Dr Snezana Georgieva ICMA International Consortium for Medical by mikeholy

VIEWS: 65 PAGES: 19

									Strategic assessment of policy,
     quality and access to
 contraception and abortion
    services in Macedonia
           2007/08


         Main findings
     Family planning and
contraception in the context of
   reproductive behavior in
          Macedonia
         POPULATION INDICATORS IN
                  MACEDONIA


• Decreasing birth rate
• Increasing total mortality rate
• Decreasing infant mortality rate
• Reduced rate of demographic growth ( natural
  increase)
• Regional disparities in population indicators
        POPULATION INDICATORS IN
              MACEDONIA
20
18
16
14
12
                                                                                    1996
10
                                                                                    2006
8
6
4
2
0
     Birth rate   Total mortality rate   Infant mortality rate   Natural increase
       Reproductive behavior
• Age structure of pregnant women ( 2006)
             » 64,5% - 20-29 years
             » 7,2% - 15-19 years ( fertility rate – 20,1 per 1000)
• Average age of mother for the first newborn
             » 1996 – 23,7 year
             » 2000- 24,1 year
             » 2004 24,8 year
• Total fertility rate
             » 1996 – 1,9
             » 2000- 1,7
             » 2004 – 1,5

• Regional disparities
Family planning counseling
  services ( no of visits)
                               No of visits

50000
45000
40000
35000
30000
25000
20000
15000
10000
 5000
    0
        1996   1997   1998   1999   2001   2002   2003   2004   2005   2006
  Utilization of family planning services in
        public health sector- Some indicators
• 9,9% ( 12,6% in private HC) of recorded
  first visits ( 2006) are among female
  adolescents ( age 15-19)
• 1,6% contraceptive coverage rate among
  female adolescents ( 2006)
• Total coverage with FPS
          »   2003- 3% with average 1,5 visits per woman
          »   2004- 2,7% with average 1,4 visits per woman
          »   2005 – 2,6% (1,5 visits per woman )
          »   2006 – 2,9% ( 1,4 visits per women)
   Abortion rate per 100 life births in
              Macedonia
               60

               50

               40

               30

               20

               10

                0
                     1996 1997 1998 1999 2001 2002 2003 2004 2005 2006
        per 100 LB   48,4 44,4 44,6 33,6 34,4 32,2   28   31,8 28,3 27,3



13.6 per 1000 women ( 15-44 ) for 2006 ??????? ( sub registration)
       Knowledge, perception and attitudes regarding
                     contraception




•   women in reproductive age,
•   community members ,
•   local government authorities,
•    adolescents

(focus group discussion , in depth interview , questionnaire survey )
Women’s perception

 » Unmotivated health care providers to
   discuss with clients about family planning
   issues
 » Lack of access to information for
   contraceptive option
 » Fear of adverse effects due to contraceptive
   use ( hormonal contraceptive, IUD…)
 » Financial barriers –contraceptive pills ,
   IUD… are not in essential drug list
Adolescent perception

 » Misinformation about adverse effect of
   using oral contraception ( obesities ,
   masculinization , vaginal bleeding …)
 » Insufficient knowledge about urgent
   contraception
 » Inappropriate interaction with health care
   providers ( privacy , confidentiality , sense
   of safety in discussing contraceptive and
   sexual issues )
Health care provider perception
        ( gynecologist)
      » Expensive contraception drugs
      » No policy for free of charge contraception
        for socially vulnerable groups
      » Overburden with routine health practice (
        lack of time for family planning
        counseling)
      » Family planning counseling should be part
        of PHC basic benefit package
      Knowledge, perception and attitudes
      regarding abortion services




•   women in reproductive age,
•   community members ,
•   local government authorities,
•   adolescents


(focus group discussion , in depth interview , questionnaire survey )
           Summary

– Liberal attitudes towards abortion
– Lack of knowledge about abortion legislation
  framework
– Inadequate post abortion counseling in health
  care facilities
– Gander role in decision making for abortion (
  the influence of male partner in some
  population groups)
– Inadequate respect of rights of privacy and
  confidentiality in public hospitals
Quality of abortion services

   – Discrepancy in perception of abortion
     services quality among health care
     providers and WHO guidelines for safe
     abortion
   – Quality matters as: right to information,
     right to choose abortion technique and
     type of anesthesia, pre and post abortion
     counseling are not considered as strong
     quality issue.
– Use of abortion method – is not comply
  with WHO recommendation
   » First trimester – dilatation, vacuum
     aspiration and curettage
   » Second trimester –(intra- amniotic
     installation of 20% NaCl, )
   » Medical abortion is not available
– Pain management is not comply on
  WHO recommendation (general
  anesthesia or no anesthesia)
– No existence of up to date safe abortion
  medical protocols
Data collection , monitoring and
  evaluation of abortion and
     contraceptive services

• Insufficient data managements ( sub-
  registration in private health facilities, )
• No available national abortion data
  disaggregate by age, location, method of
  use, early and late post abortion
  complication
• No appropriate and standard follow-up post
  abortion procedure
• General competence of doctors and medical
  assistants is quite good.
• Residents learn to perform the abortion within the
  first surgical procedures.
• Obstetrician-gynaecologists consider abortion to
  be simple and routine.
• The most important criterion of a doctor
  competence, according to their own opinion, is
  lack of abortion-related complications cases.
• No recorded any case of abortion-induced
  maternal mortality over the past 10-15 years

								
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