Hello, my name is Jerusalem Makonnen, I am a family nurse practitioner, and I would like to welcome you to this course, Contraception:

Choices, Culture and Consequences. Today, we're going to take a look at what's going on globally and here in the United States around the concept of care and really why it is important. I'm gonna focus on really, understanding the significance of family planning, why is this so important? we're gonna talk about what unintended, what the rights of unintended pregnancy are, globally, both unmet, the unmet need for contraception, as well as the unintended rates here in the United States. We're gonna take a look at the trends, for what, amongst the world population, and look at kind of what are some of the implications of that. And then we're going to identify at some of the contraceptive methods that are currently available here in the United States and globally. This is information from the World Health Organization, looking, and, and their definition of what unmet need is. women with unmet need are those who are fecund, which means fertile, and sexually active. But are not using any method of contraception. they report not wanting any more children, or wanting to delay the birth of their next child. This number is really, they're looking at women, fifteen to 49 years old. They are looking at, specifically, married women or women that are in a union, when they're talking about unmet need and the data that you're gonna see around unmet need. This is a pretty interesting graphic that looks at what is happening and what has happened around contraceptive use, starting in the 1990's and on through 2007. What, what we see here is that the use of contraceptive in the 1990's is almost increased in every region between 1990 and 2000. But by 2007, what we see is that really there's not much progress. We see kind of a slowing down between say, for example in Sub-Saharan Africa, we see here twelve%,. Big jump here between 1990's and 2000. But then, kind of a leveling, leveling off, almost everywhere, w e see that leveling off. And we, and why, and why, we really are wanting to answer, why are we seeing that? We see here that, really, the, some of the areas where the methods that are, you know, lacking, are really in, mostly in sub-Saharan Africa as well as Oceania. Those are the regions of the globe that, that, where we see, a percent of. In terms

of percent of, percentage of method use of the lowest. In this graph here which was from the current report in November of 2012 from the UN Organization, the UN Family Planning, Family Population Organization, where they looked at every method. this is a pretty accurate look at what methods are currently used globally and which methods are used most. Again we can see here female and male sterilization, female sterilization pretty much dominates here at 30%,. and then with 23% for the intrauterine contraceptives following pretty closely. In developing countries, there are about 222 million women with pretty much more access to really reliable, hm and, and high quality family planning services. we have seen the meeting this need could really prevent maternal mortality, globally about, 27% it could result in about a twenty percent drop in the total maternal death each year by reducing the number of unintended pregnancies. A recent study just supported that evidence. So it's very compelling to start working on some of these issues. Millennium development goals that were put into place currently by our, we're looking at really trying to reduce by three quarters the maternal mortality ratio globally. We would like to achieve universal access to re, reproductive health by 2015. Okay. The current, report that was released in November 2012, really calls for radically increasing financial support, and political commitment. To really ensuring that, that, family planning is available. And that it is a human right. that, especially voluntary family planning should be available everywhere. it is really important that we reduce the number of unintended pregnancies and abortions, by increasing this availability. And also engaging, members of the population, that, in the past, that have not been, engaged in this process, readily. Men, adolescents, folks that un-, un-, that are unmarried, and really including all women that need contraception. the other emphasis in this report, is really taking a look at including the emergency contraception as a choice that is readily available. Some of these data, we really take for granted in the United States. But what's staggering that is, that even in the United States we have about 49% of pregnancies that are unintended. This is a data from a survey of the national survey of family growth which happens every four years or so.

This, the most recent survey was done around 2006 and this is the data from there. But. But, but, again, half of all pregnancies in the United States are also unintended. and nearly half of them in the United States not only were unintended, but aproc, aproximately, about eleven percent of those were not using any kind of contra, contraception at all. The other half were perhaps using contraception, but were not using, either using it correctly, or had contraceptive method failure. Again, globally and here in the United States, unintended pregnancy is a very common effect event. negative consequences for both the health of women and their children, very expensive for the health care system, as well as really we need to take a look at now as providers, really making taking that responsibility and making sure that we're providing access to all women. So, here are some of the outcomes that are presented in the healthy people of 2020 report in the United States. So, a couple of things that can happen most women that have an unintended pregnancy will delay initiating prenatal care outcomes of maternal depression. There are birth defects low, low birth weight children. again another, another unintended consequence of these unintended pregnancies here in the United States. This is just a graphic to show, what methods are currently being used in the United St ates. The leading current method of contraception in the United States was oral contraception, at about seventeen%.. And then, again, when you take a look at this, very few women, have ever used, when they were asked in this study. very few men, the number of women that were, have, had ever use emergency contraception, was quite low, but it has reason in the past, hm, in that time frame, that they were looking at, between 2002 and 2008. Hm, all other methods, about eighteen%.. There has been also a slight bump up, in the use of intra-uterine devices, hm, in the United States, especially among women that have had one to two children. So to kind of reiterate, this is a high priority for all primary care providers. We are trying to take a look at making sure that preconception care happens not only in the family planning arena but throughout. When you're seeing a woman with hypertension, with chronic disease, really sitting down and talking about preconception care, which means really talking about desire

for, for fertility and what the plan is, talking a little bit about that to kind of start ahead in terms of counseling. Around the different family planning methods, really Also here, in other states, one of the main objectives of healthy, healthy family, healthy, people 20-20 is to reduce unintended pregnancy. So, really trying to provide broader access to women, hm, for family planning. in looking at this graph, we can see that by 2029, the population of women who are going to be needing contraception is really poise to grow. By 2029 there could be about 70,000,000 plus women in the age group of fifteen to 44 who are going to be ready to use a method. On this table here, here you'll see all of the contraceptive methods that are currently available globally and here in the United States. and one thing to remember to take a look at is to see how they're arranged here. There are hormonal methods. There are non hormonal methods. There are methods that can be taken daily. used every day. There can, there are methods that are more long term where a woman can use them for ten years, five years. There are methods that are reversible or non-reversible. So really taking a look at this table and being able to understand how the methods are categorised, within the hormonal methods. There are progestin-only methods. They are methods that are combined, both estrogen and progesterone, really important to understand how they each work and how they would work with a specific, person sitting here in front of you in the office. Looking at the different barrier methods and seeing, how, how they are used. Most of the barrier methods need to be used with each act of intercourse. So, that may make a difference, in terms of how a person uses it. But I just wanted to put all the methods here that are available and, and in this category, so we can take a look at them and then, start thinking about them when we review them on an individual basis. I'd like to conclude this presentation with this slide, and really wanting us to have a conversation around what is happening, and the impact of family planning on women's rights, and also their ability to access family planning and its implications for public health. Very, very important, and I really want to leave you with this, and, and thinking about the data that has been presented today, and, and, having you think about really the significance, of

family planning and its impact on our environment globally as well.