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Melinda Gates Pledges to Support Family Planning

Melinda Gates Pledges to Support Family Planning

On April 5, 2012, Melinda Gates announced her commitment to support family planning for the next 10 years during a TEDxChange held in Berlin, Germany sponsored by The Bill & Melinda Gates Foundation.

Melinda Gates shared her personal story of how she came to be an advocate for helping the world’s poorest women gain access to contraceptives. In her talk, she discussed why contraceptives should not be controversial. Her talk launched a major push for the BMFG around the critical role family planning plays in advancing women’s health and ensuring that women are empowered to decide when and if to have children. It also launched an effort to collect stories through: “How have contraceptives changed your life?” Go to  http://nocontroversy.tedxchange.org/ to share your story.

TEDxChange Berlin was a worldwide event with over 200 satellite events taking place in more than 60 countries around the world.

To view the event visit http://tedxchange.org and for more information visit http://www.ted.com/pages/tedxchange_overview.

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Melinda Gates: 2011 International Conference on Family Planning

Melinda Gates: 2011 International Conference on Family Planning

“Small investments in family planning pay huge dividends for women and their families,” Melinda Gates told conference attendees in a video shown during Tuesday’s opening ceremony for the 2011 International Conference on Family Planning.

Gates said she plans to devote much of her time in the future advocating for the 215 million women who don’t want to have a child but cannot access modern contraceptives. (Video courtesy of the Gates Foundation.)

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Greetings From Hillary Clinton

Greetings From Hillary Clinton

A letter of support from Hillary Clinton, U.S. Secretary of State:

On behalf of the U.S. Department of State, it gives me great pleasure to extend my greetings to those gathered in Dakar for the International Family Planning Conference. While I regret I am unable to be with you in person today, I thank you for your leadership and hard work, and for your commitment to providing family planning and reproductive health care and services to the women and families who most need them.

With 53 million unintended pregnancies in the developing world each year, and 215 million women facing unmet needs for family planning, this is the year we must commit ourselves to accelerating our efforts to ensure that all women have access to family planning and reproductive health care and services.

Family planning is the basic right of all individuals and couples to have the information and means to decide freely and responsibly the number, spacing and timing of their children, and my travels as Secretary of State have only reinforced my strong belief that continued U.S. commitment and involvement in this issue is of paramount importance. I am proud to be a member of the global community of partners working to promote reproductive health and rights, united in our belief that voluntary family planning provides a solid foundation for all women to achieve their God-given potential.

What is most impressive about this conference, and those of you in attendance, is the conviction we share to working with all our partners in the global community to achieve our common goals, for our community is much larger and more diverse than just state actors, it is all of us: NGOs, international organizations, civil society and private sector partners and dedicated citizens. Those of you here today are on the frontlines of this global effort, not only with your work, but through your efforts to change minds and attitudes, and the very circumstances that keep women and girls from reaching their full potential.

I have long believed that empowering women is the key to unlocking many of the challenges we face around the world. Our bottom line is and must remain the empowerment of women and young people to control their own sexual and reproductive choices. By improving access to reproductive health services, including family planning, we create a ripple effect that helps women care for their families, support their communities and lead their countries to be healthier and more productive.

The United States, through the Global Heath Initiative and the good work of USAID, is committed to working with all of you to avert maternal death and disability, which is one of the greatest moral, human rights and development challenges of our time, and is the world’s largest health inequity. I pledge to continue to do all in my power to contribute to ending the needless death and suffering of women from complications of pregnancy and childbirth, and I ask each of you to join me in pledging to do the same.

Your continued support and commitment is essential to fighting for the lives of women and ensuring today’s young girls and boys live in a tomorrow that holds out great promise. Together, through our work, we possess the power to help foster strong, healthy families, and thriving communities and countries.
Thank you for your dedication and hard work, and please know you have my very best wishes for a successful conference.

Sincerely,

Hillary Rodham Clinton

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Babtunde Osotimehin on JHSPH Blog: The 21st Century Imperative

Babtunde Osotimehin on JHSPH Blog: The 21st Century Imperative

Babatunde Osotimehin, executive director of UNFPA (United Nations Population Fund), was among the presenters at the opening ceremony. Here are some excerpts from his remarks.

This conference in Dakar is officially about family planning. But it’s also about a larger effort to improve women’s and children’s health. It’s about every woman, every child.  It is about accelerating social and economic progress.  And it’s about a new path to sustainable development.

Family planning programmes not only save and improve the lives of women and children; they empower people, strengthen health systems, and reduce poverty.Voluntary family planning allows women and couples to determine the number, timing, and spacing of their children.  It is—and has to be—an essential part of integrated reproductive and maternal health programs, because wanted pregnancies are healthier pregnancies. Family planning can save lives. It is estimated that as many as one third of maternal deaths could be prevented if the unmet need for family planning were to be eliminated.

Yet, 215 million women who want to avoid or delay pregnancy still have no access to modern contraception, with life-threatening consequences. Every year, 358,000 women die from pregnancy-related complications.

Fulfilling the unmet need for modern family planning in developing countries would cost $3.6 billion, but this investment would actually lower the cost of providing maternal and newborn health services by $5.1 billion, resulting in a net total savings of $1.5 billion.

To meet the global demand for family planning, we must galvanize greater political and financial support.  We must hold governments accountable for their commitments, and champion innovation and access—both in the North and in the South. Investing in voluntary family planning today will not only pay dividends now, but will also help history’s largest generation of young people enjoy opportunities and forge a brighter future.

As our numbers keep growing past 7 billion, and so many suffer from poverty, poor health and lack of opportunities, it is more important than ever to ensure that every child is wanted and that everyone has the power and the right to manage their own fertility.

Sustainable development is the imperative of the 21st century. We must invest in people. We know the benefits, and we know what needs to be done. Now it’s time to redouble our efforts and deliver on our joint commitments.

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Chelsea Polis on Hormonal Contraception and HIV

Chelsea Polis on Hormonal Contraception and HIV

In October, The Lancet Infectious Diseases published a study by Renee Heffron and colleagues suggesting that HIV-negative women using hormonal contraception (HC) might be at increased risk for HIV infection. The study also suggested that HIV-positive women using HC might be at increased risk of transmitting HIV to an uninfected male sexual partner. These new findings will be a topic of conversation at the 2011 International Conference on Family Planning later this month in Dakar, Senegal.

Chelsea Polis is an epidemiologist at USAID who received her PhD in reproductive health from the Johns Hopkins Bloomberg School of Public Health (JHSPH) in 2009, and holds an associate faculty appointment in the JHSPH Department of Epidemiology. Working with colleagues at CDC and WHO, Polis is leading two systematic reviews of the evidence to address HC and HIV risk. She offered her perspectives in the following emailed Q&A.

Should women reconsider their HC use in light of this study?

No; at this time, women need not reconsider their HC use in light of this study alone. For the time being, USAID and WHO have not recommended any change to current contraceptive guidelines. Careful evaluation of the Heffron study is underway. This study has several strengths, but also has limitations that complicate the ability to draw definitive causal inference between HC and HIV risk. In addition, previous studies have found inconsistent results. The scientific community is intently focused on understanding and incorporating new evidence in a thorough but rapid manner, and is working to establish consensus on interpretation of the new findings.

It remains critical that known risks and benefits of various contraceptive methods are clearly communicated. If it is ultimately determined that HC increases HIV risk, this will need to be communicated. People should also be informed that HC is not intended to protect against HIV or other sexually transmitted infections (STIs), and that dual protection against unintended pregnancy and STIs/HIV may be achieved by using condoms along with a highly effective contraceptive method.

Why is HC use important, particularly in settings of high HIV risk?

HC methods are highly effective at preventing pregnancy, and are among the most commonly used contraceptive methods in sub-Saharan Africa. Unintended pregnancy is associated with multiple adverse outcomes, including maternal and infant mortality. HIV-positive women report high rates of unintended pregnancy, and helping these women access voluntary contraceptive services could contribute to reductions in perinatal HIV. Furthermore, unanswered questions remain with respect to the relationship between pregnancy and risk of HIV acquisition in women and transmission to men. Competing risks must be carefully considered.

What do current guidelines suggest with respect to use of HC by women at risk of or living with HIV?

WHO continually updates the Medical Eligibility Criteria for Contraceptive Use (MEC), which encapsulates the latest data into clear recommendations for use by policy-makers, family planning program managers, and the scientific community. The 2009 MEC suggests no restrictions on use of hormonal contraceptive pills, injections, implants, patches, or rings for women at risk of or living with HIV. Women on antiretroviral therapy (ART) should confirm that no drug interactions are expected with HC for their regimen. Women with AIDS who are not clinically well on ART typically should not undergo IUD insertion, whether hormonal or non-hormonal. However, women with HIV and those who are clinically well on ART can generally use hormonal or non-hormonal IUDs. In general, hormonal methods are currently considered to be safe for most women, regardless of their HIV risk or status.

How will findings from the Heffron study be incorporated into global guidance?

The World Health Organization (WHO), in collaboration with USAID and other partners, will convene a meeting of a multi-disciplinary group of experts in January 2012. This technical consultation will seek scientific consensus on the Heffron study and other new studies, and assess whether the current WHO recommendations for contraceptive use among women at risk of or living with HIV remain consistent with the current body of evidence.

What are the strengths and weaknesses of the Heffron study?

The Heffron analysis has several strengths, including the fact that they prospectively collected detailed information at frequent follow-up visits, and analyzed a large population of HIV serodiscordant couples in multiple countries. The majority of previous studies have only analyzed women, without having information on partner HIV status. The study also used multiple statistical techniques to attempt to control for confounding. The investigators measured not only actual HIV seroconversions, but also assessed for differences in genital viral shedding by HC status, as a potential biological mechanism for female-to-male HIV transmission.

This study also has several limitations. It was not originally designed to examine if HC impacts the risk of HIV. Women self-selected their contraceptive method (if any), and HC users may have higher coital frequency, lower condom use, and less consistent condom use (and therefore, greater exposure to HIV) than non-users of HC. Though the investigators attempted to control for confounding, statistical adjustment may not be able to adequately account for such differences. Adjustment for sensitive behaviors like unprotected sex may be particularly complicated, since this uses self-reported information of unknown accuracy, and inadequate measurement can lead to inadequate adjustment. In addition, although the investigators theorized that the increased genital viral shedding seen among injectable users could explain the doubling in risk of HIV transmission to men, previous studies suggest that over five times that amount of genital shedding would generate only a 67% increase in risk of HIV transmission. So, it is unclear if the observed differences in shedding could explain the increased risk of female-to-male transmission, or whether other potential explanations might explain these findings.

Could there be differences between HC users and non-users that some studies do not adequately account for?

In any observational study, the potential for unmeasured or residual confounding is always a concern. As one example, I’ve been thinking a lot about potential differences in both the level and quality of condom use between HC users and non-users, and whether various study methodologies adequately address these concerns. We know HC users in many populations are less likely to use condoms, but among those that do, the quality of condom use might also be different than in women who don’t use HC but do use condoms. HC users already have an effective method of contraception, so if they use condom, they are more likely used to prevent HIV/STIs. Non-users of HC might use condoms for pregnancy prevention, or for HIV/STI prevention, or both. Some studies suggest that condom use is more consistent when used for pregnancy prevention than when used for infection prevention. Consistent condom use is associated with reduced risks of HIV, but oftentimes, inconsistent condom use is not. Also, women using condoms to prevent infection might use them with men perceived as “high-risk,” whereas condoms for contraception would likely be used with any fertile partner, including “low-risk” partners. So, although some observational studies do attempt to adjust for condom use differences between HC users and non-users, adjusting for “any” condom use may not capture potential differences in consistency of use or partner risk. Comparing findings of studies by how they addressed condom use does seem to suggest some potentially interesting patterns.  However, this body of evidence is extremely complicated, and we will be considering condom use and many other factors in the systematic reviews. Our ultimate goal is to provide accurate, unbiased, comprehensive, and up-to-date information on the risks and benefits of HC, in order to help individuals around the world make voluntary, well-informed decisions about their reproductive health.

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