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QUINACRINE STERILIZATION:
POTENTIAL IMPACT OF
ITS AVAILABILITY
IN INDONESIA
  • Dr. TINA AGOESTINA, Sp.OG
  • Rumah Sakit Ibu & Anak Sukajadi
  • Bandung - Indonesia
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INDONESIA
(FP, MATERNAL MORTALITY)
  • 1970: 40.000, CONTRACEPTORS
  • 2002: 24.565.611, CONTRACEPTORS
  •           36 MILLION MARRIED COUPLES
  • MMR IS HIGH: 334/100.000 LB
  • STERILIZATION IS VERY LOW: 3.7%
  • QS AVAILABILITY IN FP PROGRAM CAN LOWER THE COSTS OF FP SERVICES (CBA MODEL)
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TAB . 1 CONTRACEPTIVE METHOD PREVALENCE, POPULATION GROWTH (ANNUAL GROWTH  RATE), FERTILITY, IMR, AND MMR IN INDONESIA
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THE UNMET NEED FOR STERILIZATION
  • UNSTERILIZED WOMEN STATING WANT NO MORE CHILDREN, 65%
  • QS INSERTION ~ IUD PROCEDURE
  • IUD SERVICES MOSTLY BY TRAINED PARAMEDICS WITH GREAT SUCCESS, INCLUDING RURAL AREAS
  • QS IS THE LEADING CANDIDATE TO RAISE THE CONTRACEPTIVE PREVALENCE
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TAB. 2 GROSS LIFE-TABLE PREGNANCY, CONTINUATION AND FOLLOW-UP RATES FOR 100 WOMEN HAVING THREE COMPLETE INSERTIONS OF QUINACRINE HYDROCHLORIDE PELLETS (n=98)*
  • PERIOD (MONTHS)
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NFPCB: DECIDED TO CONDUCT MULTICENTER RCT 1 vs 2 QS INSERTIONS
  • THE POTENTIAL OF QS :
  • P TO INCREASE CONTRACEPTIVE PREV.
  • P TO DECREASE MATERNAL MORTALITY
  • QS: REASONABLE OPTION FOR WELL-INFORMED WOMEN, WITH INCREASED COMPLICATION RISKS AND NO ACCESS TO SURGICAL STERILIZATION
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TAB. 3  CUM. LIFE-TABLE PREGN. FAILURE RATES PER 100 WOMEN AFTER TRANSCERV. INSERTION          1 Vs. 2 OF QUIN. (252 mg) + DICLOFENAC. (70 mg) RCT 1 vs 2 INSERTIONS IN 6 CENTERS
  • PERIOD (MO)
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TAB. 4 PREVALENCE OF AND ESTIMATED INCIDENCE OF PRINCIPLE CONTRACEPTION METHODS IN INDONESIA 2002 - 2003
  • METHOD
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TAB. 5 ESTIMATED ANNUAL CONTRACEPTIVE COST (US$) BY PRINCIPAL METHODS, INDONESIA 2002 - 2003
  • METHOD
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ASSUMPTIONS FOR COST/BENEFITS ANALYSIS MODEL
  • 20% SUBSTITUTION OF QS FOR CURRENT METHOD PER YEAR FOR WOMEN DESIRING NO MORE CHILDREN
  • 50% OF WOMEN CURRENTLY ON REVERSIBLE METHODS WANT NO MORE CHILDREN
  • COST OF QS IS TWICE THAT OF IUD INSERTIONS, OR $20
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TAB. 6 ESTIMATES OF CONTRACEPTIVE SAVINGS (US$) BY AVAILABILITY OF QS AND 20% ACCEPTANCE AT FIRST YEAR FOR INDONESIA
BY METHOD
  • METHOD
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TAB. 7 ESTIMATED MATERNAL MORTALITY SAVINGS BY AVAILABILITY OF QS IN 2003
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CONCLUSION
  • THE FINANCIAL AND HEALTH IMPLICATIOINS OF AVAILAIBILITY OF QS ARE CONSIDERABLE
  • IT IS TIME FOR THE NFPCB:
  • P  TO MAKE THE DECISION TO COMPLETE
  • CLINICAL TRIALS NEEDED  FOR
  • APPROVING QS AS AN ADDITIONAL
  • METHOD
  • P TO IMPROVE TRANSPARENCY FOR
  • ERRONEOUS REPORTS THAT HAVE
  • DELAYED THIS DECISION