Dr Ruwaida Rashid
MOH / WCHD Director
2011

1. Situation of family planning methods use in Jordan.
2. Interventions to improve access to long acting contraceptives in Jordan.
 Jordan Contraceptives Logistic System.
 Improving Access to IUDs at MCH Centers.
 Introducing Long Acting Hormonal Methods (Implants) in the Jordan Contraceptives Logistic System.
 Family Planning Sentinel Surveillance at MCH Centers .
3.
Recommended Actions.

1.

Current Use of Family Planning
Methods and Method Mix / 2009

Percentage of currently married women 15-49 using any method
59
6

Main Reason for Discontinuation
Wanted to become pregnant
Became pregnant while using
Wanted more effective method
Side effects
Health concerns
Infrequent sex/husband away
Husband disapproved
Inconvenient to use
2
2
4
9
13
12
17
35

Impact of Changing Method Mix on Jordan’s TFR
Indicator
Average Method Effectiveness
Scenario A
Current Method Mix remains constant at
2009 level
0.83
Scenario B
50% of Traditional
Method users shifts to
Modern Methods (%)
0.89
Modern CPR (%)
CYP
Unintended Pregnancies
Births
TFR
40.50
345,000
82,000
171,000
3.80
49.15
417,000
50,000
156,000
3.45

Method Mix Issues in Jordan
• Fear of side effects
• Provider bias
• Provider availability (female provider)
• User preferences
• Availability of financial resources
• Quality of counseling services (practices & space)

2.

No Products………… No programs
► Established in 1997 at MoH. All contraceptives were provided by USAID.
► In 2005, USAID started to phase out and completed in 2009. MoH started to purchase all contraceptives.
► A budget item in MoH budget is specified for contraceptives procurement in
2011.

FP Methods Available in Jordan
Contraceptive Logistic System
• Pills (combined and estrogen only pills).
• IUDs (copper T).
• Injectables (3 months ).
• Implant (one rod).
• Male condoms.

Programs Under Jordan
Contraceptive Logistic System
• Ministry of Health (health centers and hospitals)
• Royal Medical Services.
• UNRWA Clinics.
• Jordan Association for Family Planning and
Protection.
• Governmental universities hospitals .
• Private sector clinics through PSP project .
• Other NGOs
Total of 662 clinics provided with contraceptives for free.

3,60% 4,27%
26,70%
50%
IUDs
Condoms
Pills
DMPA
Implanon
17%

Method Mix for the whole System-
2010
2.60%
1.40%
21.40%
14.60%
60%
IUDs
Condoms
Pills
DMPA
Implanon

2,50%
1%
22,70%
0,80%
14%
59%
MoH
UNRWA
Universities
JAFPP
RMS
Others

 New choices of contraceptives methods should be added to the system. some of the barriers are:
• Concerns regarding stock out ,over stock, when adding different brands of combined oral pills to the system.
• Limited brands of oral pills (COCs ,POPs) and types of contraceptives registered at JFDA.
 Limited market for family planning methods in Jordan.
 Long and complicated procurement procedures.

Improving Access to Intra Uterine
Devices (IUDs) at MCH Clinics
► IUD is a long term, effective, and well accepted family planning method in Jordan.
However, access to this method is limited due to shortage of female providers.

MoH Pilot Project on IUDs
Insertion by
► Objective : Improve Access to IUD Services at MoH
Primary Health Care Level.
► Started in 2003 and continued successfully until
2009.
► 182 midwives at MCH centers were trained to offer IUD insertion service and permitted to provide the services.
► Results :
• No significant complications were reported.

NUMBER OF HEALTH CENTERS
PROVIDING IUD SERVICES 2003-2009
200
150
100
100
119
142
.n
167
175
182
175
193
50
0
2003 2004 2005 2006 2007 2008 2009

50
40
30
20
10
0
PERCENTAGE OF IUDs INSERTED
BY MIDWIVES 2004-2010
19.8
24.8
29
.n
37
42.8
46.5
39
2004 2005 2006 2007 2008 2009 2010

► Policy Change
Recently, the Minister of Health approved adding the “task of IUD insertion under physician’s supervision” in job description for midwives.

Introducing Long Acting Hormonal
Methods-Implants- in Jordan
Contraceptives Logistics System
► Why Implants ??
• Effective and long acting.
• Acceptable from male physician providers.
• Expand choices of contraceptives.
► Implants was introduced in Jordan Contraceptive
Logistic system in 2006 in cooperation with
Organon in a limited scale (two training courses).

► In cooperation with HSS
2, a core of 13 trainers were trained in 2010, then several training courses were conducted.
► Currently,
Total number of trained physicians: 94
(from MOH, JAFPP, RMS)
Number of health facilities providing implants: 48
(at MOH, RMS)

►
• High over turn of trained health providers.
• Limited promotional activities towards
Implants.
• The need for assessment of acceptance, side effects, and discontinuation of implants.

Family Planning Sentinel
Surveillance at MCH Clinics
Established in cooperation with HSS project for discontinuation of combined pills and IUDs using prospective study design.

Contraceptive Discontinuation Rate (%) by Reason and Method-(2009-2010)
Reason
Discontinuation
Rate
Method failure
Desire to become pregnant
Pills
1.5
10.2
IUDs
1.1
2.2
Switched to another method 18.6
6.6
Other reasons
Total
12.2
42
4.1
14

Percent Distribution of
Contraceptive Discontinuation by
Reason
Reason
Method failure
Husband ’s absence
Desire to become pregnant
Health reasons
Husband or others disapproval
Separation
Side effects
Other
Total
IUD
%
6.2
3.5
19.5
8
4.4
0.9
51.3
6.2
28.3
Pills
%
4.5
4.5
26.2
9.8
3.5
1.7
44.4
5.2
71.7
Total
%
5
4.3
24.3
9.3
3.8
1.5
46.4
5.5
100

►
• High discontinuation rate especially among COCs users (although less than national rate).
• Most of discontinuers (42%) switch to another method mainly condom which is less effective.
• High % of IUD users (39%) switch to COCs which is short term, while 27% of COCs users switch to IUD which is long term.
• Side effects play a major role in discontinuation and switching.

3.

► Conduct an assessment of the feasibility and effectiveness of introducing new brands and varieties of pills to Jordan FP logistic system.
► Introduce new family planning methods to the
Jordan FP logistic system.
► Simplify the procurement procedure of FP methods.

► Operationalize the Minister’s decision which approved adding IUDs insertion to midwife job description.
► Collect and analyze information on Implanon discontinuation rate, side effects, and acceptance, to be used as a tool for evidence based promotion for service providers.
► Strengthen FP communication activities on increasing demand for long-acting hormonal contraceptives, decreasing demand for traditional methods, and on birth spacing and limiting to promote appropriate method selection.

► Conduct an assessment of the family planning counseling services.
► Strengthen counseling services with focus on provision of special counseling and follow up for
COCs users, and sufficient information and counseling on side effects and on most suitable methods for limiting and spacing.