Family Planning 2020 looks toward next chapter

NAIROBI — An additional 53 million women and girls are using modern contraceptives over the past seven years in 69 of the world’s lowest-income countries, according to a report launched Monday by Family Planning 2020, a global partnership focused on family planning. With these additional users, a total of 314 million women and girls are now using contraception.

This figure falls flat of the goal set in 2012 of reaching an additional 120 million women and girls — a goal the report notes was “extremely ambitious” and that despite not reaching these goals, gains are still nearly 30% above the progress that was historically projected had the partnership not existed.

“We found that sometimes the goal itself can mask the levels of progress that are underneath it,” Beth Schlachter, executive director of Family Planning 2020, told Devex.

The partnership, launched in 2012 at the London Summit on Family Planning, includes governments, civil society, multilateral organizations, donors, the private sector, and the research and development community. Core partners include the Bill & Melinda Gates Foundation, the U.K. Department for International Development, the United Nations Population Fund and the U.S. Agency for International Development.  

The report release coincides with the Nairobi Summit on ICPD25 in Nairobi this week, which is the 25th anniversary of the International Conference on Population and Development in Cairo where a document on sexual and reproductive health was created that has served as a guiding document to shift family planning from a top-down approach to one that is women and girl-centered and focused on choice.

Falling short on goals

In the Family Planning 2020 framework, countries set goals focused on family planning, including the use of modern contraceptives. Modern contraceptives include options such as condoms, intrauterine devices, injectables, sterilization, birth control pills, implants, and emergency contraceptives, whereas traditional methods include periodic abstinence and withdrawal.

Only 9 of the 69 countries are on track to meet the goals set for growth in contraceptive use by next year, including Mozambique, Chad, Cameroon, Kyrgyz Republic, Zimbabwe, Kenya, Ghana, Burkina Faso, and Sri Lanka. Another 13 countries are within a few percentage points of reaching their goals, according to the report.

The rate at which women and girls are using modern contraceptives increased, globally, by about 2% since 2012. The largest increases were in Eastern and Southern Africa, with increases of about 7%.

But even when countries keep the rates of modern contraceptives stable, they often still increase the number of people on contraceptives due to population growth. The number of women and girls of reproductive age has risen by 100 million since 2012, for a total of 926 million women of reproductive age globally.

Funding challenges

Funding remains a key obstacle. The report notes that women’s health care is underfunded everywhere in the world and about 230 million women and girls who want access to contraceptives are not receiving them.

The report breaks down the sources of funding. In 2017, international donors contributed about 45% of family planning funds; domestic governments about 32%; out-of-pocket spending about 19%; and other domestic sources, such as national NGOs, corporations, and insurance companies, about 4%.

Of the 69 countries in the partnership, the ones with the highest levels of domestic funding expenditures on family planning include India, Bangladesh, and Indonesia.

“We're looking at more effective models like the Global Financing Facility, that are seeking to ensure that family planning is seen as a part of regular primary health care for women,” Schlachter said.

Global momentum surrounding universal health coverage also offers the “potential to shift resources away from vertical funding models toward a broader investment in health systems and integrated service delivery,” according to the report.

Moving forward

The partnership is now examining what its framework will look like after 2020. Instead of readjusting the goal of 120 million girls and women on contraceptive methods, the partnership will continue to work toward that goal within the same 2030 timeline of the Sustainable Development Goals, Schlachter said.

"The vision that is emerging calls for integrated services that are accountable to women and girls and responsive to their needs, that advance the gender transformative potential of engaging men and boys as critical partners, that prioritize adolescents and youth, and that leave no one behind. It calls for a framework that is country-led, sustainably financed, inclusive of young people, synced with the shift toward universal health coverage, and aligned with the Sustainable Development Goals," according to the report.

One of the areas the partnership aims to focus on includes integrated services. This means ensuring that a woman or girl “at every service delivery point is comprehensively informed of every choice available to her,” according to the report, in areas including family planning, HIV, STI, and cervical cancer services.

Results for the Evidence for Contraceptive Options and HIV Outcomes, or ECHO, trial were released this year that examined the levels of HIV infection among women using three different contraceptive methods. It found “no significant difference in risk of HIV infection”

between the three methods — alarmingly, it also found that women in the study had the same rate of HIV infection as sexually active women in the same region who weren’t part of the study.

The study underscored the need to “improve the quality of information and counseling women receive from health care providers, expand the mix of available contraceptive methods, and push for integration of services and resources,” according to the report.

The report notes that the family planning and HIV communities are looking at a wider range of contraceptive methods, integrated services, flexible funding from donors, and the central role of women and girls in programs and policymaking as key priority areas moving forward.