50 vending machines for 11 dzongkhags to enhance access to condoms

While the health ministry will install 50 condom vending machines in 11 dzongkhags by the end of next month, the contraceptive injection, Depot Medroxyprogesterone Acetate (DMPA) remains the most used contraceptive in the country, records for the last five years show.

DMPA is injected every 12 weeks to prevent pregnancy.

Programme officer with the health ministry’s reproductive, maternal and neonatal health programme, Pema Lethro, said convenience could be a reason for women preferring DMPA to other contraceptives. “It can be injected once in three months (four cycles in a year).”

Gynecologist at the national referral hospital in Thimphu, Dr Phurb Dorji said the reason for women preferring DMPA could be because of its long duration of three months. The other reason could also be because health staff in rural areas promote it. “It doesn’t need internal examination like copper T and it is a reliable method trusted by women,” Dr Phurb Dorji said.

About 21,344 women in the country used DMPA last year. The lowest number of women who availed DMPA in the last five years was in 2013 at 19,381.

Of the six contraceptive methods available in the country, tubectomy and vasectomy are the permanent methods. Tubectomy is a surgical procedure for female sterilisation while vasectomy is for the male. More men opted for vasectomy than women in the last five years.

Intrauterine device (IUD), condom, oral contraceptive pills and injectable are temporary contraceptive methods currently available in the country.

Pema Lethro said a study is being undertaken to assess the reasons for women’s preference for one contraceptive over another. “But all the methods are effective.”

For instance, he said that copper-T IUD could be effective for 10 years. Condoms provide protection from unplanned pregnancy and sexually transmitted infections.

Pema Lethro said that before the women make any contraceptive choices, health care providers explain the risks and benefits of each method. A screening is also done to ensure that the right method is used with an informed decision.

However, going by the number of distribution after DMPA, the most common contraceptive is condom. The health sector distributed 12,274 condoms in 2014 and 8,865 in 2015, while 7,607 were distributed last year.

To enhance access to condoms at all times, the health ministry has procured the 50 vending machines.

Chief programme officer with the health ministry’s communicable disease division, Namgay Tshering said the machines are installed as a complementary approach to the existing mechanism of condom distribution.

“This is primarily to enhance accessibility to condoms at all times,” Namgay Tshering said. “The national programme has already prepared the standard operating procedures (SOPs) for the operationalisation of the machines.”

The machines will be installed in Thimphu, Paro, Wangdue, Punakha, Trongsa, Bumthang, Mongar, Trashigang, Samdrupjongkhar, Chukha and Gelephu.

Namgay Tshering said these locations are selected based on population size, sexual vulnerability and ongoing developmental projects.

The machines will vend three condoms after one pays Nu 5. The identified machine outlet owners who will also be taking care of the machines will collect the money and look after the replenishment of the condoms. A certain amount of the money collected will be given to the outlet owners. The initiative is expected to generate more demand for the use of condoms.

Copper-T IUD is the least common contraceptive method preferred by the women in the country at 1,609 last year. About 1,500 women used IUD for birth control in the previous two years.

Pema Lethro said contraceptives are used for delaying pregnancy, spacing birth, avoiding unwanted pregnancy and preventing sexually transmitted infections. “Strict compliance with the use of contraceptives by the users, as advised by health care providers will play an important role in achieving these results.”

According to the Bhutan Multiple Indicator Survey 2010, the contraceptive prevalence rate in the country is 65.6 percent with an unmet need of 11.7 percent. Women with unmet needs are those who want to stop or delay childbearing but are not using any contraceptives.

Pema Lethro said strategies and standards are developed and revised from time to time to respond to the needs of the population. “Advocacies are being conducted to sensitise public on the importance of family planning services through media and meetings.”

Reproductive, maternal and neonatal health programme also involve in building competency of healthcare providers through training and workshops.

Family planning was introduced in the health care delivery system in 1971 to address high maternal and infant mortality rates.

Dechen Tshomo

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