Contraceptive Use & Abortion Rates

Westhoff CW. DHS Analytical Studies No. 13 A New Approach to Estimating Abortion Rates, USAID 2008

Mexico: Maternal Mortality

MMR 1990-2013: actual vs. committed

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

19901991199219931994199519961997199819992000200120022003200420052006200720082009201020112012

Pre-Eclampsia Otras causas

Hemorragia obstétrica Causas indirectas

Aborto Infección puerperal

% of MM causes 1990-2013

-

100.0

200.0

300.0

400.0

500.0

600.0

700.0

800.0

900.0

-

20.0

40.0

60.0

80.0

100.0

120.0

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Aborto c/complicación Patológicas Aborto s/complicación Total aborto

*/ Rate: N° of Abortion-related Hospitalization per 100,000 women 15-44 ys. Source: Ipas México, 2015

Mexico: Abortion Hospitalization Rates

2000-2013

Mexico: Contraceptive use….

63.1

36.4

55.4

72.5

44.7

62.9

0

10

20

30

40

50

60

70

80

90

TOTAL 15-19 20-24 25-29 30-34 35-39 40-44 45-49

…& Unmet needs

1992 2009

Index

Maternal and Reproductive Health Indicators

(MDG 5):

• Maternal Mortality Rate

• Contraceptive Prevalence/unmet needs,

• Mexico as a case study.

Access and procurement of RMNH commodities:

• Model Lists of Essential Medicines (EMs) and

interventions

• EC and misoprostol as case studies

Access to and consistent

procurement of reproductive,

maternal and neonatal health

commodities

Role of international

agencies and networks

Model Lists of Essential

Medicines (EMs) and

interventions

Essential Drugs in SRMN Health

http://www.rhsupplies.org/fileadmin/user_upload/Maternal_Health_Supplies/Essential_Medicines/

WHO MLEM: Contraceptives

Map of Emergency Contraceptive

WHO MLEM: Oxytocics

Misoprostol

Technical

Guidelines

Total World Market for Misoprostol

Source: RHSC:Investing in production of high quality misoprostol for low resource settings, 2015

Map of misoprostol

Emergency

Contraception

Misoprostol

Mexico case study

Mexico: Essential Interventions & Drugs

in SRMN Health

ICD -10 ICD-9

Essential Drug List

(Cuadro Básico de Medicamentos)

Federal Normative Support & Technical Guidelines (NOMs/GPCs)

EC in the FP Norm

1. Yuzpe Regimen

2. LevoNorgestrel only: > 12 commercial brands

3. Progestin- Receptor Modulator: Ulipristal

AE de Progestina sola

CLAVE 2210

levonorgestrel 0.750 mg. con dos tabletas

22

CAUSES 2014: Contraceptives # 89 FP Methods: Hormonal

OC Dg 0.15 mg + EE2 0.03 mg

Lng 0.15 mg + EE2 0.03 mg

Lng 0.03 mg

NET .400 mg + EE2 0.035 mg

Inyectables MAP 25 mg + Cipionate E2 5 mg IM

NET 50 mg + EE2 IM

NET 200 mg IM

Implant EtoNg 68.0 mg

Transdermal Patch Norelgestromin 6.00 mg EE2 0.60 mg

EC Lng 0.750 mg

# 91 FP Methods: IUD

Medicated IUD Lng 0.52 mg

Copper IUD IUD Cu 380, IUD Cu 375 short, IUD Cu 375 std,

Tshaped IUD nulliparous

#240/#251 Permanent FP Method Women/men

Permanent Methods TL/vasectomy

#90 Contraceptive counselling/condoms

Condom MALE AND FEMALE

EC sales in Mexico 2004-2013

24

CAUSES 2014: Abortion

Normative Support: Technical Guidelines (MoH) GPC IMSS 088 08 Misoprostol recommended CAUSES #243 Dx & Tx of Incomplete Abortion (does not

include Legal Termination of Pregnancy) ICD-10: O02, O03, O04, O05, O06 ICD-9: 69.02 D&C; 69.52 MVA No oxytocic included

Prevención, Diagnóstico y Manejo

de la Hemorragia Obstétrica

Lineamiento Técnico

Centro Nacional de Equidad de Género

y Salud Reproductiva

CAUSES 2014: Post-partum

Hemorrhage

Normative Support: 3 NOMs & 3 GPC Misoprostol mentioned CAUSES #194 Tx of Obstetric/Puerperal Hemorrhage

ICD-10: O72

Oxytocic included: Ergometrin Oxytocin

Prevención, Diagnóstico y Manejo

de la Hemorragia Obstétrica

Lineamiento Técnico

Centro Nacional de Equidad de Género

y Salud Reproductiva

http://reprolineplus.org/misoprostol-case

What do we need?

Alignement in SRMN Health

Technical Norms & Guidelines Programs and Services

▫ Different Goals/Indicators ▫ “Coverage” vs. Access ▫ Interventions vs. Supplies ▫ Unmet/Met need

Budget: ▫ Federal & State level ▫ Different sources of Budgetary lines

Accountability ▫ Transparency (robust and public information systems) ▫ Effective mechanisms for enforcement, justiceability, redress

and remedy

Access to medicines for women and

children

THANKS Dr. Raffaela Schiavon

Ipas Mexico