The Postabortion Family Planning Project PAC Connection Semi-Annual - - PowerPoint PPT Presentation

The Postabortion Family Planning Project

PAC Connection Semi-Annual Meeting January 20, 2015 Grace Lusiola, Project Director

• Background

– Postabortion FP – Long-acting and permanent methods

• The Postabortion Family Planning Project
• Questions and discussion

Outline

Context

Worldwide:

• 40% of all pregnancies are

unintended (75 million annually)

• 47% of unintended pregnancies will

end in an induced abortion (35 million annually)

• 9% of maternal deaths are

attributable to unsafe abortion (38,000 annually)

Sources: Darroch, J.E. and Singh, S., Adding It Up: The Costs and Benefits of Investing in Family

Planning and Maternal and Newborn Health— Estimation Methodology, New York: Guttmacher Institute, 2011. and Sedgh G et al., Induced abortion: estimated rates and trends worldwide, Lancet, 2007, 370(9595):1338–1345.

Postabortion care is a critical opportunity to provide FP to women at high risk of a repeat unintended pregnancy and induced abortion.

Postabortion FP

Postabortion FP is widely recognized as a priority:

• 2013 joint consensus statement (FIGO, ICM, ICN, White

Ribbon Alliance, USAID, BMGF)

• USAID’s and other PAC models
• USAID High Impact Practice
• 2014 WHO-led research prioritization

I mmediately do..

Community Empowerment through Community Awareness and Mobilization Emergency Treatment

FP Counseling, Provision; Selected RH (STI ,HI V)

Method matters

Source: Trussell J. Contraceptive Efficacy. In Hatcher RA, Trussell J, Nelson AL, Cates W, Kowal D, Policar M. Contraceptive Techology: Twentieth Revised Edition. New York NY: Ardent Media, 2011.

The relative effectiveness of various methods at preventing pregnancy:

Method

• No. of unintended

pregnancies among 1,000 women in first year of typical use No method 400 Traditional Withdrawal 220 Short-acting Female condom 210 Male condom 180 Pill 90 Injectable 60 Long-acting and permanent IUD (CU-T 380A/LNG-IUS) 8/2 Female sterilization 5 Vasectomy 1.5 Implant 0.5

Method matters (continued)

% of users continuing family planning methods at one year (worldwide)

Source: Analyses of global DHS data, CYP update analyses under the RESPOND Project

Tubal ligation ~100% Vasectomy ~100% Implants 87% IUD 84% Pill 51% Injectables 53% Periodic abstinence 54% Condoms 50%

Postabortion FP method mix in Tanzania

500 1000 1500 2000 2500 3000 PAC clients Counseled on FP Received a method Number of PAC clients

PAC clients in Mwanza region, 2013

Condoms Pills Injectables IUD Implant Female sterilization

Source: RESPOND Tanzania Project

87%

The Postabortion Family Planning Project

• Five year Cooperative Agreement awarded (2014 to 2019)
• Ceiling of $5 million; $1 million each year
• Purpose: accelerate reductions in maternal and newborn

mortality with increased equity to end preventable child and maternal deaths

• Objective: increase informed and voluntary postabortion use of

LARCs/PMs.

• To be implemented in Tanzania and up to two other countries
• APS to coordinate closely with the Maternal Child Survival

Project and other global projects

The Postabortion FP Project Model

1. Improve organization of PAC services to facilitate FP counseling and services prior to discharge from the facility; 2. Strengthen FP services and referrals; improve method mix to include LARCs and/or referrals for PMs; 3. Facilitate logistics improvements to reduce stockouts; 4. Build policymaker, community, and client demand/support for postabortion FP; and 5. Address provider attitudes limiting delivery of postabortion FP.

In established PAC programs will ...

Phased implementation approach: Phase I

• Identify and establish model(s) to ensure delivery of FP counseling and

services prior to discharge in existing PAC sites in each country

• Provider training and supportive supervision in LARCs and, where there is

enough demand, training in PMs

• Begin implementation research, M&E, and documentation
• Consider scale-up concerns and plan for scale-up

Phased implementation approach: Phase II

• Provide TA, tools, and support to facilitate scale up in new

districts

• Document processes and outcomes

Phased implementation approach: Phase III

• Support monitoring of sites
• Ensure that learning informs institutionalization
• Complete evaluation activities, create final toolkits, consolidate lessons

learned

• Disseminate findings, lessons, and tools at field and global levels
• Advocate for/facilitate institutionalization of postabortion FP within

partners.

Illustrative global activities beginning in Year One

• Collaborate with the International Confederation of Midwives for

competency-based FP training for midwifery tutors

• Review the Global PAC Curriculum to determine how to include

IUD and implant training

• Review BEmONC Curricula for the inclusion
• f postabortion FP
• Identify additional countr(ies) for

implementation

Planned field activities

Year One

• Implement baseline study in Tanzania
• Assess training needs
• Begin trainings and supportive

supervision for providers

Future years

• Build LARC service capacity
• Strengthen referrals for permanent

methods

• Ensure availability of supplies and

equipment

• TA for demand creation and male involvement

Asanteni sana! Questions?