Contraception in Sarawak –where are we now?

Dr. Radziah Hj MohamadFamily Health Development Section

State Health Department22.11.2014

Globally, many pregnancies are still unintended

Global data 2008

Epidemiology of Contraceptive

• Usage varies in many parts of the world; • Increase in Asia & Latin America• Low in sub Saharan Africa

• Globally, slight increase in modern contraceptive usage from 54% in 1990 to 57% in 2012

• Malaysia, the family contraceptive prevalence rate was at 51.9% (2004), overall achievement low despite vigorous effort

Factors related to increase use of contraceptive.• Greater availability of reliable contraceptive methods.• Continuous effort to promote the use of family planning

• Greater access to the contraceptive

The Un-met Need

• Annually, 6 million to 27 million unintended pregnancies occur among

people practicing contraception.• 120-150 million , couples do not use

contraceptive

Unmet Need for spacing childbearing-proportion of currently married women who want to posphone their next birth for 2 years or more but not using an effective Family Planning

Un-met need for limiting childbearing- Proportion of currently married women who do not want any more children but are not using an effective family planning method

Health Concerns and Opposition to Family Planning Are Leading Reasons That Women Do Not Use Modern Contraception, Even Though They Want to Avoid Becoming Pregnant

Source: Jacqueline E. Darroch, Gilda Sedgh, and Haley Ball, Contraceptive Technologies: Responding to Women's Needs (New York:

Guttmacher Institute, 2011).

Contraceptive Prevalence Rates (CPR) - Malaysia

5.3

34.4

51.4 53 54.551.9

1966 1974 1984 1988 1994 2004

Source – Malaysia Population Family Survey 2004, LPPKN

Modern method = 34%

The proportion of women of reproductive age (married) who are currently using a

contraceptive method

Status Of Family Planning Practices

0

10

20

30

40

50

60

1974 19841994

2004

36

52.2 54.851.9

26.330.3

30.234.4

any method modern method

0

10

20

30

40

50

60

1989 2004 1980 2004

50.1 50.4

57.8

53

30.1

37.4

44.4 42.3

any method modern method

Sabah Sarawak

Peninsular

1974 -20041989 -2004

The correlation of contraceptive use and maternal death

Lifetime Risk for Maternal Mortality & Percentage of Modern Contraceptive Usage

Country Lifetime Risk for

Maternal Mortality

( 1 in number stated)

Percent of women

using modern

contraception

Bangladesh 1 : 59 43%

Chad 1 : 11 2%

Malawi 1 : 7 26%

Pakistan 1 : 31 20%

Australia 1 : 5,800 72%

Malaysia 1 : 660 42%

Maternal Deaths By Practice Of FP : Malaysia 2006 - 2011

Family

Planning

2009 2010 2011

n % n % n %

Ever User 38 24.7 29 19.9 40 30.8

None user 114 74.0 86 58.9 65 50.0

Don't know 2 1.3 31 21.2 25 19.2

Total 154 100.0 146 100.0 130 100.0

Family Planning As An Indicator Towards Achieving Mdg Goals

Family Planning As An Indicator Towards Achieving MDG Goals

Family Planning

2006 2007 2008

n % n % n %

Ever use 30 23.6 25 18.4 24 18.3

None user 68 53.5 86 63.2 82 62.6

Don’t know 29 22.9 25 18.4 27 19.1

Total 127 100.0 136 100.0 133 100.0

Data source : report on the CEMD in Malaysia 2006-2008

Family Planning Usage Among Reported Maternal Death , Malaysia 2006-2008

Contraceptive in Sarawak.To begin with:

• 1966, provision of services by Sarawak Family Planning Association (SFPA) with support of International Planned Parenthood Federation (IPPF)

• 1977, The National Family Planning Programme extended to Sarawak , incorporate the activity into MCH programme

Objectives :To promotes the health of the mothers and

children ; encourage spacing of the childbirth

Millennium years:Continuation of the traditional services in MCH

2008 clinic near SFPA Facilities initiated the service2012 – expansion of services in the hospital2013 – all health clinic & hospital involved

Sarawak NPFDB –started 2002

National population and Family Federation board

Main Agencies Providing FP In Sarawak –MOH, FHRAM

0

20

40

60

80

100

120

1970 1980 1990 2000 2010

MOH

FRHAM

New Acceptor for FP Sarawak

Percentage of New Acceptor of Contraceptive by Method Sarawak (2010-2014)

84.68

78.94

68.55

58.9154.14

15.3121.06

31.45

41.0945.79

0.01 0 0 0 0.010

10

20

30

40

50

60

70

80

90

2010 2011 2012 2013 2014(till Sept)

Pill

Inj

Implan

IUCD

others

New Approach of Family Planning Services

• Emphasis services to the target groups ( High Risk Client)• Emphasis on effectiveness to improve provision of a quality

services ( timing, method )• Monitor the work process more effective and quality( good model of care) using qualitative indicators .

General Objective: Reduce morbidity and mortality among children and mothers due to pregnancy and / complications of pregnancy through family planning

practices

Specific Objective:• Determine a basic level of effective family planning

practices among high-risk customers . • Ensuring effective family planning practices and continued

for at least 2 years

IndicatorsQuantitative Indicator;

Percentage of high risk clients whom are registered in the programmepractice family planning method code 1 in the current year

( Code 1 = method of contraception with a Pearl index < 9)

Qualitative Indicator:

Percentage of high risk client whom practice effective family planning methods ( code 1 ) continuously for 2 years

( Code 1 = method of contraception with a Pearl index < 9 )

MODEL OF GOOD CARE

6 Critical Steps• Registration Of Clients• Identification Of Risk Groups

Pregnancy• Counseling Process• Use Of The Guidelines Of WHO -

WHO Medical Eligibility Criteria For Starting Contraceptive Methods "

• Detection & Tindaksusul Dropout Cases

• Management Of Contraceptive Supplies And Data

NEGERI 2011 (Julai – Dis) 2012 2013

Bil. KesBerisiko

Pencapaian%

Bil. KesBerisiko

Pencapaian%

Bil. KesBerisiko

Pencapaian%

Perlis 611 73.15 1,050 79.70 1,173 75.45

Kedah 4,661 81.98 9,156 84.39 8,996 84.2

Pulau Pinang 1,823 57.49 4,063 76.00 3,527 77.06

Perak 10,243 50.79 19,143 55.20 7,804 64.57

WP Kuala Lumpur 775 57.16 2,545 65.3 2,545 65.3

WP Putrajaya 125 80.00 213 89.7 123 92.68

Selangor 5,873 64.16 13,107 60.00 12,364 72.57

Negeri Sembilan 1,781 55.59 3,149 67.2 6,343 72.46

Melaka 1,098 68.49 2,702 72.0 3,530 74.16

Johor 6,602 56.76 12,077 71.17 13,988 75.53

Pahang 2,803 81.16 6,322 84.4 5,326 87.40

Terengganu 2,542 60.54 6,103 64.53 7,341 65.60

Kelantan 4,733 56.22 10,512 67.6 8,275 83.34

WP Labuan 217 59.45 493 86.21 357 97.20

Sabah 6,480 61.42 21,335 76.20 8,673 80.99

Sarawak 8,287 80.31 17,064 78.45 16,141 83.01

MALAYSIA 58,654 64.03 129,034 70.78 106,506 76.87

Amalan Perancang Keluarga Yang Berkesan di KalanganPelanggan Berisiko : INDIKATOR PENGGUNAAN 2011-2013p

Amalan Perancang Keluarga Yang Berkesan di Kalangan Pelanggan Berisiko: INDIKATOR KUALITI KOHORT 2011(QAP/ PK/ 22)

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Perlis 477 405 3 14 65 0 46 62 1 311 83

Kedah 4694 3837 352 134 373 45 231 583 40 3135 69.5

P. Pinang 1823 1048 410 176 189 27 0 54 23 1090 68.5

Perak 7804 5039 841 1701 223 0 24 0 0 5376 69.0

WPKL & Putrajaya

275 191 20 53 11 1 31 30 6 166 67.8

Selangor 8331 5041 943 1968 345 110 450 650 170 3518 44.0

N Sembilan 1739 1083 188 319 149 3 104 56 7 1423 86.8

Melaka 573 417 52 59 45 7 28 64 12 349 63.2

Johor 3110 1692 209 275 934 57 162 216 30 2071 68.9

Pahang 5218 4651 143 147 239 34 191 222 16 4289 85.3

Terengganu 1236 825 101 125 185 2 70 156 17 690 59.1

Kelantan 4875 3361 147 456 911 69 348 444 21 2923 63.6

WP Labuan 217 129 11 11 66 0 27 16 2 100 52.6

Sabah 8163 5091 372 854 1846 55 728 1062 110 3698 49.4

Sarawak 8539 6871 460 304 904 170 651 953 85 5500 68.2

Malaysia 57074 39681 4252 6596 6485 580 3091 4568 540 34639 60.7

UPDATES : FAMILY PLANNING SERVICES

Actions

• Monitoring of state performance based on pre determined targets by Family Health Development Division (FHDD). -

• Family planning services in hospital • initiation of FP for post natal and post abortion patients (hosp with specialist : 82.4%,

hosp without specialist : 60%)• Dedicated ‘expert family planning team ‘ in hospitals

• Reactivate national family planning training by KKM• Reactivate family planning promotion –

• Production of pamphlets/booklets in 2011 & distributed to clinics and hospitals • Production of video documentary (topics : Kaedah Perancang keluarga, kaedah implan)

in 2013- Uploaded to MyHealth, youtube & distribution of VCDs to clinics and hospitals • Introduction of quality indicator on effective family planning amongst high risk women• Wider range of contraceptives

• More choice of contraceptives procured via central contract • Inclusion of Low dose Ethinylestradiol and Etonogestrel Implant in the MOH drug

formulary since 2011• Unresolved issue : Downgrade of Etonogestrel Implant from List A* to List AKK