Editorial by Thérèse Delvaux (Department of Public Health, Woman and Child Health Research Centre, ITM Belgium)
New data on contraception released last week show that “an estimated 222 million of women have an unmet need for modern contraception. The proportion of married women using modern contraceptives in the developing world as a whole barely changed between 2008 (56%) and 2012 (57%). However, there were significant regional variations. Substantial increases occurred in Eastern Africa (from 20% to 27%) and Southeast Asia (from 50% to 56%), while there was little change in Western Africa and Middle Africa, regions where fewer than 10% of married women use modern contraceptives” (Guttmacher – UNFPA report).
Family planning (FP) is essential in achieving the United Nations’ Millennium Development Goals. Addressing the current unmet need for modern contraceptive methods would serve all women in developing countries who currently have such an unmet need and “would prevent an additional 54 million unintended pregnancies, including 21 million unplanned births, 26 million abortions (of which 16 million would be unsafe) and seven million miscarriages; this would also prevent 79,000 maternal deaths and 1.1 million infant deaths”. FP can also generate a range of other benefits, such as reducing poverty and helping countries achieve economic development goals. According to recent demographic projections, Sub-Saharan Africa has the highest fertility rate in the world, averaging 5.5 births per woman. The region’s mid-2007 population of 788 million is projected to increase to 1.2 billion by 2025.
Access to FP is an often neglected development priority in many low-resource settings where only a limited range of contraceptive methods are available today: mostly pills, injectables (Depo Provera) and condoms. Intra-uterine devices common in several Asian countries are barely used in sub-Saharan Africa. Similarly, contraceptive implants are only starting to be available in most low-resource countries. Therefore, increased access to FP and to a wider range of existing contraceptive methods is needed, particularly in sub-Saharan Africa where unmet need and unintended pregnancy rates are among the highest. Further research and development in new contraceptive methods, including multipurpose technologies to prevent both pregnancies and HIV, is also vital to improve FP programs and services.
There is clearly a momentum for FP: following the UN Secretary-General’s Global Strategy for Women’s and Children’s Health, launched in 2010-11 and promoting a comprehensive set of interventions and services including FP, in a few days, on July 11th, 2012, a FP summit hosted by the UK Government and the Gates Foundation will take place in London. The Summit will seek commitments from the global community to expand the availability of “voluntary family planning information, services, and supplies to enable 120 million more women and girls in the world’s poorest countries to be using contraception by 2020”. “Meeting the global demand for voluntary family planning will not only save and improve the lives of women and children; it will empower women, reduce poverty and ultimately build stronger nations,” noted Dr. Babatunde Osotimehin, executive director of UNFPA.
In order to reach these goals there is first a need for a rights-based approach. In light of the upcoming family planning summit, concerns have been raised by many human rights and sexual and reproductive health and rights (SRHR) organisations which led to a revised summit background document. The introduction of performance-based family planning indicators might be a threat to free contraceptive choice and may lead to some coercive measures to reach targets set by donors. There is also a fear of going back to vertical programmes thereby losing the gains made following the 1994 Cairo programme of action and the introduction of SRHR, including integration of SRH services, strong linkages between HIV and FP and meeting the needs of people living with HIV. Addressing the structural barriers to accessing family planning and other sexual and reproductive health services faced by women and girls in all their diversity without discrimination is warranted. Finally, generic drugs need definitely to remain on the agenda when negotiating more accessible contraceptive methods at higher levels and with pharmaceutical companies. Documenting and monitoring the implementation of this new initiative is therefore crucial.
We don’t only need to do it but also do it right!