E2A Newsletter, April 2015
Jeff Spieler gives insight into new contraceptive technologies
Jeff Spieler, who has worked for more than 43 years, internationally, in the fields of family planning and reproductive health and in his last post before retiring served USAID as Senior Technical Advisor for Science and Technology in Population and Reproductive Health, visited E2A Wednesday, April 29, to give staff and colleagues from other organizations and agencies a contraceptive technology update.
To reduce unintended pregnancies, Spieler offered three imminent priorities.
“The overwhelming priority is to get the methods out that we have,” he said.
It is then to “tinker with existing methods to make them somewhat different: easier to use, more acceptable, less expensive.”
And, finally, it is to fill in gaps that are missing in the panoply of existing contraceptive methods.
Before giving an overview of that panoply, he spoke about effectiveness. Ineffectiveness, he said, is directly related to the degree of opportunity for the user not to use the method correctly.
In the evidence Spieler presented on effectiveness during typical use, implants were determined the most effective (resulting in .5 unintended pregnancies per 1,000 women according to data derived from a 2011 study published in Contraception), while male and female condoms were determined least effective at 210 and 220 unintended pregnancies per 1,000 women, respectively. However, compared to using no method (850 pregnancies per 1,000 women) even withdrawal significantly reduces the risk of unplanned pregnancy.
Regardless of effectiveness, he said, women need to be given choice. Some women report, for example, that safety and absence of side effects is more important to them than effectiveness; he said providers are more concerned about effectiveness because women are using contraception to prevent unplanned pregnancy.
He then gave an overview of modern contraceptive methods, including:
- The female condom and woman’s condom (seen to left in photo above)—the latter which was recently developed by PATH, an E2A core partner.
- The SILCS/Caya Diaphragm, which was approved by the Federal Drug Administration in 2014, and, according to Spieler, was developed by PATH with USAID funding using an iterative process to improve upon the current diaphragm.
- Implants, including Implanon and Jadelle, with a brief discussion of the ongoing debate about offering progestin-only methods immediate postpartum. He mentioned that the recently completed World Health Organization study comparing Jadelle and Implanon to the CuT380 IUD showed that Implanon is effective for five years.
- Injectables, such as Depo-Provera and Cyclofem.
- Sayana Press (seen to right in photo above), which is the subcutanous injection of Depo-Provera in the Uniject device; according to Spieler, the "game-changing" aspect of this method is the potential for self-injection at home every three months.
- The newly approved Liletta LNG-IUD, which Spieler said will become available inexpensively compared to the Mirena IUD through the public health system in the US, describing the ongoing work to reduce cost enough for public sector use in developing countries.
- Oral contraceptives, emphasizing the positive effect on reducing ovarian and uterine cancers.
- Emergency contraceptives, presenting evidence on the lack of awareness about emergency contraceptives in many countries.
- Fertility awareness, such as CycleBeads for Standard Days Method and Lactational Amenorrhea Method.
- Permanent methods, including tubal ligation and vasectomy.
- Nestorone® and Etinylestradiol, a new contraceptive vaginal ring that lasts for one year and was developed by the Population Council, which Spieler said is the only long-acting hormonal method that could be completely controlled by the woman herself (she can take it in and out herself).
On Spieler’s wish list for contraceptives that have not yet been developed are:
• An oral contraceptive that does not contain hormones (and prevents breast cancer)
• Biodegradable implants
• Nonsurgical sterilization (possibly as an injection)
• Novel multipurpose/dual protection methods
• Post-testicular methods for men—something that prevents sperm from being motile after it is produced
Cameroon: building competencies for a strong postpartum family planning program
To ensure that the E2A-supported postpartum family planning program in Cameroon offers the full range of contraceptive options to women, master trainers and providers recently underwent a series of trainings to build their competencies in intrauterine device (IUD) insertions and administration of implants.
The E2A-supported program is based at four hospitals in the Central region of Cameroon, where the Ministry of Health’s Division of Family Health requested that E2A work with the ministry to develop a postpartum family planning program that offers voluntary family planning and counseling and provision of a range of contraceptive methods. The program focuses on the immediate and extended postpartum period—from the first day to a full year after a birth—to improve access to contraceptives during a critical period in a place where only 14 percent of reproductive-age women use modern contraception.
The postpartum family planning strategy being applied is grounded in one developed by the World Health Organization, the USAID-funded Maternal and Child Health Integrated Program, and USAID. Women are reached at opportunistic times when they use health care services: during antenatal care, immunization visits for their babies, at the family planning unit, and in the obstetric room. At the same time, community outreach workers and peer educators offer family planning counseling and referrals.
The recent trainings reached 15 master trainers: eight from selected hospitals, one from the Ministry of Health, and six from the national social marketing association. During the training, they learned about healthy timing and spacing of pregnancy messages; the nuances of postpartum IUD and implant insertion techniques; managing side effects; compliance with US Government family planning regulations; and skills for training providers in these elements. They practiced the techniques for administration of IUDs and implants on anatomic models, and attended a three-day practicum in four hospitals in Cameroon’s capital, Yaoundé. They then developed plans for leading trainings with providers the following week, and each trainer developed an individual action plan for application at their hospitals.
With support and coaching from E2A, eight trainers then went on to train 24 providers from the four practicum hospitals, who also developed action plans for applying their learnings during future work. Pre- and post-test scores among providers show significant improvements in knowledge—from an average score of 48% pre-test to 93% post-test.
The Division of Family Health and Management Sciences for Health, the E2A partner leading the postpartum family planning program in Cameroon, will follow up on application of action plans developed during the trainings, including enhanced supervision, sufficient and appropriate equipment and supplies, and the use of sound data-collection systems. This last item includes adding a column to delivery registers where the provision of postpartum IUDs and implants can be recorded and analyzed monthly.
Since the training, the Central Hospital created its first family planning unit, but has not yet staffed it with a nurse or midwife. E2A will continue to work closely with the Division of Family Health to see that it is fully staffed and equipped. There have also been 54 immediate postpartum IUD and 20 immediate postpartum implant insertions—services not previously offered before the training.
New youth-focused E2A briefs in French
With E2A’s growing focus on the family planning and reproductive health needs of youth in West Africa and other Francophone countries, we have published several new briefs in French:
- On E2A’s behavior-change program with university students in Niger: E2A au Niger: Leadership Universitaire pour Changement en Santé Sexuelle et Reproductive
- On E2A’s many youth-focused programs: E2A: Programmes pour les Jeunes
- On E2A’s assessment of youth-friendly health services in Malawi: Evaluation des services de santé adaptés aux jeunes au Malawi récapitulatif de l'évaluation