State Priority 1: Improve women/maternal health through cancer screening, prenatal services and family planning services
Domain: Women/Maternal Health
NPM 1: Percent of women with a past year preventive medical visit
|
Annual Objective |
2016 |
2017 |
2018 |
2019 |
|
Annual Indicator |
21.7 |
35.4 |
37.7 |
48.3 |
|
Numerator |
2,150 |
3,085 |
3,733 |
8,951 |
|
Denominator |
9,891 |
10,197 |
9,896 |
18,513 |
|
Data Source |
MCH Program |
MCH Program |
MCH Program |
MCH-JS |
|
Data Source Year |
2016 |
2017 |
2018 |
2019 |
MCH Program for Women/Maternal Health
In 2019, MCH Program conducted OI outreach visits to 6 outer islands to perform cancer screening services thru VIA(Visual inspection with acetic acid)and pap smear as well as Family planning and preconception services to girls and women of childbearing in the outer islands. There is a challenge in bringing women for screening due to confidentiality issues and services provided. Majority women come in for screening if there is a Medical mission for Gyn (Canvasback) on island compared to the number coming in to see our OBGYNs on island. Pap smears are read, and results given to the clients the same week compared to Majuro Hospital where results are sent off to Hawaii for interpretation. For the outer islands, women only access services when there is a team. Women tend to not visit the health center since the health worker is a male and women tend to come to Hospital only when they are sick and need medical treatment. There is a great need to do community awareness on the importance of annual medical checkup and family planning.
For Family planning, there is a need to increase community awareness. There is an increase in the teen births compared to previous years. With this the program arranged for presentations with the Teen Pregnancy prevention at school and did outreach visits to the outer islands. The YTYIH after dark clinic opens twice a week from 5:00-9:00 pm for teens to access services.
.
In 2018, there was a Canvasback Mission where 432 women where seen for papsmear in Majuro Atoll.
Also the MCH Program in partnership with Cancer Program strengthen the cervical cancer screening. Cancer Program through CDC grant contracted Women United Together Marshall Islands (WUTMI) as patient navigators to women in the community to avail the cervical cancer and colorectal cancer screening on weekends and after working hours. This was implemented in the communities and gov’t agencies as well as private businesses. Women’s Clinic managed by the MCH program opens its Saturday service to accommodate women that are working on weekdays and women that are hesitant to come during regular clinic hours.
SPM 1 - Percent of Women ages 25-49 yrs. old screened for cervical cancer
|
|
2017 |
2018 |
2019 |
|
Annual Objective |
20 |
11 |
13 |
|
Annual Indicator |
10.2 |
10.9 |
13 |
|
Numerator |
828 |
856 |
892 |
|
Denominator |
8,009 |
7,849 |
6,644 |
|
Data Source |
MCH Program |
MCH Program |
MCH Program |
|
Data Source Year |
2017 |
2018 |
2019 |
We did not meet our annual objective for 2019. MCH Program implemented the change in cervical cancer screening in Ebeye MCH Program including data recording and collection. There is a challenge in data recording and collection since MCH cervical cancer screening database is not functioning. There is a plan to include data in the Health Information System which will help improve data collection. If a woman in outer islands is found with abnormal results, patients from Outer Islands are referred to Majuro for further evaluation and treatment with the support of MCH funds.
Recommended national cervical cancer screening:
Pap smear: 21-65 years old
VIA: 30-49 years old
Top 3 Cancer for Female are cervical, breast and uterine. Most of the cases that are registered are in the late stage. If screened early, development of the cancer can be stopped.
Improve Pregnancy by making quality maternal services more available and accessible.
There are 3 OBGYNE in Majuro and 2 OBGYNE in Ebeye for MCH/Reproductive Health Services. OBGYNEs provides training to the MCH Prenatal and Post-Partum Services, Maternity Ward, and Labor & Delivery Ward. WHO initiative “First Embrace” where in newborn is immediately put into the mom’s chest and arms. With the Pediatrician, breastfeeding training was also conducted.
There is a continued collaboration with UNFPA to provide training to OBGNYs and midwives on the safe delivery app and the management on the third stage of labor. Because of the pandemic, training was delayed and will take place late this year. There are plans in place to expand RH services to the communities.
Prenatal Services in Majuro and Ebeye includes Tests: HIV/STI, blood chemistry, diabetes screening, urinalysis, stool, and dental checkup. Every pregnant mother is counselled on family planning methods, effects of HIV/STIs on the baby, good nutrition during pregnancy, after delivery and during breastfeeding, good personal hygiene, benefits of breastfeeding, dangers of bottle-feeding, effects of smoking and alcohol and other substances. All pregnant mothers are immunized annually for Tdap during their first initial visit. For Outer Islands, prenatal services is limited to pregnancy management, and counselling. More than 90% of pregnant mothers come to Majuro for delivery. There is a challenge in women coming in for early booking, majority come in during 2nd trimester or late in 3rd trimester or when in labor.
Chlamydia and Gonorrhea screening resumed in 2019 with the availability of Gene expert and reagents.
|
FY2018 |
Majuro |
Ebeye |
Total |
% |
|
Sexually transmitted disease prevalence among pregnant women |
||||
|
# of pregnant women who screen + for each of the following tests: |
|
|
|
|
|
RPR (for syphilis) + |
15 |
5 |
20 |
2% |
|
Chlamydia Antigen + |
32 |
0 |
32 |
3% |
|
Gonorrhea Antigen + |
9 |
0 |
9 |
1% |
|
Hepatitis B Surface Antigen + |
4 |
14 |
18 |
2% |
|
# of pregnant women tested for each disease |
686 |
291 |
977 |
|
|
Key Performance Indicator |
Target |
2016 Result |
2017 results |
2018 results |
2019 results |
|
Pregnant ♀- Syphilis prevalence (%) |
NT |
Ø |
Ø |
2% |
1% |
|
Pregnant ♀- Gonorrhea prevalence (%) |
NT |
Ø |
Ø |
3% |
2% |
|
Pregnant ♀- Chlamydia prevalence (%) |
NT |
Ø |
Ø |
1% |
14% |
|
Pregnant ♀- Hepatitis B infection (%) |
NT |
Ø |
Ø |
2% |
2% |
Family Planning Program
Contraceptive Prevalence Rate, RMI, FY2011-FY2018 |
|
||||||||
|
Description |
FY2011 |
FY2012 |
FY2013 |
FY2014 |
FY2015 |
FY2016 |
FY2017 |
FY2018 |
FY2019 |
|
No. of Women 15-44 yrs old that used at least one method of contraception |
1,234 |
1,373 |
1,721 |
1,917 |
1,836 |
1,826 |
1,825 |
1,984 |
1,443 |
|
No. of 15-44 yrs old women |
11,867 |
11,799 |
11,757 |
11,746 |
11,751 |
11,761 |
11,773 |
11,790 |
11,789 |
|
Contraceptive Rate |
10% |
12% |
15% |
16% |
16% |
16% |
16% |
16.8% |
12.3% |
|
Source: Family Planning Program |
|
||||||||
|
RMI Unduplicated Female Users Family Planning Services, 2017 |
||||||||||
|
|
<15 |
15-17 |
18-19 |
20-24 |
25-29 |
30-34 |
35-39 |
40-44 |
>44 |
Total |
|
Primary Method |
||||||||||
|
Female Sterilization |
0 |
0 |
0 |
5 |
34 |
120 |
252 |
183 |
106 |
700 |
|
Hormonal Implant |
7 |
28 |
45 |
121 |
87 |
77 |
37 |
21 |
4 |
427 |
|
3-Month hormonal injection |
3 |
19 |
38 |
106 |
67 |
76 |
47 |
33 |
12 |
401 |
|
Oral Contraceptive |
0 |
6 |
28 |
48 |
32 |
36 |
33 |
20 |
10 |
213 |
|
Female Condom |
1 |
0 |
0 |
0 |
0 |
0 |
1 |
0 |
1 |
3 |
|
Fertility Awareness Method (FAM) |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
|
Intrauterine Device (IUD) |
0 |
0 |
0 |
0 |
0 |
1 |
1 |
0 |
0 |
2 |
|
Abstinence |
0 |
1 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
1 |
|
Withdrawal or other method |
0 |
0 |
1 |
2 |
1 |
1 |
1 |
0 |
0 |
6 |
|
Total |
11 |
54 |
112 |
282 |
221 |
311 |
372 |
257 |
133 |
1,753 |
|
No Method |
||||||||||
|
Pregnancy or Seeking Pregnancy |
4 |
30 |
90 |
243 |
185 |
157 |
83 |
18 |
1 |
811 |
|
Other Reason |
0 |
2 |
16 |
34 |
52 |
43 |
27 |
19 |
21 |
214 |
|
Total |
4 |
32 |
106 |
277 |
237 |
200 |
110 |
37 |
22 |
1,025 |
|
Rely on Method |
||||||||||
|
Vasectomy |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
|
Male Condom |
1 |
0 |
1 |
0 |
1 |
0 |
1 |
0 |
2 |
6 |
|
Total |
1 |
0 |
1 |
0 |
1 |
0 |
1 |
0 |
2 |
6 |
|
Total Female Users of Family Planning clinic |
16 |
86 |
219 |
559 |
459 |
511 |
483 |
294 |
157 |
2,784 |
|
Source: Family Planning Program |
||||||||||
Male Unduplicated Users in Family Planning Clinics, RMI, FY2018 |
||||||||||
|
Primary Method |
<15 |
15-17 |
18-19 |
20-24 |
25-29 |
30-34 |
35-39 |
40-44 |
>44 |
Total |
|
Vasectomy |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
|
Male Condom |
0 |
0 |
1 |
1 |
0 |
0 |
0 |
0 |
0 |
2 |
|
Other Reason |
0 |
0 |
0 |
2 |
0 |
3 |
2 |
0 |
0 |
2 |
|
Total Male Users of Family Planning clinic |
0 |
0 |
1 |
3 |
0 |
3 |
2 |
0 |
0 |
4 |
|
Source: Family Planning Program |
||||||||||
Highlights for Family Planning
The after Dark Clinic at Youth to Youth in Health every Monday and Friday from 5:00 PM to 9:00 PM. During these clinics hrs., MCH/FP Staff provides Family planning services including giving contraceptives, counselling, and cervical screening. Aside from the youth, anyone who comes into the clinic will be served. College of the Marshall Islands has a nurse who also provides Family planning services to the students. With the outreach mobile visits, 6 Outer Islands were visited and provided with Family Planning Services.
Aside from the main FP clinics, services are available in Post-Partum visits and Maternity Wards for free. Female sterilization also available and performed by the OBGYNs.
Challenges: Less men accessing services at the FP clinic. Myths associated with the methods. To address these issues, there is a need to increase community awareness and knowledge on the methods and the benefits of family planning.
To Top
Narrative Search