Download - Dr. j melgar family planning and development
Global Rationales & Actual Benefits of Family Planning
Junice L.Demeterio-MelgarTraining of Medical Educators in
Family PlanningSilliman University, May 2010
Some early FP technology
pig intestine condoms
Crododile dung pessary
weasel’s testicles
Oral mercury Gold/silver diaphragm
lemon
Ian Fortey, Cracked.com
4 Pre Sept 1994 Rationales
• Population control – Government FP programs
• Birth control
• Contraception
• Responsible parenthood
Pop theory: too many people consume resources, destroy environment
World Pop in 2010: over 7 B
Thomas Malthus 1766-1834
“population increases geometrically while subsistence increases in arithmetic ratio”
http://www.economyprofessor.com/economictheories/malthusian-population-theory.php
“Overpopulation is not simply population density but the numbers of people in an area relative to its resources and the capacity of the environment to sustain human activities”.
Paul Ehrlich 1932-present
Women’s Reproductive Rights: pregnancy can be unwelcome
Margaret Sanger 1979-1966
"no woman can call herself free who doesn't own and control her own body.“http://www.nurses.info/personalities_margaret_sanger.htm
feminist writer (Married Love, Wise Parenthood)
Marie Stopes 1880-1958
Women’ right to FP (CEDAW 12.1 &General Recommendation No. 21
Article 16 (1) (e)
• 21. Women are entitled to decide on the no. and spacing of their children
• 22. Women need information and services on sexuality and contraception
• 23. Ensuring women’s right to FP results in family wellbeing, environmental protection and sustainable economic & social development.
Religious doctrine: all births are blessings
Pope Paul VI, 1897-1978
-Marriage & conjugal love are naturally ordained toward procreation and education of children. Every marital act must be open to the procreation of human life.
-Prohibited: abortion, temporary or permanent sterilization, contraception, includig emergency contraception
- Allowed: rhythm
Humanae Vitae (1968)
Humanae Vitae cont’d…
Dangers of artificial contraception:
1. Lowers moral standards, inc. marital infidelity
2. Causes men to disrespect women
3. Allows State to dictate on couples’ private decisions
http://www.vatican.va/holy_father/paul_vi/encyclicals/documents/hf_p-vi_enc_25071968_humanae-vitae_en.html
Medical science: FP as necessary Health service to women
WHO, USFDA, FIGO, ACOG, Williams…
• Pregnancy is established when a fertilized egg implants on the uterine lining. USFDA, AMA, ACOG, FIGO, Williams Obstetrics 22nd ed.
• Contraception prevents pregnancy mainly through preventing ovulation and fertilization. WHO Expert Opinion on House Bill 4643 On Abortive Substances and Devices in the Philippines,2006
• Contraceptives are not abortifacients.WHO Expert Opinion on House Bill 4643 On Abortive Substances and Devices in the Philippines,2006
Abortion is different from contraception
Abortion is the termination of pregnancy, before the fetus develops sufficiently to survive – i.e. prior to 20 weeks gestation or less than 500g birthweight. Williams Obstetrics 22nd ed.
Medical abortion drugs: mifepristone, misoprostol;Surgical methods: transcervical procedures, eg vacuum aspiration, dilatation and curettage, and dilatation and evacuation. WHO Expert Opinion on House Bill 4643 On Abortive Substances and Devices in the Philippines,2006
Contraceptives very safe
• OCP nonsmoker, per 100T users:1.5Per year: 1:67,000
• OCP heavy smoker, per 100T: 59Per year: 1:1,700
-IUD (per year), per 100T users 0.01Per year: 1:10,000
• Barriers, per 100T per 100T users 0.0 Per year: 0
• FAB, per 100T users: 0.0 Per year: 0
• Female sterilization, per 100T users 2.6 Per year: 1:38,000
• Male sterilization, per 100T users 0.1 Per year: 1:1,000,000
Contraceptive Technnology 17th ed, 1998
…compared to• Risk of death from pregnancy & childbirth in Asia
– Per 100T livebirths 390– Lifetime risk: 1:65
• Other risks of death in US– Motorcycling, per 100T users: 100
• Per year:1:1,000
– Automobile driving, per 100T users: 16• Per year:
1:6,000
– Continuing the pregnancy, per 100T LB: 10• Lifetime risk: 1:10,000Contraceptive Technnology 17th ed, 1998
TYP
USE
.1 .15 .3 .5 .8 1 2 6-8 14 20 20 21 26 85
COR
CON
USE
.1 .1 .3 .5 .6 .5 .5 .1 3 6 1-9 5 6 85
NO
RP
LAN
TV
AS
EC
TOM
YIN
JEC
TAB
LEFS
TER
ILIZ
NTC
u380
AIU
DP
OP
brea
stfe
edin
gLA
M6m
osO
CP
CO
ND
OM
DIA
PH
+SP
ER
MC
IDFA
B
FCO
ND
OM
SS
PE
RM
CID
NO
ME
TH
OD
0-1: Always very effective
2-9: Effective as common-Ly used. Very effective when used correctly &consistently.
10-30: Only somewhat effective ascommonly used. Effective when used correctly & consistently
(0-1) (2-9) (10-30)
Pregnancies per 100 Women in 1st 12 mos Use
Modern Contraceptives: Very Effective
WHO, USAID, Bloomberfg, Family Planning A Global Handbook, 2007
Contraceptives: in WHO Core List of Essential Medicines
Minimum medicine needs for a basic health care system, listing the most efficacious, safe and cost-effective medicines for priority conditions. Priority conditionsare selected on the basis of current and estimated future public health relevance, and potential for safe and cost-effective treatment.
http://www.who.int/medicines/publications/essentialmedicines/en/
Women
PopulationChurch
Medical
ICPDPOA
1994
The Reproductive Health Consensus
ICPD POA major Goals (1.12)
– sustained econ growth in the context of sustainable development
– education, especially for girls – gender equity and equality – infant, child and maternal mortality reduction – provision of universal access to RH services,
FP & sexual health.
Reproductive Healthstate of health in all matters relating to the reproductive system,its functions and processes
Implies: • satisfying & safe sex life• capability to reproduce • freedom to decide if, when, and how often to
reproduce– right to FP
• access to health services that will enable women to survive pregnancy & child birth, and for infants to be born healthy
• right to sexual health Intl Conf. on Pop. & Devt. Programme of Action Ch 7 Para. 2
•FP counselling, IEC & services; •Maternal & child health •Infertility prevention & treatment of infertility•Abortion per para. 8.25, including prevention & management of consequences •RTIs, STIs & other conditions - prevention & treatment •Sexuality & responsible parenthood IE & counselling •Referrals for complicated cases•Active discouragement of harmful practices, such as FGM,
ICPD 7.6
RH services as part of Primary Health Care
•No promo of abortion as FP•Address public health impact•Prevention of unwanted pregnancy•Compassionate counselling of women with unwanted pregnancies •Abortion policy change must be done according to national legislative processes •In circumstances where abortion is not against the law, such abortion should be safe. In all cases, women should have access to quality services for the management of complications arising from abortion. •Post-abortion counselling, education and family-planning services to avoid repeat abortions.
Abortion – according to ICPD POA 8.25
Goal: enable couples and individuals to decide freely and responsibly no.& spacing of their children
Ensure informed free choice, is essential to long-term success of FP programs.
Coercion, incentives and disincentives, targets & quotas have not worked
Governmental goals for FP should be defined in terms of UNMET NEED for information and services.
ICPD POA 7.12
FP Program principles
Bruce-Jain Framework of Quality FP Care (1990)
• Choice of contraceptive methods
• Full & accurate information
• Technical competence
• Interpersonal communication
• Continuity of care and follow up
• Appropriate constellation of servicesCreel et al, Overview of Quality of Care in Reproductive Health: Definitions and
Measurements of Quality of Care, PRB & PopCouncil 2002
FP Benefits
• Saves women’s, men’s & children’s lives
• Improves women’s & family’s productivity
• Generates public health savings
• Reduces population pressure on scarce resources
Guttmacher Institute and UNFPA, Adding it Up: The Costs and Benefits of Investing in Family Planning
and Maternal and Newborn Health, 2009; Population Reference Bureau, Family Planning Saves Lives, 2009
Comparative Cost-Effectiveness of FPIntervention Cost $ per
DALY saved
Insecticide-treated bednets 3-20Malaria prevntn for pregnant women 29TB treatment (epidemic sitns) 6-60Modern contraceptive methods 62ARV treatment India 150
ARV treatment Sub-Saharan Africa 252-547BCG vaccination of children 48-203Oral rehydration therapy 1,268Cholera immunization 3,516
Guttmacher Institute and UNFPA, Adding it Up: The Costs and Benefits of Investing in Family Planning and Maternal and Newborn Health, 2009