Dr Miriam Chipimo – Senior Policy & Programme Adviser, UNAIDS Strengthen access to comprehensive SRHR services, with specific focus on family planning services Presentation at the Maternal & Child Health Indaba Birchwood Hotel, Johannesburg Dr Miriam Chipimo – Senior Policy & Programme Adviser, UNAIDS 16th July 2012

Maternal Health & the MDGs, ICPD and HLM (June 2011) Both the International Conference on Population and Development and Millennium Development Goals call for a 75 per cent reduction in maternal mortality between 1990 and 2015. This three-pronged strategy is key to the accomplishment of the goal: All women have access to contraception to avoid unintended pregnancies All pregnant women have access to skilled care at the time of birth All those with complications have timely access to quality emergency obstetric care Global Plan Towards Elimination of New Infections Among Children by 2015 and Keeping their Mothers Alive was launched at the HLM in June 2011 Prong 2 address unmet need for FP

London Summit on Family Planning 11 July 2012 Lack of contraceptives has resulted in over 60 million unintended pregnancies every year, putting women at risk of death or disability during pregnancy, as well as unsafe abortions. An estimated 220 million girls and women around the world would use contraceptives if they had access to them Measures would avert an unintended pregnancies over the next eight years and mean that 212,000 fewer women and girls would die in pregnancy or childbirth. Universal access to reproductive health was first laid out at the International Conference on Population and Development (ICPD) in 1994. Yet, two decades later, many governments have still not prioritized funding for voluntary family planning. Gates Foundation, the British Government and countries attending the summit have pledged contributions to address the unmet need for contraceptives in selected countries

Modeling the Unmet need for FP and HIV Preliminary modeling results by UNAIDS using Spectrum suggest that by meeting family planning needs, far fewer women would require ARVs for PMTCT, compared to the number if family planning demand remained unmet. A recent analysis of data from 139 countries assessed the contribution of family planning to HIV prevention. The main results are for the 14 countries with the largest number of HIV-positive pregnant women. The cost of providing family planning to all HIV-positive women who wish to prevent unintended births is almost $26 million in these same countries. If all HIV-positive women in these countries who wanted to avoid unintended pregnancy could do so, this would translate to cost savings-$359 per HIV infection averted.

EMTCT Prong 2: Number of births among all women if unmet need for FP is eliminated by 2015 Eliminating unmet need for FP will reduce # births among all women (regardless of HIV status) from 2.1m in 2009 to 1.6m in 2015).

Cost savings Availing family planning to all HIV-positive women who wish to prevent unintended births would avert HIV infection at $184 less than provision of the most efficacious PMTCT regimen. Taken together, these findings provide evidence to support the argument for women’s right to simultaneous universal access to HCT and appropriate reproductive health/family planning services, so that all women, including those who are living with HIV, may make fully informed decisions about when and whether to have children. National strategies should adopt a comprehensive approach to preventing mother-to-child transmission and thus focus on preventing perinatal HIV transmission as well as unintended pregnancies

Guidance on HIV & hormonal contraception WHO expert group reviewed all the available evidence on possible increased risk of HIV acquisition, Women using progestogen-only injectable contraception should be strongly advised: to also always use condoms, male or female, and other HIV preventive measures. Expansion of contraceptive method mix and further research on the relationship between hormonal contraception and HIV infection is essential.

Why have we not being linking SRH and HIV, EMTCT? Vertical – Policies, Programmes and Interventions Government Structures Humans Resources and Human Factor Weak Health System Not enough Domestic Resources

How Can we Speed Up interventions Coordination and Collaboration – Government, Donors, Partners, CSOs & Communities National Ownership, Leadership & Resources Strengthening of Health System Human Resources Strengthening Change of Mindset - Everyone

Opportunities SRH and HIV and AIDS Linkages Interagency Coordination – Global Fund, USAID, DFID, EC, bilaterals, multilaterals AU’s commitments - MPoA and CARMMA Policies at Global, Regional and National levels National Strategic Plans in some countries, including MNH Road Maps MDGs reviews Gender and Young People programmes

Recommendations Women living with HIV can continue to use all existing hormonal contraceptive methods without restriction. • Consistent and correct use of condoms, male or female, is critical for prevention of HIV transmission to non-infected sexual partners. • Voluntary use of contraception by HIV-positive women who wish to prevent pregnancy continues to be an important strategy for the reduction of mother-to-child HIV transmission

Proposed interventions HIV prevention and SRH integration (including EMTCT, MMC, STIs, dual protection) with the basic package of services at PHC facilities as part of PHC re-engineering: Engage provinces and districts with high teenage pregnancies in developing targeted interventions Strengthen programmes to prevent primary transmission of HIV among young women through the integration of PMTCT into SRH and fertility management services at PHC level (with specific focus on those who test negative and specific positive prevention interventions) Increased number of learners and educators accessing HIV services in colleges & universities. Support the development of Prevention policy, strategy and guidelines for PLHIV

Proposed interventions Strategic information on access to and uptake of HCT and SRH including dual contraception -data disaggregated by sex and age. Sectoral data analysis at national and provincial level should be done, especially on young people Develop a comprehensive SRH package (including HCT and TB prevention) of interventions with a focus on young people at all health care facilities by end of 2013 Increase the number of young people who access comprehensive SRH, FP and prevention services Increase condom distribution and consistent, correct use by young people (with the focus on young women) Integration of PMTCT into SRH and fertility management services at PHC level. Increased number of students and educators accessing SRH and HIV services in colleges & universities HIV Prevention and SRH policy, strategy and guidelines for PLHIV.

Thank you