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Sharon L Camp: Putting family planning back on the global agenda

13 Jul, 12 | by BMJ

What will it take to ensure that all women in the developing world can determine for themselves when and if to have a child, have healthy and planned pregnancies, and increase their chances of leading healthier, more productive lives? This week, world leaders gathered at the London Summit on Family Planning to address these questions and commit to action. The gathering came not a moment too soon.

A new study by the Guttmacher Institute and the United Nations Population Fund (UNFPA) has found that 222 million women in developing countries who want to avoid pregnancy still lack the services they need to do so.  Not only are we making little progress in meeting contraceptive needs, in the 69 poorest countries, the number of women lacking services has actually increased since 2008.

The lack of family planning can have devastating consequences­­­:  In 2012, an estimated 291 000 women in developing countries will die from pregnancy related causes, and 104 000 of these women did not want to be pregnant in the first place, a sobering statistic.

Expanding and improving the quality of family planning programmes in the developing world would have a dramatic impact. If all women who currently want to avoid a pregnancy were using modern contraceptives, there would be 54 million fewer unintended pregnancies annually; maternal mortality would decline by 27%, saving the lives of 79 000 women each year; and infant deaths would drop by one million. What’s more, if women spaced their births by three years, which many would like to do, deaths among children aged five and younger would drop by 25%.

So what will it take to make these dramatic gains a reality? Currently, approximately US$4 billion are spent each year on contraceptive care in developing countries (with households and governments in those countries paying the bulk of the costs). Increasing expenditures to cover all women who want care but do not have it would require doubling that amount. This may sound like a big increase, but the investment would be modest in relation to the remarkable returns it would achieve.  And surprisingly, it would actually lower total health-related costs. The additional US$4.1 billion investment needed would save $5.7 billion in maternal and newborn health care­­.  In other words, it would save $1.40 for every dollar spent­­, money that could be invested in other critical areas.

In addition to improving public health, satisfying unmet need for modern contraceptives would bring a host of other benefits. Enabling women to control their fertility and time their births means better chances for higher educational attainment, increased employment opportunities, and enhanced social and economic status. Family savings and investments would rise, spurring economic growth and reducing poverty. These advances at the family level would in turn make social and economic development goals easier to achieve, benefiting society as a whole.

The case for empowering women to become pregnant only when they want to be is clear.  While multiple barriers need to be overcome, the solution is at hand.  But everyone will have to do their part.   The admirable work of the United Kingdom and the Bill and Melinda Gates Foundation in hosting the London Summit on Family Planning serves as a model that is already generating significant new funding for international family planning, even in a time of budget austerity.  While the United States has been and remains the single largest donor to global family planning and reproductive health programmes, it—like most donor countries—can and should do more. And, critically, developing country governments must make support for family planning a higher priority, which will not only improve their citizens’ lives but make it easier to achieve their developmental goals.

At the Summit, an impressive US$4.6 billion in new funding was pledged to meet the contraceptive needs of women and couples in the poorest countries.  But translating the Summit’s promise into actual results will require not just more investment, but smarter investment: Quality of care must be improved, access to family planning services and counseling must be dramatically expanded, and a range of contraceptive methods must be made available to women regardless of their marital status.  Women in the developing world face many barriers to improving their lives— not having the ability to control their own fertility should not be one of them.

Sharon L. Camp is president and CEO of the Guttmacher Institute.

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