5 topics to watch at the London Family Planning Summit

Read Devex takeaways and analysis from the London Family Planning Summit.

Five years after a pledge to make contraceptives available to an additional 120 million women and girls worldwide, representatives of governments, NGOs and the private sector will gather on Tuesday to ask why global progress on family planning has stalled.

The London Family Planning Summit will “check in” on advances and obstacles since its predecessor event in 2012, which saw donors and developing countries come together to work on improving access to family planning services. With a view to reaching an additional 120 million women by 2020, the event raised $2.6 billion in new financial commitments and political support from more than 40 developing countries, leading to the creation of the Family Planning 2020 partnership to support work toward the targets.

Progress so far has been disappointing, however, with only 30 million additional women and girls reached since 2012, according to a mid-way review. Additionally, there remain an estimated 214 million women and girls in developing countries who want to delay or avoid pregnancy but do not have access to contraception, according to the latest data from the Guttmacher Institute, released last week.

Guttmacher estimates that expanding services to meet all women’s needs for contraception in developing regions would cost $11 billion annually. However, each additional dollar spent on contraceptive services above current levels would save $2.30 on the cost of providing support for unintended pregnancies, it says.

This week’s summit — co-hosted by the Bill & Melinda Gates Foundation, the United Nations Population Fund and the government of the United Kingdom — aims to troubleshoot problems and secure additional support from donors and governments. It comes as the family planning community attempts to navigate a path forward following severe funding cuts from its biggest donor, the United States. Earlier this year, President Donald Trump’s administration revived an expanded version of the global gag rule and cut $32.5 million in funding to the UNFPA, the U.N. agency responsible for reproductive health. Trump’s budget request also proposes zeroing out all family planning funding in the U.S. foreign assistance budget.
The U.S. is by far the largest bilateral family planning donor worldwide, leaving some advocates wondering what the conference will be able to deliver under these circumstances.

There have been some positive results since 2012, however. In 2015, Marie Stopes International doubled its FP2020 goal from 6 million to 12 million new users by 2020 due to its strong performance. The Ouagadougou Partnership, made up of nine West African countries, also more than doubled its target after meeting its commitment to reach an additional 1 million women in just three years.

A number of European countries, as well as Canada, have made valiant efforts to fill the funding gap created by the US — estimated at $600 million — through the She Decides fund, announced by the Dutch government in February. On Thursday, the Netherlands allocated an additional 15 million euros ($17 million) to the pot.

Beth Schlachter, executive director of FP2020, said the summit could act as an opportunity to bring the sector together at a difficult time. “[In spite of] uncertainty within the Trump administration [the Summit] allows us to come together and move forward as a community,” she said.*

But campaigners told Devex that funding for family planning was inadequate to meet the increasing demand for contraception even before the U.S. pulled back.

Taboos around contraceptive use also threaten the success of interventions, while new setbacks in supply chains for reproductive health services and products present challenges and barriers to access.

Nobody is expecting to solve these issues over the course of a day-long summit, officials told Devex, but several funding announcements are expected from donors such as the U.K., as well as high-level buy-in from government officials, including several ministers of finance.

New data from Marie Stopes International reiterates the need for swift action, estimating that if the world’s poorest 69 countries offered contraception to every woman who wants it by 2030, this would prevent 1.6 billion unintended pregnancies, more than 500 million unsafe abortions, and 1.5 million maternal deaths.
Around 600 people are expected to attend the event, which has a packed agenda including high-level speakers such as Melinda Gates — co-chair of the Bill & Melinda Gates Foundation — and will see the launch of a number of new reports and evaluations, as well as a host of side events. Satellite events will also run in parallel to the summit across 22 developing countries.

Devex rounds up five of the top topics to watch.

Adolescent girls

Adolescent girls often lack access to family planning due to social norms, provider bias and cultural beliefs about contraception. How to better serve them will be a key topic at the summit.

Twenty thousand adolescent girls give birth every day, mostly in developing countries. Almost 85 percent of these births are the result of child marriages, according to UNFPA statistics.

“Adolescents have very different needs to older women and thus require a different approach and services,” said Schlachter, who added that a failure to effectively target this group is one reason why the partnership has so far fallen short of its targets.

Furthermore, with 1.2 billion adolescents worldwide — a number that is growing — “we’re looking at the largest generation of adolescents in history, so there’s an urgency there,” she said.

Improved data will help interventions target young people. The FP2020 Secretariat is calling on its members to sign a statement committing to collect age and sex disaggregated data. A funding announcement is also expected to support this work.

Population Council recently launched the Girl Innovation, Research, and Learning Center, a new global research unit to promote evidence-based approaches to improving sexual and reproductive health outcomes, as well as other issues affecting this age group.

The International Planned Parenthood Federation has also published  a report today with recommendations and best practices for reaching underserved populations, including adolescents, women and couples living with HIV, refugee populations, and the very poor.
However, Jonathan Rucks, head of advocacy at PAI — a Washington, D.C.-based policy and advocacy group for reproductive health — said that while the rhetoric around focusing on adolescents is valid, in reality many developing countries are doing little to support this work.

“While there is always a lot of discussion, there is resistance to youth accessing contraception at the country level so I hope there is a candid discussion about that,” he said.

Researchers at the Overseas Development Institute compared the urgent need for new funds to tackle adolescent pregnancy to the swift funding response to the HIV epidemic.

“Donors urgently need to scale up efforts, in a way that we saw with the global campaign against HIV and AIDS, which managed to turn the tide on new infections in less than two decades,” said Nicola Jones, principal research fellow at ODI.

Reaching women and girls in humanitarian settings

Women and girls in the midst of humanitarian crises, especially conflict situations, are at higher risk of violence and sexual exploitation, unwanted pregnancy, HIV infection, early or forced marriage, and maternal disability or death, according to UNFPA. More women may also wish to delay or prevent pregnancy in such unstable environments.

However, providing family planning services in fragile settings is challenging.

The U.S. was the world’s second-largest donor to UNFPA’s humanitarian work, supplying services and contraception to many of the hardest to reach women and girls in refugee camps, for example. The loss of this funding will be on many people’s minds at the summit.

A side event will focus on the need to prioritize family planning in emergency response. It is hoped that new approaches to meeting this need — alongside funding commitments — will emerge.

A rights-based agenda

Putting the rights-based agenda for sexual and reproductive health and rights front and center will be another major topic at the FP2020 event, especially as attendees grapple with what many have described as a “backlash” against women’s rights in a number of countries.

FP2020’s executive director said the summit hopes to communicate the need to focus not just on hitting numeric targets in terms of access, but also on ensuring that FP2020’s principles — including empowerment, rights, equal access and quality — are integrated into family planning programs.

“There are numeric goals but it’s really about how we do that work that matters,” she said.

PAI’s Rucks noted that some of the initial commitments made under FP2020 were too ambitious and overly focused on financial and numeric targets — but this has since changed, he said.

“Some commitments were very lofty but FP2020 has made concerted effort to make sure the commitments are the right size for the country and also [to] include rights language since it’s not just about monetary commitments, it’s also about advocacy,” he told Devex.

New options — and changing advice

Offering women and girls a wider range of contraceptive options — and ensuring they have full access to information about those options — is key to the rights-based agenda. It can also drive uptake: Increasing the contraceptive options available by just one has shown to increase use within a community, the summit’s organizers said.

Linked to this, the event will include updates and announcements related to new products, innovations and partnerships to improve the delivery and quality of services.

The World Health Organization’s recent move to reclassify progestogen-only injectable contraceptives — such as Depo-Provera and Sayana Press — due to rising concerns about their potential link to a higher incidence of HIV infection in at-risk communities, also puts the issue of choice in the spotlight. WHO still says the contraceptive benefits outweigh any risks, but says that women should be advised of the risk.

These two contraceptives have the potential to increase access to underserved populations because of their low-maintenance and discrete dosing methods, and affordability. The Gates Foundation is a major backer of Sayana Press and recently orchestrated an arrangement that reduced the price per dose to less than $1, further complicating the debate.

Tuesday’s summit will likely address concerns among implementing organizations about the need to retrain in-country providers to identify women at higher risk of HIV transmission, but also about how to communicate WHO guidance without alienating potential users while respecting their rights to full disclosure of information.

The U.S. and abortion — two elephants in the room

The summit’s conveners are keen not to let concerns over Trump’s family planning policies overwhelm the event.

However, the loss of U.S. funding and leadership on family planning will no doubt come up repeatedly during Tuesday’s sessions. The U.S. Agency for International Development is deploying a representative to the summit — Ellen Starbird, director of the Office of Population and Reproductive Health — but as a civil servant, she is unlikely to be able to shed any light on future funding and political leanings.

In conversations with Devex, some members of the family planning community pointed out that there is still money left in the USAID kitty to spend on family planning this fiscal year, and that it’s too early to tell where next year’s budget will land. Furthermore, this is not the first time the U.S. has withdrawn support for family planning.

However, others were less optimistic. Rucks said he wants countries and donors to use the summit as an opportunity to protest: “This could be used as a moment to galvanize support for family planning in a hostile environment in which the U.S. is giving legitimacy to conservative movements around the world,” he said.

Rucks also warned that — while abortion is technically not a method of family planning according to the definition agreed at the International Conference on Population and Development in 1994 — leaving it off the table runs the risk of “validating” the Trump administration’s position by “sweeping it under the rug.”

“If you want to reduce maternal death you can’t not talk about access to safe abortion,” he said, adding that he hopes the Trump administration’s “negative framing” of abortion will not divide civil society groups working on family planning.

“I hope civil society actors come together,” he said. “We shouldn’t let this punitive administration divide our community.”

EDITOR’S NOTE: This article has been amended to clarify the exact wording of a quote from Beth Schlachter, executive director of FP2020.

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