Family planning: It's time to invest

When the International Conference on Family Planning — scheduled to take place in Indonesia this week — was postponed by the eruption of Mount Rinjani and a subsequent ash cloud, the news was met first with disappointment, but swiftly with resolve. Organizations working in reproductive health know from long experience that even the best laid plans can never be taken for granted. Our starting point is this: the right to contraception is universal. Yet the financial resources needed to satisfy the desire of women, men and young people who want to control their fertility are far from assured. This challenge grows every day as the largest youth cohort in history comes of age. As we move into a new era of development, the world will face tough choices about how to spend its finite resources to achieve the Sustainable Development Goals. Many of these choices will fall to governments, yet few leaders of developing economies might think first of prioritizing investment in preventative health, especially contraception, to assure their countries’ continued development. As a service provider in 37 countries, we believe this is a profound miscalculation. Contraception changes lives. At Marie Stopes International, we see the impact our services have on the lives of our clients every day. Through them, we see how access to contraception produces social and economic benefits for families, communities and economies. We believe, as do many others, that universal access to contraception is an essential foundation for development. As a community, we have excelled in quantifying the health impact of increased use of contraception, particularly in terms of outcomes like maternal mortality and unsafe abortions prevented. However, a definitive approach to costing and measuring the wider impacts of contraception remains elusive. As an organization that is driven by results, we want to quantify this wider impact of contraception on development to give us a clear understanding of how it is intrinsically linked to the SDG agenda and achievement of the demographic dividend. ‘Compelling’ results We started by mining internal data from 11 of our country programs to explore the correlations between a country’s contraceptive prevalence rate and other social and economic indicators. We then imagined the hypothetical emerging country of Contraceptia, with 2.2 million women of reproductive age. We looked at what would happen if contraceptive prevalence in Contraceptia was increased by 5 percent, to identify social and economic changes associated with the corresponding increased contraceptive use. The results were compelling. There was an increase in gross domestic product of $1,700, a 3.4 percent increase in girls’ primary school completion rate — from 69.9 percent to 73.3 percent. Contraceptia’s “gender equity index” score improved by 2.5 points; its foreign aid and government revenue ratio fell from 32 percent to 29 percent; while its “fragile state index” score dropped four points from 91 to 87, moving it out of the “alert” category. While we know that correlation is not causation, and that more in-depth work is needed, we are encouraged that the data do appear to suggest a starting point to build an evidence base for how to measure the impact of contraception on social and economic development. With more work, we believe we can find data that proves a crucial point: that contraception is one of the smartest upstream investments governments can make for the future prosperity and security of their citizens. In sustainability terms, there are few areas of development that can match expanding access to contraception in lasting impact. Consider Zimbabwe. Today, the country boasts one of the highest contraceptive prevalence rates in Africa, despite its people enduring periods of significant economic hardship. It is no coincidence that nationwide drives to promote family planning stretch back more than 60 years, leading to successive generations of women not only understanding the value of having that choice, but demanding the same rights that were afforded to their mothers and grandmothers. Once demand is created within a community, it grows roots. If meeting global development needs were as simple as building a house, giving people the ability to choose the size of their family would not be a brick or a beam. It would be part of the foundations, an essential and intrinsic part of development. Women with control over their fertility are more likely to complete education and become financially independent. Families with the ability to choose whether and when to have children are less likely to fall into — or remain trapped in — poverty. Time to act, time to invest We believe it is time to act and time to invest. This should be the aim of everything we work for today, and throughout the years to come: no woman who has gained access to contraception — and indeed comprehensive safe abortion services for when contraception fails — should ever be denied it again. If the world is serious about ending poverty by 2030, access to contraception cannot be allowed to fall off the agenda, or left unfunded. As health issues move increasingly towards domestic financing, the priority developing economies give to contraception is a foot poised above the pedals of their own development. They will either choose the accelerator or the brake. Disinvest altogether, and they may find themselves in reverse. We can’t expect anyone to reach this conclusion by themselves. We must get better at talking about this, basing our arguments on agreed indicators, on evidence, on verifiable data, and so speak more convincingly of the wider benefits of contraception — to governments, to major funding partners, to each other, and to those who are not yet convinced. It may not be easy, but we owe it to the women, girls and men we serve to make the strongest case possible for sustained investment in universal access to contraception. To read additional content on global health, go to Focus On: Global Health in partnership with Johnson & Johnson.