1. Taking a new look: Expanding Contraceptive Method Choice and Access through Improved Programming for Long-acting and Permanent Methods (LA/PMs)/Global Lynn Bakamjian, MPH Director, RESPOND Project, EngenderHealth

2. Long-acting and Permanent Methods of Contraception Long-Acting Methods –IUD: CuT380A, MultiLoad 375, Levonorgesterol-IUS (Mirena®) –Implants: Implanon®, Jadelle®, Sino-implant II Permanent Methods –Female Sterilization / Bilateral Tubal Ligation –Male Sterilization / Vasectomy (NSV)

3. LA/PMs are most effective methods No method850 Withdrawal270 Female Condom210 Male Condom150 Pill80 Injectable30 Copper T 380A8 Female Sterilization5 LNG-IUS2 Vasectomy1.5 Implants0.5 No. of unintended pregnancies among 1,000 women in 1 year (typical use) Source: Trussell J. Contraceptive efficacy, In Hatcher RA, et al. Contraceptive Technology: Ninteenth Revised Edition. New York NY: Ardent Media, 2007.

4. 10,950 pills (1 every day) 120 injections (1 every 3 months) 6 to 10 implants (1 every 3 to 5 years) 3 IUDs (1 every 10 years) 1 sterilization (one-time only) Number of client actions required to maintain method over RH lifetime

5. A case of two countries: Cambodia: 4% = 10,000 users and 2,500 unintended pregnancies averted Pakistan: 4% = 100,000 users and 25,000 unintended pregnancies averted If only 4% of current oral contraceptive users switched to IUDs or implants, how many unintended pregnancies would be averted over a five-year period? (based on Hubacher et al, Contraception, 2008)

6. D S Long Acting: Implants and IUDs Permanent: Vasectomy, Female Sterilization L Delaying first births -Youth -Nulliperous Spacing between births -Postpartum -Postabortion Limiting births after desired fertility goals are reached H HIV+ can use any LAPM LA/PMs and Meeting Reproductive Intentions

7. Demand for spacing, unmet and met by type of method % MWRA

8. Demand for Limiting, unmet and met by type of method % MWRA

9. Why are these methods underutilized? Physical Cost Knowledge Lack of awareness Provider bias Provider- dependent Medical barriers (inappropriate criteria) Gender and socio- cultural norms Time Myths and misconceptions

10. Proven strategies for expanding access to LA/PMs: Communicate to level the playing field for LA/PMs Advocate at all levels Engage communities to address barriers, including gender lens Focus on the fundamentals of care (choice, safety and quality) in service delivery Look for no missed opportunities to integrate services/referrals (postpartum, postabortion, private sector, mobile outreach, etc.) Address supply, demand and policy/environment factors holistically Program examples: Repositioning IUD in public sector through supply, demand and supportive environment approach in India (Pop Council, 2008) Clinic franchising and health fairs to increase awareness and access to IUDs in Nepal, Pakistan (PSI, 2006) Overcoming myths and misconceptions for vasectomy in Bangladesh (ACQUIRE, 2008)

11. www.respond-project.org