Access to medicines for women and children - ohchr.org · Contraceptive Use/Unmet needs Every year,...
Transcript of Access to medicines for women and children - ohchr.org · Contraceptive Use/Unmet needs Every year,...
Access to medicines for women
and children
ACCESS TO ESSENTIAL MATERNAL AND
REPRODUCTIVE DRUGS: WHERE ARE WE?
Dr. Raffaela Schiavon
Ipas Mexico
Index
Maternal and Reproductive Health Indicators
(MDG 5):
• Maternal Mortality Rate
• Contraceptive Prevalence/Unmet Needs
• Mexico as a case study.
Access and procurement of RMNH commodities:
• Model Lists of Essential Medicines (MLEMs)
and interventions
• EC and misoprostol as case studies
Maternal Mortality Ratio 1990-2013
http://www.who.int/gho/maternal_health/mortality/maternal/en/index1.html
Contraceptive Use/Unmet needs
In 2014, there are 1,556 million women of reproductive
age; 877 million want to avoid pregnancy (36% to stop
and 21% to delay childbearing).
Contraceptive Use/Unmet needs Every year, there are 123 million desired and 87 million undesired pregnancies. Most of them are due to non-use or under-use of modern contraceptives. Reducing the number of unintended pregnancies could avert 60% of maternal deaths and 57% of child deaths (WHO, 2014).
Undesired/ Pregnant Women
Undesired/Non-pregnant Women (n,%)
Pooled 12,874 (100%) 111, 301 (100%)
Modern Methods 11.3% 50.5%
Traditional Methods 10.3% 20.9%
No Method 78.4% 28.6%
Bellizzi S et al. Hum. Reprod. 2015;humrep.deu348
Modern Contraceptive Use & Abortion Rates
Westhoff CW. DHS Analytical Studies No. 13 A New Approach to Estimating Abortion Rates, USAID 2008
Mexico: Maternal Mortality
MMR 1990-2013: actual vs. committed
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
19901991199219931994199519961997199819992000200120022003200420052006200720082009201020112012
Pre-Eclampsia Otras causas
Hemorragia obstétrica Causas indirectas
Aborto Infección puerperal
% of MM causes 1990-2013
-
100.0
200.0
300.0
400.0
500.0
600.0
700.0
800.0
900.0
-
20.0
40.0
60.0
80.0
100.0
120.0
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
Aborto c/complicación Patológicas Aborto s/complicación Total aborto
*/ Rate: N° of Abortion-related Hospitalization per 100,000 women 15-44 ys. Source: Ipas México, 2015
Mexico: Abortion Hospitalization Rates
2000-2013
Mexico: Contraceptive use….
63.1
36.4
55.4
72.5
44.7
62.9
0
10
20
30
40
50
60
70
80
90
TOTAL 15-19 20-24 25-29 30-34 35-39 40-44 45-49
…& Unmet needs
1992 2009
Index
Maternal and Reproductive Health Indicators
(MDG 5):
• Maternal Mortality Rate
• Contraceptive Prevalence/unmet needs,
• Mexico as a case study.
Access and procurement of RMNH commodities:
• Model Lists of Essential Medicines (EMs) and
interventions
• EC and misoprostol as case studies
Access to and consistent
procurement of reproductive,
maternal and neonatal health
commodities
Role of international
agencies and networks
Model Lists of Essential
Medicines (EMs) and
interventions
Essential Drugs in SRMN Health
http://www.rhsupplies.org/fileadmin/user_upload/Maternal_Health_Supplies/Essential_Medicines/
WHO MLEM: Contraceptives
Map of Emergency Contraceptive
WHO MLEM: Oxytocics
Misoprostol
Technical
Guidelines
Total World Market for Misoprostol
Source: RHSC:Investing in production of high quality misoprostol for low resource settings, 2015
Map of misoprostol
Emergency
Contraception
Misoprostol
Mexico case study
Mexico: Essential Interventions & Drugs
in SRMN Health
ICD -10 ICD-9
Essential Drug List
(Cuadro Básico de Medicamentos)
Federal Normative Support & Technical Guidelines (NOMs/GPCs)
EC in the FP Norm
1. Yuzpe Regimen
2. LevoNorgestrel only: > 12 commercial brands
3. Progestin- Receptor Modulator: Ulipristal
AE de Progestina sola
CLAVE 2210
levonorgestrel 0.750 mg. con dos tabletas
22
CAUSES 2014: Contraceptives # 89 FP Methods: Hormonal
OC Dg 0.15 mg + EE2 0.03 mg
Lng 0.15 mg + EE2 0.03 mg
Lng 0.03 mg
NET .400 mg + EE2 0.035 mg
Inyectables MAP 25 mg + Cipionate E2 5 mg IM
NET 50 mg + EE2 IM
NET 200 mg IM
Implant EtoNg 68.0 mg
Transdermal Patch Norelgestromin 6.00 mg EE2 0.60 mg
EC Lng 0.750 mg
# 91 FP Methods: IUD
Medicated IUD Lng 0.52 mg
Copper IUD IUD Cu 380, IUD Cu 375 short, IUD Cu 375 std,
Tshaped IUD nulliparous
#240/#251 Permanent FP Method Women/men
Permanent Methods TL/vasectomy
#90 Contraceptive counselling/condoms
Condom MALE AND FEMALE
EC sales in Mexico 2004-2013
24
CAUSES 2014: Abortion
Normative Support: Technical Guidelines (MoH) GPC IMSS 088 08 Misoprostol recommended CAUSES #243 Dx & Tx of Incomplete Abortion (does not
include Legal Termination of Pregnancy) ICD-10: O02, O03, O04, O05, O06 ICD-9: 69.02 D&C; 69.52 MVA No oxytocic included
Prevención, Diagnóstico y Manejo
de la Hemorragia Obstétrica
Lineamiento Técnico
Centro Nacional de Equidad de Género
y Salud Reproductiva
CAUSES 2014: Post-partum
Hemorrhage
Normative Support: 3 NOMs & 3 GPC Misoprostol mentioned CAUSES #194 Tx of Obstetric/Puerperal Hemorrhage
ICD-10: O72
Oxytocic included: Ergometrin Oxytocin
Prevención, Diagnóstico y Manejo
de la Hemorragia Obstétrica
Lineamiento Técnico
Centro Nacional de Equidad de Género
y Salud Reproductiva
http://reprolineplus.org/misoprostol-case
What do we need?
Alignement in SRMN Health
Technical Norms & Guidelines Programs and Services
▫ Different Goals/Indicators ▫ “Coverage” vs. Access ▫ Interventions vs. Supplies ▫ Unmet/Met need
Budget: ▫ Federal & State level ▫ Different sources of Budgetary lines
Accountability ▫ Transparency (robust and public information systems) ▫ Effective mechanisms for enforcement, justiceability, redress
and remedy
Access to medicines for women and
children
THANKS Dr. Raffaela Schiavon
Ipas Mexico