Contraception(331).

CONTRACEPTION AND FAMILY PLANNING IN SOUTH AFRICA

Objectives of the Session

  • Understand personal beliefs and values in the provision and use of contraception.

  • Comprehend human rights principles related to contraception provision.

  • Educate clients on various contraception methods and their mechanism of action.

  • Assess women and provide guidance regarding appropriate contraception methods.

  • Counsel clients prior to initiating contraception.

  • Educate clients on the choices and benefits of contraceptive methods, including child spacing, maternal well-being, economic considerations, and planned pregnancy.

  • Perform screening to determine the best contraceptive options.

Challenges to Contraception Use

  • Understand reasons for non-use and provide health education.

  • Global strategies and indicators that influence family planning programs:

    • Frameworks and goals relevant to family planning.

    • Basic indicators for population and family planning used for global decision-making.

    • Apply human rights principles to family planning programs.

Demographics and Global Health Statistics

  • Global Data from 2019:

    • There are 1.9 billion women of reproductive age (15-49 years).

    • 1.1 billion of these women have a need for family planning:

    • 842 million are using contraceptive methods.

    • 270 million have an unmet need for contraception.

    • Proportion of family planning needs satisfied by modern methods (SDG indicator 3.7.1) has stagnated at 77% globally from 2015 to 2020, but has increased from 55% to 58% in Africa.

  • Health Implications:

    • Use of contraception advances human rights to determine childbirth number and spacing.

    • Access to preferred methods enhances rights such as life, liberty, freedom of opinion, and access to education, which brings health benefits.

    • Increased time between births reduces health risks and infant mortality rates:

    • Births less than 2 years apart increase infant mortality by 45% compared to 2-3 years apart.

  • Trends:

    • Desire for family planning has risen significantly:

    • From 900 million in 2000 to nearly 1.1 billion in 2020.

    • Modern contraceptive use increased from 663 million to 851 million between 2000 and 2020 with a contraceptive prevalence rate from 47.7 to 49.0%. Projection indicates an additional 70 million women will be using contraception by 2030.

  • Barriers Addressing Demand:

    • Limited choice of methods, service access issues, fears of side effects, cultural/religious opposition, gender-based barriers, and quality of available services contribute to contraceptive underuse.

Global Strategies for Family Planning

WHO Reproductive Health Strategies

  • Five core reproductive and sexual health aspects:

    1. Improving antenatal, perinatal, postpartum, and newborn care.

    2. High-quality family planning services, including infertility services.

    3. Eliminating unsafe abortion.

    4. Combating STIs, including HIV and reproductive tract infections.

    5. Promoting sexual health.

Key Action Areas for Countries

  • Strengthening health system capacity.

  • Enhancing information for priority setting.

  • Mobilizing political will.

  • Creating supportive legislative and regulatory frameworks.

  • Strengthening monitoring, evaluation, and accountability.

Human Rights Principles in Family Planning Programs

Definition of Human Rights

  • All human beings are born free and equal in dignity and rights (Universal Declaration of Human Rights).

  • Human Rights treaties include obligations like achieving the highest attainable standard of health related to family planning.

Key Obligations of Health Systems

  • Availability:

    • Sufficient public health facilities, goods, and services must be accessible without restriction.

  • Accessibility:

    • Four Component Framework:

    • Non-discrimination.

    • Physical accessibility.

    • Economic accessibility.

    • Information accessibility.

  • Acceptability:

    • Respect for medical ethics, cultural appropriateness, and confidentiality in health services.

  • Quality:

    • Health services must be scientifically and medically appropriate, involving skilled personnel and compliant equipment.

Autonomy and Agency

  • Individuals must have the ability to make informed choices regarding the number and spacing of their children without coercion or discrimination.

  • Comprehensive access to contraceptive methods must be ensured, including various types like barrier methods, long-acting reversible, and permanent contraception options.

  • Contraceptive information must be offered in a non-discriminatory manner, preserving individuals' dignity and rights.

Empowerment and Equity

  • Empower individuals to become the main agents in deciding their reproductive futures through access to information, services, and supplies.

  • Ensure non-discrimination in accessing contraceptive information and services, regardless of age, geographic location, or other non-medically indicated characteristics.

Informed Choice and Rights-Based Family Planning

  • Importance of informed choice in contraceptive planning and family planning services must be highlighted to ensure client satisfaction and adherence.

  • Rights-based family planning emphasizes the responsibility of individuals and couples to freely decide and plan their reproductive future.

Types of Contraceptive Methods

Mechanisms of Action and Effectiveness

  • Contraceptive methods have varying mechanisms of action, categorized by effectiveness:

    • Very effective: 0-0.9 pregnancies per 100 women.

    • Effective: 1-9 pregnancies per 100 women.

    • Moderately effective: 10-19 pregnancies per 100 women.

    • Less effective: 20 or more pregnancies per 100 women.

  • Potential complications or concerns should be clearly communicated to clients to allow them to make informed decisions, taking possible side effects and contraindications into account.

Common Contraceptive Methods (Estimates)

  • As per the 2019 figures:

    • Rhythm: 29 million users (3%)

    • Male condom: 189 million users (21%)

    • Pill: 151 million users (16%)

    • Withdrawal: 47 million users (5%)

    • Other methods: 15 million users (2%)

    • Female sterilization: 219 million users (24%)

    • Male sterilization: 16 million users (2%)

    • IUD: 159 million users (17%)

    • Injectable: 74 million users (8%)

    • Implant: 23 million users (2%)

National Contraception Clinical Guidelines 2019

  • Medical eligibility criteria for contraception.

  • Suitability is assessed based on specific factors including existing medical conditions versus the associated health benefits.

Case Studies and Counseling Best Practices

  • Importance and impact of counseling discussed in prescription and management of contraception:

    • Addresses client satisfaction and adherence to chosen methods;

    • Strategies for effective communication and engagement to empower clients.

Core Counseling Principles

  • Build trust and rapport; prioritize patient comfort and confidentiality.

  • Provide a clear decision-making process and educate clients on potential side effects and management options.

  • Encourage couples to participate in contraception discussions and consider supportive counseling opportunities for shared decision-making.

Method-Specific Counseling

  • Consideration of individual factors influencing contraceptive choices, including potential drug interactions with ART, TB medication, etc.

  • Provide comprehensive education on the effectiveness and risks associated with different methods prior to client decision-making.

Integrated Approach to Sexual and Reproductive Health

Framework for All-Inclusive Care

  • Emphasize the integration of various health services, which include STIs and HIV testing, TB prevention, and comprehensive reproductive health services.

  • Address the unique needs of diverse groups, including adolescents, men, LGBTQI+ individuals, and women approaching menopause.

Special Considerations for Vulnerable Groups

  • Adolescents and young women should be especially motivated towards safe sex practices.

  • Health service providers need to be mindful of unique cultural sensitivities that affect accessibility and provider-client interactions.

Support for LGBTQI+ Individuals

  • Need for affirmative communication; removing prejudicial language is critical to fostering inclusive environments.

  • Provide counseling on relevant sexual health risks, including prevention strategies tailored to the unique experiences of the LGBTQI+ community.

References

  • National Contraception Clinical Guidelines (2019).

  • Practical Approach to Care Kit (PACK), 2023.

  • National Integrated Sexual and Reproductive Health and Rights Policy (2019).