Repositioning in Action E-Bulletin

April 2008

New Advocacy Tools Make the Case for Long-Acting and Permanent Methods of Family Planning

Intrauterine devices (IUDs) and contraceptive implants are ideal contraceptive options for many women who wish to delay, space, or limit their pregnancies. For men and women who are sure they want no more children, male and female sterilization are also reliable options. Collectively, these four methods of family planning are referred to as long-acting and permanent methods (LAPMs).

While LAPMs are highly effective contraceptive methods, they remain the least accessible and least used contraceptives in sub-Saharan Africa. In many sub-Saharan African countries, fewer than 10 percent of women are using a LAPM, even though more than twice that many report a desire to limit the number of children they have or to space the next pregnancy for two or more years. Programmatic challenges such as low availability of equipment and supplies, policy barriers, provider bias, and other misconceptions are among the obstacles that continue to inhibit access to LAPMs. However, many of these can be overcome if policymakers and program managers promote an enabling environment through evidence-based policies and guidelines, improved provision of services, and education of communities and providers.

Advantages of the Methods
Increasing access to LAPMs is a vital element of repositioning family planning in sub-Saharan Africa. Improved access will ensure that women and men can choose from a wider range of contraceptive methods, fulfill their reproductive intentions, and improve the health of their families. Reasons to advocate for greater access to LAPMs include:

• Effectiveness and convenience: LAPMs are the most effective methods for preventing pregnancy. Because their effectiveness is not dependent on daily or monthly action, they require almost no attention after they are initiated. LAPMs also have lower rates of discontinuation than shorter-acting methods.
• Cost effectiveness: A comparison of 15 contraceptive methods in the United States shows that over time, LAPMs are among the most cost-effective methods of family planning.
• Health benefits: Studies show that the use of family planning, including LAPMs, can lower rates of maternal mortality by 25 percent and rates of infant mortality by 10 percent. Implants and female sterilization protect against ovarian cancer, and use of an IUD or implant may help prevent endometrial cancer. Use of an implant also decreases the risk of anemia.
• HIV prevention: LAPM use is part of an important, but often overlooked, strategy for preventing mother-to-child transmission of HIV. The use of family planning is already preventing the birth of an estimated 173,000 HIV-infected infants each year in sub-Saharan Africa.

Resources for Advocates
Credible information lays the foundation for successful advocacy. The following three resources contain evidence-based information that can be used to make the case for including LAPMs in reproductive health programs in sub-Saharan Africa and throughout the world.

1. Long-Acting and Permanent Methods: Addressing Unmet Need for Family Planning in Africa is a new advocacy package that can be used to justify the financial and human resources needed to ensure the delivery of high-quality comprehensive LAPM services. It can also inform policymakers, program managers, and donors on the benefits of and approaches for introducing or revitalizing LAPMs within national programs in sub-Saharan Africa. When possible the package should be adapted to a specific country, community, or other local setting. The package includes the following eight briefs:

Brief 1: The Case for Long-Acting and Permanent Methods
Brief 2: The Benefits of Long-Acting and Permanent Methods for Individuals
Brief 3: The Role of Long-Acting and Permanent Methods in National Programs
Brief 4: Strategies to Improve Availability, Access, and Acceptability
Brief 5: Contraceptive Implants: Safe, Effective, Long-Acting, Reversible
Brief 6: IUDs: A Resurging Method
Brief 7: Female Sterilization: The Most Popular Method of Modern Contraception
Brief 8: Vasectomy: Safe, Convenient, Effective – and Underutilized

2. The IUD Toolkit is a comprehensive source of up-to-date information about the IUD. This online resource for program mangers, policymakers, family planning providers, and potential clients offers guidance on best practices, training materials, case studies, and tools to help increase access to high-quality IUD services.
3. The Implants Toolkit is an online resource providing comprehensive information and tools to improve access to high-quality services for contraceptive implants. It includes information on the new implants Implanon, Jadelle, and Sino-Implant (II). The information is organized by topic and intended audience.

We Want to Tell Your Repositioning Story

Please contact Carmen Coles at ccoles@usaid.gov with your successes in family planning programming.

For more information on Repositioning Family Planning, please contact Alexandra Todd at atodd@usaid.govor Carmen Coles at ccoles@usaid.gov.

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