Academic journal article International Journal of Child Health and Human Development

The Use of Oral and Emergency Contraception in Women: Understanding the Maternal Contribution to Survival Convergence

Academic journal article International Journal of Child Health and Human Development

The Use of Oral and Emergency Contraception in Women: Understanding the Maternal Contribution to Survival Convergence

Article excerpt

Introduction

The goals of implementing a family planning program is not only to reduce population growth through the increased use of contraceptives and reduced fertility, but to reduce maternal mortality and unplanned pregnancies. The leading causes of maternal mortality-postpartum haemorrhage, elevated blood pressure, infections and unsafe abortion-are, to a large extent, preventable. Ensuring the availability of certain services-such as family planning, prenatal care, skilled care at birth, reproductive health care after delivery and a range of services for adolescents- is key to preventing maternal deaths and improving the quality of life for woman and children (1).

Ahmed et al. (2) provided the largest global estimate of the possible effect of contraceptive use on maternal mortality reduction (previous millennium goal number 5) and concluded that, "the use of contraception is a substantial and effective primary prevention strategy to reduce maternal mortality in developing countries". The maternal mortality in Trinidad was 46 per 100,000 live births in 2010 down from 53.3 in 2008 with a target to reduce maternal mortality to 14 per 100 000 live births by 2015 (3). Globally, contraceptives help prevent an estimated 2.7 million infant deaths and the loss of 60 million years of healthy life (4). More recently the Collaborative Group on Epidemiological Studies on Endometrial Cancer concluded that the use of oral contraceptives confers long-term protection against endometrial cancer, by preventing 400?000 cases of endometrial cancer before the age of 75 years over the past 50 years (1965-2014) (5).

The need to have a well-organized and coordinated birth control program in small population size countries such as Trinidad (population 1.3 million) is driven more by the desire to prevent unintended pregnancies rather than population control. Unintended pregnancy is a major public health concern (6-8). The Centers for Disease Control and Prevention (CDC) defines an unintended pregnancy as a pregnancy that is mistimed, unplanned, or unwanted at the time of conception (9). In developed countries such as the United States of America (USA), about 3.5 million unintended pregnancies occur annually, half of which result from contraceptive failure or inadequate contraceptive technique (9). In addition The National Survey of Family Growth (2002) reported that 49% of pregnancies in the USA were unintended (10). Similarly, in Trinidad, it was shown that 64% of pregnancies in North Central Trinidad were unplanned and of these, 60.8% were due to lack of contraceptive use (11). An unintended birth is associated with adverse social and health outcomes for both the mother and child (12-14).

Over the past three decades the age of first sexual intercourse has declined. In 1988, the median age at first sex was 17.8 years and by 2006-2010 declined to 17.1 years (15). This decline suggests that women may be spending a significantly larger part of their reproductive years at risk of an unintended pregnancy (16). Hence, the effective use of family planning services can protect women during this period and therefore reduce the occurrence of unintended pregnancies.

Of the several approaches currently available in Trinidad oral contraceptives (OC) and emergency contraception (EC) are both utilized. EC is defined as any method a women can use after intercourse to prevent pregnancy (17, 18), but is not recommended as a routine form of contraception. Its use should be warranted after a known contraceptive failure, unprotected sexual intercourse or for victims of sexual assault. In Trinidad OC is available from organised Family Planning Clinics without any cost to the client through various funding mechanisms. On the other hand EC is only available by purchasing a product from a registered pharmacy. Therefore of all the available methods of contraception EC is unique. It is easily available as it is an over the counter drug (OTC), requires no professional intervention and therefore susceptible to abuse. …

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