Momentum, May 2013: Family Planning

NEWS FROM THE POPULATION COUNCIL

MomentumMAY 2013

Council research shows that when couples are able to plan and space their pregnancies, they can invest more in each family member. IN THIS ISSUE: president’S MESSAGE: A Renewed Global Commitment Accessing Long-acting Reversible Contraception EXPANDing Access: Public–Private Partnerships BREAKING DOWN BARRIERS TO EMERGENCY CONTRACEPTION ONE RING FOR ONE YEAR Comprehensive Sexual and Reproductive Health Counseling PROFILES: ALI MIR, RESEARCHER IN PAKISTAN, and VALERIE TARICO, COUNCIL DONOR

Y E IDEAS A R EVIDENCE 60 S IMPACT CONSIDER THESE NUMBERS*: THE NEED THE IMPACT Addressing all unmet need for modern family planning would in 222 MILLION each year result in: Women in the developing world would like to delay or stop childbearing but are not using a modern method of contraception. 54 Million 21 Million FEWER Unintended pregnancies FEWER Unplanned births, which or almost 150,000 unintended amounts to over 57,000 per day 20 MILLION 60 MILLION pregnancies per day. Women in developing countries have Women give birth each year unsafe abortions each year. Every without antenatal, delivery, 1.1 Million year, 80,000 of these women will die. and newborn care. FEWER infant deaths, or just over 3,000 per day *Sources: Guttmacher Institute, UNFPA, UNICEF, WHO, and The World Bank C TIONS Y Z ELE MA N PRODU B PHOTO

COVER PHOTO: VIKRAM RAGHUVANSHI 1 president’s message A Renewed Global Commitment

by Peter J. Donaldson

The Population Council believes that when women have access SINCE 1952, POPULATION COUNCIL to family planning and can

plan childbearing, everyone Y OLLIVIER G IR A RD RESEARCH HAS HELPED WOMEN TO PLAN benefits.W omen and children are THEIR FAMILIES AND IMPROVE THEIR LIVES. healthier; families and communities invest B PHOTO more in education and healthcare; and poverty is reduced. We have devoted the family planning, and created a new global Momentum, we are developing a Pakistan (page 14), and Valerie Tarico, who past 60 years to research that changes partnership, FP2020, which pledges the one-year contraceptive vaginal ring (page talks about why she supports the Council policies and improves programs by making sound investment of resources to enable 10), expanding access to long-acting (page 15). contraception more widely available and 120 million more women and girls to use reversible contraceptives, (page 4), and affordable to women, improving quality of contraceptives by 2020. Currently, more forming public-private partnerships to While the London Summit has given new care, reducing side effects, and evaluating than 222 million women in the developing make family planning more widely available energy to global family planning efforts, safety, so women can determine the world want to prevent pregnancy, but are (page 6). The Council has championed the much more needs to be done. The Population number of children they want, and live not using modern contraception. If we can introduction of emergency contraception Council squarely addresses those needs by healthy, productive lives. meet their needs, we can prevent 54 million into national family planning programs developing new contraceptive unintended pregnancies every year and (page 8) and strengthened the integration Thankfully, we are seeing a renewed methods, producing data for save the lives of more than 80,000 women of HIV prevention with family planning decisionmaking, and delivering interest in the power of family planning. and 1.1 million infants. (page 12). In July 2012, the London Summit on program and policy solutions to Family Planning mobilized several billion The Council will make an important You will also meet Council researcher increase contraceptive use, thus enabling dollars, secured financial and political contribution to help achieve the goals of Dr. Ali Mir, who led the Council’s large women to plan their families and safeguard commitments from governments for FP2020. As you will read in this issue of family planning demonstration project in their health and well-being.

2 3 TION C OUN IL Accessing Long-acting Y O F THE POPUL A C OURTES PHOTO Y Reversible To meet women’s needs for safe, effective, and Contraception affordable contraceptive methods, the Population B PHOTO Council is furthering access to long-acting reversible contraceptives (LARCs).

THE PROBLEM Women should have Population Council is a leader in more women in the developing world by Jadelle Access Program access to contraceptive methods that meet expanding access to LARCs. In May 2012, 2020. In September 2012, the UN their family planning needs throughout their the Council, the International Federation announced an initiative to reproductive lives. Highly effective long- of Gynecology and Obstetrics, and the Ensuring that effective THE IMPACT significantly expand access to acting reversible contraceptives (LARCs) are Reproductive Health Supplies Coalition contraceptive methods are part of Jadelle®, the two-rod levonorgestrel a desirable option for many women, but lack convened leading experts to develop the global effort to improve women’s contraceptive implant. The Jadelle of awareness, access, and provider training, strategies to improve access to LARCs, reproductive health will accelerate Access Program will reduce the along with high cost and misunderstandings including reducing their cost, improving progress toward meeting the Millennium implant’s price by more than 50 about LARCs, often prevent healthcare provider training, and integrating LARCs Development Goal of universal access to percent over the next six years, providers from including them among the into national health care systems. reproductive health services. making it available to over 27 million contraceptive methods offered. These recommendations were a key women in developing countries. focus of the London Summit on Family Donors and Partners Anonymous, Jadelle was developed by the Planning in July, where the Council and Bayer Schering Pharma AG, Bill & Melinda THE PROGRESS In addition Gates Foundation, International Federation Population Council in conjunction colleague organizations pledged their to developing many of the long-acting of Gynecology and Obstetrics, Government of with Leiras (now Bayer Schering commitment to the global effort to reversible contraceptive methods available Norway, Reproductive Health Supplies Coalition, Pharma AG). today—including the copper intrauterine provide contraceptives (including LARCs), U.K. Department for International Development, device and contraceptive implants—the information, and services to 120 million U.S. Agency for International Development.

4 5 EXPANDing Access: Public–Private Partnerships

The Population Council initiated public-private partnerships to deliver new contraceptive technologies to poor women at no cost. G R AF I A IN C. OTO Y F B PHOTO

THE PROBLEM Despite advances THE PROGRESS In recent years, those who can afford to pay. The Council THE IMPACT The ARCH Foundation in contraceptive technology, it is often public sector and nonprofit organizations and Bayer Pharma, the global licensee has provided more than 120,000 Mirena difficult for women and health care have teamed up with the private sector to for the Mirena® intrauterine system (IUS) intrauterine systems since its founding in providers in low-resource settings to combine on-the-ground knowledge with the work through two foundations to provide 2002. The ICA Foundation has provided access methods. Barriers include limited resources needed to expand contraceptive intrauterine contraception at no cost to low- 50,000 LNG IUSs to a network of 25 information about contraceptive options, access. Through these partnerships, the income women. The ARCH Foundation makes recipient organizations in Africa, Asia and high cost, and lack of access to clinics with private sector has demonstrated success Mirena available in the United States, and Latin America. knowledgeable providers that offer a wide in providing subsidized services for the the ICA Foundation partners provide the LNG choice of methods. poor, while simultaneously employing IUS (identical to Mirena, but with a different Donor and PartneR Bayer Pharma commercial marketing strategies for inserter) internationally.

6 7 BREAKING DOWN BARRIERS TO EMERGENCY CONTRACEPTION Understanding attitudes about the acceptance and use of emergency contraception can lead to

Y O F THE solutions to increase availability. TION C OUN IL POPUL A C OURTES PHOTO

THE PROBLEM Emergency THE PROGRESS Recognizing the leaders, too, hold positive views of ECP, helping to create a more supportive contraception (EC) is an effective and safe critical role of providers and key opinion believing it fills an important niche in environment around ECP. In India, the method of preventing pregnancy. Because it leaders in determining access to ECP, the contraceptive method mix. However, Ministry of Health is now supplying provides pregnancy protection after sexual the Council conducted a study in India, the study also identified gaps in provider ECP to community volunteers in rural intercourse, EC is an important family Nigeria, and Senegal to understand knowledge of ECP mechanism of action, areas, and in Nigeria and Senegal, planning option for women. In theory, EC attitudes, beliefs, and practices of efficacy, and timing of use, and indicated study findings are being used to improve pills (ECP) are widely available in many providers, government officials, and that providers and opinion leaders provision of ECP in the public and countries; in practice, access is limited decisionmakers on provision and generally did not support providing ECP to private sectors. because of lack of information and training use of ECP. Through surveys and in- women in advance of sexual intercourse. in ECP provision. Many providers and key depth interviews, Council researchers Donors and Partners Family Care opinion leaders have misperceptions and discovered that a majority of providers International; International Consortium Results from the study negative attitudes that prevent ECP from consider ECP to be safe and effective THE IMPACT for Emergency Contraception (ICEC), Bill & are being used to sensitize decisionmakers being offered to clients. in preventing pregnancy. Opinion Melinda Gates Foundation in family planning sectors and are

8 9 ONE RING FOR ONE YEAR

The Council is developing a one-year vaginal ring that, once approved, will provide women

worldwide with an easy-to-use, woman-controlled, HOL M ES Y- highly effective contraceptive method. Y KA REN TWEED B PHOTO

THE PROBLEM It is difficult for many THE PROGRESS The Council is Results from acceptability studies indicate tive choice and availability. More than poor women living in rural areas to obtain developing a contraceptive vaginal ring that the majority of study participants found it 120 million women worldwide have used a contraceptive method of their choice. a woman can insert and remove herself easy to use and comfortable. The Council a Council-developed contraceptive. The Pharmacies need to be well-stocked, and and that is effective for one year. After she is finalizing a submission to the US Food Council’s new vaginal ring, if approved, trained medical workers must be on hand inserts it, the ring is left in for three weeks, and Drug Administration for approval of the will provide women, particularly those to provide methods and counsel clients removed for one week of menstruation, ring, so that it may be available to women living in resource-poor areas, with a safe about benefits and side effects. In low- cleaned, and reinserted for the next cycle. in the United States and pave the way for and effective contraceptive method that resource settings, women who want to This ring is designed to function well in approval worldwide. is under their control. prevent or space their pregnancies need tropical climates and needs no refrigeration affordable contraception that does not during storage and distribution, making it Donors and Partners U.S. Agency THE IMPACT The Council’s ground- for International Development, Bill & Melinda depend on regular visits to a pharmacy or an especially attractive option for women breaking biomedical research has shaped Gates Foundation, Avis and Clifford Barrus health care provider. and providers in the developing world. the way the world thinks about contracep- Foundation.

10 11 Comprehensive Sexual and Reproductive Health Counseling TION C OUN IL The Balanced Counseling Strategy brings integrated sexual and reproductive health Y O F THE POPUL A information to up to 40% more clients in areas

with high rates of HIV and STIs. Y C OURTES PHOTO B PHOTO

THE PROBLEM In countries with low Strategy Plus (BCS+), a collection of THE IMPACT According to a a part of their national family planning contraceptive prevalence and high rates of interactive, client-friendly job aids to family planning advisor in South Sudan, programs, it has been translated into HIV infection, it can be difficult for family integrate family planning with STI/HIV “The cards were very handy, making multiple languages, and it is used by planning service providers to effectively meet screening, counseling, and services. my counseling sessions very easy, and providers in Afghanistan, India, Mali, the multiple sexual health needs of their Comprised of provider manuals, training the feedback from the participants was Mexico, South Africa, South Sudan, clients. Separating family planning services guides, 26 palm-sized counseling cards, great! Now, all 44 pilot primary health and Swaziland. and STI prevention counseling is inefficient and service algorithms in the form of facilities in the ten states of South Sudan for clients and providers, yet providers often decision trees, the BCS+ is versatile have copies for their day-to-day use.” Donors and Partners U.S. Agency lack the counseling strategies needed to enough to serve women in different socio- With the BCS+, family planning providers for International Development, Bill & Melinda address complex sexual health needs. cultural and clinical settings. The BCS+ are able to reach up to 40 percent more Gates Foundation, International Planned covers a wide variety of reproductive health clients with HIV and STI counseling. The Parenthood Federation, London School of Hygiene and Tropical Medicine. THE PROGRESS The Population considerations, including postpartum Ministries of Health in Kenya, Swaziland, Council developed the Balancing Counseling family planning and cervical cancer. and Zambia have adopted the BCS+ as

12 13 A CONVERSATION WITH PROFILE ALI MIR Valerie Tarico Chief of Party, FALAH Project, Pakistan Council Donor

concept of birth spacing for improved maternal WHY I GIVE TO THE What led you to enter the field of After 20 years as a child and family and newborn health. This removed many of public health? therapist, I took time off to travel with my POPULATION COUNCIL the religious and cultural barriers to family After medical school, I worked for two years husband and daughters. We stayed on an in a rural community. By observing the many planning use. The Pakistani government and ashram in India, dove in the Great Barrier health issues people faced and how they policymakers accepted and implemented our Reef, and lingered in a Rwandan village. could be addressed through preventive practices. In his World Population Day speech, We also visited a health clinic in Tanzania. the Prime Minister of Pakistan argued that it There, women were lined up in a cement measures, I developed a deep interest in contraceptive pills gets pregnant. should be mandatory that birth spacing services waiting room, some with a toddler beside public health. I completed my Master’s in With intrauterine contraception be provided by facilities across the country. them and a baby in their arms. Each Public Health from the University of Leeds developed by the Council, like client had walked or scraped together bus before coming to the Population Council. My ParaGard and Mirena®, the odds of How do you successfully work in a fare, some spending the whole day on dissertation was an action plan for improving pregnancy drop to 1 in 500. That’s a challenging political climate? the trip to the clinic to get a contraceptive family planning delivery in Pakistan. Since total game changer when it comes to The Population Council is genuinely respected injection—a process they repeated three joining the Population Council, I have been empowering a woman to decide how by the government and other NGOs. We are months later. proud to see some of my suggestions and she wants to live. recommendations implemented. able to work in areas that others might find hard because of our longstanding history Although I can drive or walk minutes to Thanks in large part to the Population and the trust we have established with get to clinics, I chose for 13 years to What impact has the FALAH (Family Council and its partners, we are policymakers, partners, and community-based use a ParaGard® IUD, since I didn’t want Advancement for Life and Health) project on the cusp of a contraceptive organizations. We are widely recognized for to think about contraception every day had on women’s health and lives? technology revolution. Melinda Gates, our ability to be objective and impartial. As an and loved having a less than one percent Through FALAH, we worked with the health who is committed to increasing example, the FALAH project recorded some chance of pregnancy. Those Tanzanian and population welfare departments of access to contraception for women major successes in the Khyber Pakhtunkhwa women were going to such great effort! the Pakistani government in rural, socially in developing countries, tells of her province in north western Pakistan, Could I do the same under those conservative areas to promote the concept encounter with an African mother considered to be one of the most traditional circumstances? When I returned home, who said, “I want to bring every of “birth spacing” as an acceptable health and conservative regions of the country. I started exploring ways to help other good thing to one child before I have intervention to protect the lives of women women have better options. and infants. Our communications campaign What are your greatest challenges in another.” I believe in the power of voluntary family planning to promote reached more than 50 million men and the work ahead? The Population Council does important a child’s well-being, marital stability, women. Contraceptive use increased by 28 work related to HIV prevention and The Population Council needs to keep family health, and the empowerment percent in three and a half years. girls’ empowerment, but I was drawn a spotlight on population issues so that and education of girls and women. to the organization for other reasons. provincial governments continue to include Whether at the individual level or at What has been your greatest The Council’s approach to research and them in the development of their policies. the aggregate level, I can’t overstate accomplishment at the Council? technology development starts by looking During upcoming elections in Pakistan, family the ripple effects of the Population at the big picture to overcome the gaps In the final years of FALAH, our team achieved planning needs to be at the top of the political Council’s research. what we set out to do by helping couples to agenda. We are educating major political in contraceptive methods currently on better plan their families and improve their parties to make them aware of the importance the market. I am especially impressed health. We moved away from the traditional of population issues so that regardless of who by the Council’s work on long-acting, family planning concept of promoting small is victorious, they can implement policies in reversible contraceptive methods. Each families to a new paradigm that uses the their provinces after elections. year, one in 12 women who use oral

14 15 By age 28, Asma, a woman living more than 50 million people THE POPULATION COUNCIL DEVELOPS in a rural village in Pakistan, like Asma with information PRODUCTS, GENERATES EVIDENCE, AND had six children. There was no about family planning. As DELIVERS SOLUTIONS THAT PROTECT AND formal system of information a result, contraceptive use PROMOTE WOMEN’S HEALTH. on contraceptive services in her increased by 28 percent in Worldwide, the Population Council and our village. Women in the village said some of the most conservative partners help millions of women like Asma to that family planning methods areas of the country. The access the reproductive health care services and had severe side effects. highest increases were among supplies they need to safely plan their families. poor, rural, and younger With your help, we will develop contraceptive In Asma’s village and other couples. The Pakistani methods and undertake groundbreaking areas of Pakistan, the Population government and policymakers research to inform family planning policy and Council promoted healthy “birth acknowledged that redefining program development. Your contribution allows spacing” and engaged the family planning as “birth us to improve the health of women, expand their support of religious leaders who spacing” for maternal and economic opportunities, and improve the welfare exerted strong influence over child health has the potential of their families and communities. family planning decisions. In to contribute significantly to Sign up for the Population Council email list four years, the project reached increased contraceptive use. to receive news about our research: www.popcouncil.org/signup Support the Population Council: www.popcouncil.org/supporting TION C OUN IL Y O F THE POPUL A C OURTES PHOTO

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