Workshop on Investing in Family Planning The Case for LAPMs A family planning forecasting tool for evidence based advocacy and planning Workshop on Investing in Family Planning The Case for LAPMs A family planning forecasting tool for evidence based advocacy and planning John M. Pile, Roy Jacobstein, Jan Kumar, Alyson Smith, Jane Wickstrom The ACQUIRE Project Kampala, Uganda January 29-31, 2007

The number of women of reproductive age is large and growing.

Demand for family planning is high, yet…. Globally ~716 million women use FP In Sub-Saharan Africa ~26 million women use FP In Uganda ~ 1 million women use FP

Globally over 120 million women have unmet need for FP In Sub-Saharan Africa ~30 million women have an unmet need for FP. In Uganda ~ 1.8 million have unmet need Significant unmet need for family planning

Family planning saves lives—addressing unmet need in Uganda Meeting the unmet need for family planning by 2015 would result in an estimated 4.6 million fewer unintended pregnancies 1.2 million fewer abortions 2.8 million fewer unintended births ~17,000 maternal lives saved ~1.1 million children lives saved

Reducing unmet need for FP can help countries to meet the MD Goals by reducing the cost of meeting the MD Goals. Liz Gilbert, the David & Lucile Packard Foundation Chamberlain Diala, JHU/CCP Family Planning and the Millennium Development Goals

Focus on 5 of 8 Millennium Development Goals: Achieve universal primary education Reduce child mortality Improve maternal health Ensure environmental sustainability Combat HIV/AIDS, malaria and other diseases

US$ (million) Family Planning, $97 M Education, $158 M Immunization, $52 M Water & Sanitation, $59 M Maternal Health, $126 M Malaria, $13 M Total Savings: $408 M Total Costs: $97 M Source: Moreland and Talbird Social Sector Cost Savings and Family Planning Costs in Uganda

Family planning can have a significant and cost- effective impact in HIV/AIDS prevention efforts

Source: USAID. Adding Family Planning to PMTCT Sites Increases PMTCT Benefits. Global Health Issue Brief. July Benefits of PMTCT Services and Family Planning Added to PMTCT Services in 14 High-Prevalence Countries in 2007

IUCDs Implants Vasectomy Minilap The Case for LAPMs

LAPMs are an important and attractive method option for women and men who wish –to delay a first birth, –to space births, and –to limit family size once they decide that they want to have no more children. LAPMs are equally suitable for –young and older women, –women who have been pregnant and those who have not, –people living with HIV, –as well as postpartum and post-abortion women The case for LAPMs: LAPMs address the full range of women’s and couples’ needs

Pregnancy Rates by Method The case for LAPMs: LAPMs are especially effective

% Women and men using FP methods at one year Periodic abstinence51% Condoms53% Injectables56% OC pills68% IUD78% Implants84% Tubal ligation100% Vasectomy100% Source: 2003 Kenya DHS The case for LAPMs: LAPMs have lower discontinuation rates than short- acting methods

Source: UNFPA Achieving the ICPD Goals: Reproductive Health Commodity Requirements Assumes IUD Norplant and Jadelle used for 3.5 years; Implanon for 2.5 years; and female sterilization and vasectomy for 10 years. Commodity Cost (US$) to Health Care System Per Year of Protection, by Method The case for LAPMs: LAPMs are cost effective

Source: UNFPA Achieving the ICPD Goals: Reproductive Health Commodity Requirements Comparison of Annual Contraceptive Commodity Costs for Short- and Long-acting Contraceptives Over 1 to 5 Years

LAPMs Needed, Wanted and Crucial The health and cost benefits of investing in family planning are well known, well documented and substantial. LAPMs have clear advantages among methods of family planning to both clients and health systems.

LAPMs Needed, Wanted and Crucial The unmet need for family planning in Uganda is great— 1 million Ugandan couples have an unmet need to space, 700,000 have an unmet need to limit. An investment of less than $100 million to address this unmet need will avert more than 1.1 million maternal and child deaths, 4.6 million unintended pregnancies and is more than offset by the resulting savings in achieving millennium development goals of universal primary education and environmental sustainability.

Call to Action In the absence of widespread availability and use of LAPMs, a country’s fertility will generally stay high, and national development will be low and slow. Despite other compelling public health and development challenges Uganda faces, the need to make LAPM services more widely available, accessible and used is pressing and should be given even higher priority.