KEYNOTE SESSION 1: ORGANISED BY THE WORLD HEALTH ORGANIZATION (WHO): INTERNATIONAL AND NATIONAL FAMILY PLANNING GUIDELINES
KS01 WHO Guidelines on family planning – adding more cornerstones
Michael Mbizvo, Mario Festin
World Health Organization, Geneva, Switzerland
The WHO four cornerstones of evidence-based guidance for Family Planning consists of two guidelines for programme managers, the Medical Eligibility Criteria for contraceptive use (MEC) which gives recommendations on which contraceptive methods for certain medical or health conditions, and the Selected practices recommendations (SPR) which recommends interventions if problems arise during contraceptive use. The other cornerstones are two tools of FP providers; the Decision Making Tool for family planning clients and their providers (DMT) which is a counselling and information tool on the various methods, and the family planning – Global handbook for providers which is a clinical manual which incorporates the recommendations from the MEC and SPR.
New tools have been developed to supplement these cornerstones, addressing specific audiences with particular needs:
(1) MEC Wheel which is a handy summary of the main conditions in the MEC adapted for use during provider client interactions. It is available in print, electronic, and mobile phone version.
(2) The Guide to Family Planning for Community health workers and their providers is a handier, simplified version of the DMT. It is available in English, French and Spanish, and is for adaptation into local languages and setting (launched 2012).
(3) The Reproductive Choices and Family Planning for Persons living with HIV is a counselling tool on reproductive health for HIV service providers (updated 2012).
(4) The Provider initiated Testing and Counselling Module (PITC) is a new chapter for the DMT, and is intended to be used for FP services providers when offering counselling on HIV testing (launched 2012).
(5) The Family Planning Training Resource Package is an online repository of material to be used when planning training programmes on various family planning methods (launched 2012).
(6) http://www.who.int/reproductivehealth/publications/clinical/en/
Many of these tools are being introduced to allow countries and programmes to adapt these for their specific settings and needs.
KS01-3 National family planning guidance documents in Romania
Mihai Horga
East European Institute for Reproductive Health, Tirgu-Mures, Romania
When preparing guidelines, one should ensure that the best available evidence is used in providing advice and recommendations to policy makers, managers and service providers. When implementing guidelines, it is essential to ensure that the links between an intervention and improvements in public health are the main basis for the care and services provided. This lecture presents the road from evidence to health care in the Romanian National Family Planning Programme, and discusses lessons learned. Guidelines and tools should not be imposed, but introduced through a process of change driven from within the system which leads to acceptance.
Romanian editions of key WHO evidence-based guidance documents (Medical Eligibility Criteria, the MEC Wheel, the Quick Reference Chart, Selected Practice Recommendations, Decision-Making Tool, Global Handbook) were published by the East European Institute for Reproductive Health and widely disseminated in a systematic process. They became used by policy-makers, family planning providers and managers and the scientific community.
At policy level they provided guidance in the preparation of norms and guidelines and they were embedded in the activities of the three pillars of the National Family Planning Programme: training of family planning providers, IEC and provision of free-of-charge contraceptives. Policies and guidelines, tools, job aids, education and training programmes (undergraduate, postgraduate, in-service, including interpersonal communication and counselling skills), BCC/IEC activities and working with mass media were some of the methods used by the Romanian Family Planning Programme.
The Ministry of Health has produced detailed technical norms of the Family Planning Programme in which WHO guidelines are specifically mentioned as a reference. Over 80% of primary health care units at territorial level provide family planning services based on WHO guidance. Curricula were developed and accredited for Training of Trainers, family planning basic training for primary health care providers (family physicians and nurses), family planning advanced training, post-abortion contraception training, and WHO guidelines were included into the training packages. Activities were developed and implemented in a strong partnership between Government, NGO's and development partners.
Romania's comprehensive National Family Planning Programme increased the modern contraception prevalence rate from almost 0 in 1989 to 10 in 1994 to 23.3 in 1999 to 33.9 in 2004 to 61.1 in 2006, while reducing the induced abortion rate from 163.6 per 1000 women in 1990 to 10.1 in 2010. In the same time, abortion-related maternal mortality was reduced from 147/100,000 live births in 1989 to 5 in 2010.
KEYNOTE SESSION 2: TEACHING AND QUALITY ASSURANCE IN SEXUAL REPRODUCTIVE CARE – A CRITICAL LOOK AT FERTILITY REGULATION KNOWLEDGE AND INFORMATION
KS02-1 Teaching contraception
Jean-Jacques Amy
The European Journal of Contraception and Reproductive Health Care, Brussels, Belgium
Family planning (FP) and sexual and reproductive health (SRH) now form a medical specialty in its own right, with professional organisations, scientific meetings, courses, and peer-reviewed journals. Teaching in this domain requires the diverse aspects of birth control and the safeguarding of SRH to be addressed, the main ones being listed below.
A lively historical overview will arouse interest. It should illustrate the durability of people's will to control their fertility, the unacceptable character of prohibition of contraception and abortion, and the evolution from empirically selected to rationally and scientifically developed contraceptives. The curtain having thus been raised, the speaker/faculty can now move on to discussing the major items on the agenda, for instance in the following sequence.
(1) Preservation of health. Birth planning reduces maternal and infant morbidity and mortality, particularly by spacing births, and preventing unwanted pregnancies, but also those in adolescents, women aged more than 35 years, and grand multiparae.
(2) Observance of a basic human right. The right for people to decide about the number and spacing of their offspring, to receive information about, and to have access to, contraceptive methods has been proclaimed during the past 50 years at various international meetings and by the United Nations. In all developing countries for which information is available, there are unmet needs for FP, and people's achieved family sizes exceed their desires.
(3) Curbing the population explosion. The human species, which numbered about 200 million two millennia ago, has exceeded the 7 billion mark since the end of 2011. The ability of the biosphere to counteract pollution and to renew what was destroyed is since long terribly overstretched. Whereas control over one's fertility is a right, stabilising the world population is a necessity.
(4) FP methods, SRH, and induced abortion. A comprehensive, critical, evidence-based overview of these three closely related topics is imperative. The teaching must be as interactive as possible, with ‘hands-on’ sessions focusing on methods (e.g., IUDs, implants, ...) requiring insertion of the contraceptive, and intermediate and final assessments of the acquired knowledge and skills.
(5) Training healthcare providers. In addition to teaching about and updating on methods and products, training service providers must address communication and counselling skills. These professionals must learn not to impose their views to clients; show an understanding of adolescents and people with different cultural backgrounds or lifestyles; and know that their main task consists in helping clients in making informed choices.