Family Planning

Contraception

Common Cause: Linking Menstrual Hygiene Management and Long-acting Contraception to Improve Youth Reproductive Health

~ Written by Rebecca Callahan, Scientist, Kate Rademacher, Technical Advisor, & Lucy Wilson, Monitoring and Evaluation Advisor, FHI 360

What do family planning and menstrual hygiene management (MHM) have in common? Beyond a shared purpose to improve the health and well-being of women and girls, some family planning methods can actually improve menstrual hygiene. Menstrual Hygiene Day on May 28 offers an opportunity to explore synergies between the two fields.

In recent years, the MHM movement has focused on the critical role that good menstrual hygiene management plays in enabling women and girls to achieve their full potential. Reducing the stigma associated with menstruation and ensuring that adolescent girls and women are able to safely manage their menses can eliminate some of the barriers that prevent girls and women in many countries from participating in day-to-day activities, such as attending school.

At the same time, the effort to increase access to long-acting reversible contraceptives (LARCs) for adolescents and young women has gained momentum. The LARCs for youth movement aims to expand reproductive choice and reduce unintended pregnancy. Around the world, the use of LARC methods, including intrauterine devices (IUDs) and contraceptive implants, has increased in recent years. The American College of Obstetrics and Gynecology and the American Academy of Pediatrics now recommend their use among teens.

Thus far, the complementarity of the MHM and LARCs for youth campaigns has gone unexplored.

Some LARC methods, such as the levonorgestrel-releasing intrauterine system (LNG-IUS), which is effective for up to five years, as well as shorter-acting methods, such as the three-month injectable depot-medroxyprogesterone acetate (DMPA), substantially reduce menstrual bleeding and often lead to complete cessation of menstruation, a condition known as amenorrhea.

Some women have viewed the menstrual changes associated with contraceptive use, especially increased or irregular bleeding, as a negative or undesirable side effect. However, recent evidence suggests that decreased bleeding, and amenorrhea in particular, is acceptable to women and is even considered an important side benefit.1,2 Surveys have shown that teens and young women are especially interested in limiting or controlling the timing of menstruation through the use of hormonal contraceptives.3,4

For young women in developing countries, where access to menstrual hygiene supplies and safe places to manage their menses are sometimes limited, the advantage of contraceptive-induced menstrual control could be especially important.

Youth-focused family planning initiatives are critical and could create a bridge between the MHM and family planning fields. Such linkages could focus on helping young women who are ready to use contraception learn how different family planning methods may affect their menstruation. In particular, the increasing popularity and availability of the LNG-IUS presents an opportunity both to promote highly effective, long-acting contraception and to reduce the burden of menstruation among youth.

An example of the acceptability of the LNG-IUS among teens in the United States comes from the ongoing Contraceptive CHOICE project, in which nearly one-third of women ages 15–19 enrolled in the study chose the device when offered free access to seven different long- and short-acting methods.5 After one year of use, more than 80 percent were still using this method.6

Although data from developing countries are limited, evidence from Kenya suggests a latent demand for LNG-IUS in low-resource settings when it is made available.7,8

The recent addition of LNG-IUS to the World Health Organization’s Essential Medicines List and the approval of Medicines360’s new, more affordable LNG-IUS, LILETTA, by the U.S. Food and Drug Administration, are good signs that this method will soon be more accessible to young girls and women in low- and middle-income countries. An ongoing collaboration between FHI 360, Marie Stopes International and Medicines360 to support introduction of Medicines360’s LNG-IUS in Kenya is an important first step in this effort.

Menstrual Hygiene Day calls attention to the importance of equipping girls and young women with the tools and knowledge they need to safely manage their menses. Expanding access to LARC methods for youth offers both the potential to improve reproductive health by reducing unintended pregnancy and an innovative strategy for addressing menstrual hygiene needs. We are optimistic that forging connections between the MHM and family planning fields will lead to improved outcomes for women and girls around the world.

 

References:

1. Baldaszti E, Wimmer-Puchinger B, Löschke K. Acceptability of the long-term contraceptive levonorgestrel-releasing intrauterine system (Mirena): a 3-year follow-up study. Contraception. 2003;67(2):87-91.

2. Backman T, Huhtala S, Blom T, Luoto R, Rauramo I, Koskenvuo M. Length of use and symptoms associated with premature removal of the levonorgestrel intrauterine system: a nation-wide study of 17,360 users. Br J Obstet Gynaecol. 2000;107(3):335-9.

3. Szarweski A, von Stenglin A, Rybowski S. Women’s attitudes towards monthly bleeding: results of a global population-based survey. Eur J Contracept Reprod Health Care. 2012;17:270-83.

4. Association of Reproductive Health Professionals (ARHP). Menstruation and menstrual suppression survey, 2005. Available from: http://www.arhp.org/Publications-and-Resources/Studies-and-Surveys/Menstruation-and-Menstrual-Suppression-Survey/Full-Report. Accessed 11 May 2015.

5. Secura GM, Madden T, McNicholas C, Mullersman J, Bucket CM, Zhao Q, Peipert JF. Provision of no-cost, long-acting contraception and teenage pregnancy. N Engl J Med. 2014;371(14):1316-23.

6. Rosenstock JR, Peipert JF, Madden T, Zhao Q, Secura GM. Continuation of reversible contraception in teenagers and young women. Obstet Gynecol. 2012;120(6):1298-305.

7. Hubacher D, Masaba R, Manduku CK, Chen M, Veena V. The levonorgestrel intrauterine system: cohort study to assess satisfaction in a postpartum population in Kenya. Contraception. 2015;91(4):295-300.

8. Hubacher D, Masaba R, Manduku CK, Veena V. Uptake of the levonorgestrel intrauterine system among recent postpartum women in Kenya: factors associated with decision-making. Contraception. 2013;88(1):97-102.

Innovation, Global Health Conferences

Review of Unite for Site Global Health and Innovation Conference 2015

~Written by Sarah Weber (Contact: sarahkweber@gmail.com)

I attended the Unite for Site Global Health and Innovation Conference last weekend which brought together over 2,000 global health and international development professionals, social entrepreneurs and students to exchange ideas and leading practices. One of the best parts of the conference was meeting committed global health professionals with the bonus of connecting with other TWiGH team members and viewers. The conference was held at Yale and participants had the opportunity to enjoy the quaint city of New Haven as well as the snow that fell throughout Saturday. The conference was similar to many other global health conferences I’ve attended but had a unique feel due to its social innovation edge and opportunity to hear from social entrepreneurs competing for the J.M.K. Innovation Prize. The innovation prize was established by the J.M. Kaplan Fund to provide grants to emerging social sector innovations.  

The conference had some very engaging and high profile speakers. I thoroughly enjoyed listening to the key-note address by the Honorable Minister of Health of Rwanda, Agnes Binagwaho, MD. She is an energetic women who isn’t afraid to speak her mind, even on controversial topics. She spoke about how Rwanda has greatly decreased its AIDS deaths, which is the fastest decrease ever in the world. She stressed how imperative it is that women have the choice for family planning since “There is no woman crazy enough to say, I want a baby every year”. She spoke about the need to meet people where they are and to move where you are needed most (rather than nice areas with beaches or better amenities). When asked what she would do if she were the Health Minister of the United States, she said she would put parents who refused to vaccinate their children on trial! Lastly, she urged us to work together and unite since “We live in one world, not three.”

Another engaging speaker was Cal Bruns, CEO/Chief Creative Incubationist at Matchboxology who presented on “What Condom Manufacturers Could Learn from Car Designers.” He spoke about a fact that car manufacturers learned long ago, that people are more motivated to purchase a product with a benefit that they want, rather than a product to prevent something they don’t want. He proposed that the condom companies should work on creating condoms with advanced technology such as stimulating beads on the inside of the condom to increase pleasure. Then men would be motivated to use condoms for the increased sensation which would as a by-product help reduce STIs and unwanted pregnancy. It was a different look on condom promotion than I’d heard before, but totally made sense.

The Social Impact Labs, which was the catalysis feature of the conference, brought together social entrepreneurs to pitch presentations about new innovations in front of a panel of judges and the audience in competition for the innovation prize. The innovation pitches ranged from nascent ideas, grassroots projects, to initiatives already underway being backed by large public health NGOs, universities and/or private companies. We heard about innovations ranging from a sex education program in Kenya teaching farmers to spread HIV prevention messages, a movement to create greenhouses in inner-city Baltimore to bring fresh produce to areas lacking produce options, to a project that creates wells to provide safe drinking water at a low cost to prevent arsenic poisoning in Bangladesh. The winning innovation was presented by Lucy Topaloff with a company called Miraclefeet which provides high quality, low cost braces for patients with Clubfoot in India. Miraclefeet won $10,000 which will be used to help provide braces to 40+ children. 

Overall it was a motivating and encouraging weekend. It’s always great to meet other public health professionals passionate about improving health and opportunities for disadvantaged populations globally. Listening to all the enthusiastic and motivated young people during the social innovation pitches drove home the idea that: great ideas + passion + commitment = opportunities. These individuals, in collaboration with their networks and connections, are turning ideas into solutions to help the less advantaged. That is inspiring!