New Developments in the Calculation and Use of CYP Washington DC September 8 2011 Jacqueline E Darroch PhD CYP translate contraceptives into protection from unintended pregnancy Contraceptive procedures ID: 747214
Download Presentation The PPT/PDF document "A Next Step: Estimating Impact from CYP" is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.
Slide1
A Next Step:Estimating Impact from CYP
New Developments in the Calculation and Use of CYPWashington, D.C. — September 8, 2011
Jacqueline E. Darroch, Ph.D.Slide2
CYP translate contraceptives into protection from unintended pregnancy
Contraceptive procedures
and
commodities
CYP
Units per year
+
AdjustmentsSlide3
Estimation of impacts from CYP requires additional estimation
Contraceptive procedures
and
commodities
CYP
Impacts:
Demographic,
health,
cost, etc.Slide4
Unintended pregnancy is the link between contraception and impact
Contraceptive procedures
and
commodities
CYP
Impacts:
Demographic,
health,
cost, etc.
Unintended
pregnancies
AvertedSlide5
Unintended pregnancies have multiple impacts
Unintended pregnancies averted
Unplanned births averted
Miscarriages averted
Abortions averted
Safe abortions averted
Deaths averted
DALYs averted
Unsafe abortions averted
Health care
servicesSlide6
Unintended pregnancy is the link between contraception and impact
Contraceptive procedures
and
commodities
CYP
Impacts:
Demographic,
health,
cost, etc.
Unintended
pregnancies
Averted
Impact estimation
factors from available
studies and best
guessesSlide7
Unintended pregnancy is the link between contraception and impact
Contraceptive procedures
and
commodities
CYP
Impacts:
Demographic,
health,
cost, etc.
Unintended
pregnancies
Averted
Impact estimation
factors from available
studies and best
guessesSlide8
What would be the (unintended) pregnancy rate without CYP?
Biological pregnancy rates (~85%, Trussell)From fertile couples, frequent sexual activity, trying to get pregnantResults in too high pregnancy numbersAverage population pregnancy ratesInclude intended pregnancies and those to contraceptive users
Hard to estimate because of missing/poor data on induced abortion
Women with unmet need for modern contraception
Sexually active, fertile, do not want child in next 2 years
Using traditional or no methodSlide9
Definitional issues:Contraceptive use
CYP try to estimate “active” and “effective” coverage from unintended pregnancy, adjusting for low fecundity, non-exposure, incorrect/inconsistent use; applied to all types of usersSurvey data on contraceptive use try to capture “real-life” use, among all user types and situations and levels of correct and consistent useSlide10
Measuring impacts of specific services is more complicated
CYP:
Sterilization
IUD
Implants
Injections
Patches Rings Pills Condoms Other
Selection
of usersSubstitution – methods
and/or sources
Method use
Sexual
activity/
Fecundity
Childbearing
intention
Availability and
accessibility of
needed services
Context of CYP provision: method choice, counseling, etc.
Unintended
pregnancies
Averted
Impacts:
Demographic,
health,
cost, etc.Slide11
Unintended pregnancy is the link between contraception and impact
Contraceptive procedures
and
commodities
CYP
Impacts:
Demographic,
health,
cost, etc.
Unintended
pregnancies
Averted
Impact estimation
factors from available
studies and best
guessesSlide12
February 2003 December 2009Slide13
Method users x pregnancy rates = unintended pregnancies
Modern
Tubal ligation
Vasectomy
IUD
Injection/Implant
PillsCondoms/otherTraditionalWithdrawalPer. Abst.Other
In need, no method
UnintendedPregnancies
818M women in need x Pregnancy rates = 75M unint. pregs.Modern
Tubal ligation
Vasectomy
IUD
Injection/Implant
Pills
Condoms/other
Traditional
Withdrawal
Per. Abst.
Other
In need, no method
x
=Slide14
215 million women want to avoid pregnancy but have unmet need for modern methods
Women at risk for unintended pregnancy, 2008 (818 million)
No method,
140 million
Traditional
methods,
75 million
Modern
methods,
603 millionAdding It Up, 2009Slide15
Meeting developing country unmet need for modern methods would yield
53 million fewer unintended pregnancies
22 million fewer unplanned births
25 million fewer abortions
680,000 fewer deaths among women (94,000) and newborns (586,000)
390,000 fewer children who would lose their mothers
Adding It Up,
2009Slide16
Data for estimating relative relationship among
pregnancy ratesReversible method users12-month use-failure rates, women in union, DHS data from 18 developing countriesSterilization users
Trussell review of available research
Nonusers
US: ~40%; lower sexual activity; lower fecundity?; conservative estimateSlide17
Made model output consistent
with external estimates75 million unintended pregnancies in developing countries in 2008Births: Number -UN Population Prospects; Intention status – DHS and other surveysInduced abortion – Guttmacher Institute,
Abortion Worldwide
Miscarriage – estimated
Method-specific pregnancy rates were adjusted downward to yield 75 million unintended pregnancies
Average adjustment was 0.88
Regional adjustments: 0.83 for Asia; 0.95 for Africa and 1.05 for Latin America and the Caribbean.Slide18
Rates of unintended pregnancies and pregnancies averted
Women with unmet need for modern methods, i.e. using no method or traditional method: 288/1,000If these women used modern methods: 39/1,000Unintended pregnancies that would be averted if women with unmet need used modern methods: (288-39)/1,000 = 249/1,000Slide19
Impact factors
For CYP that use conversion factors that adjust for use-effectiveness: 288/1,000 or .288 per user per yearFor CYP that use conversion factors that do not adjust for use-effectiveness:249/1,000 or 0.249 per user per yearSlide20
Some key assumptions
Ratio of unintended pregnancies prevented per modern method user is the same as per CYPRelative relationships among contraceptive and no-method use-effectiveness rates are reflected by available dataCYP, and estimated impacts, are defined and measured the same across organizations and programsSlide21
Further considerations
Since CYP use global conversion factors, use global estimate for estimating unintended pregnancies avertedSpecify what CYP conversion factors are used and adjustments they containSlide22
Unintended pregnancies have multiple impacts
Unintended pregnancies averted
Unplanned births averted
Miscarriages averted
Abortions averted
Safe abortions averted
Deaths averted
DALYs averted
Unsafe abortions averted
Health care
servicesSlide23
Data to estimate further outcomes of unintended pregnancies
Unplanned births, miscarriages, induced and unsafe abortions for regions and countries (unsafe abortions): Guttmacher InstituteMortality for countries (maternal, stillbirth, infant) and regions (unsafe abortion): WHO and IHME*
DALYs: WHO and IHME*
*Institute for Health Metrics and EvaluationSlide24
This presentation was developed with support from PATH through Reproductive Health Supplies Coalition
For more information, visit www.guttmacher.org