FP2020 reports progress on family planning, but faces an uphill battle

LONDON — A global partnership to drive access to family planning services has reported that almost 40 million more women and girls are using contraception since the initiative launched five years ago.

However, rates of progress are still falling short of what is needed to reach the partnership’s targets and those set by the Sustainable Development Agenda.

Furthermore, with donor funding for family planning declining for the second year in a row and the full force of the United States cuts set to kick in across the sector next year, progress is likely to become more challenging.

The update report by the Family Planning 2020, or FP2020, partnership, published Tuesday, tracks progress made over the last year towards achieving the target of providing an additional 120 million women and girls with access to modern contraceptive methods by 2020.  

FP2020 was set up in 2012, following the landmark London Summit on Family Planning, which raised $2.6 billion for reproductive health efforts in developing countries. A second conference held earlier this year raised another $2.6 billion.

The report finds that as of July 2017, approximately 310 million women and girls in the 69 FP2020 focus countries are using a modern method of contraception, an increase of 38.8 million since 2012 when the partnership launched. While this is 30 percent above the historical trend, it is just over half the number of new users the partnership had hoped to reach by this time. If the current rate of progress continues, FP2020 will not reach its 2020 target of 120 million new users, the partnership’s executive director Beth Schlachter said during a press briefing on Monday.

“We are not on track … and if we continue on the same arc of progress we’re on at the moment we will hit that number sometime around 2025,” she said.  

In addition, progress has been uneven across regions and demographic groups. For example, contraceptive prevalence across Africa grew by 1.2 percent over the past year, compared with a progress rate of about 0.2-0.4 percent a year in Asia. The Middle East and North Africa, and also Latin America and the Caribbean, saw the slowest levels of progress.  

However, Amanda Glassman, health expert at the Center for Global Development, a Washington, D.C.-based think tank, made the point that “any progress is good progress” and that FP2020 targets “were not projected based on a model,” and may have been “over-optimistic.”

The report also claims that between 2016 and 2017, 84 million unintended pregnancies were prevented as a result of FP2020’s efforts; as were 26 million unsafe abortions, and 125,000 maternal deaths.

It highlights trends in the popularity of contraceptive methods, with injectables being the most common contraceptive method in 28 of the focus countries. Implants and injectables are continuing to increase in prevalence.

Schlachter said the partnership was exploring what happens after the 2020 deadline, and whether the effort can be extended to 2030, to align with the Sustainable Development Goals.

“This next year is the year we are going to look more closely about what this partnership needs to do to transition from 2020 to 2030,” she said. “Some of that depends on the donors’ willingness to fund,” she said, but added that she was “very hopeful that some form of a partnership will go forward.”

An estimated 214 million women and girls in developing countries who want to delay or avoid pregnancy are still without access to contraception, according to the Guttmacher Institute.

Better data and focus on adolescents

Reproductive health and women’s rights experts welcomed the report, which they described as more detailed than FP2020’s previous annual figures and noted the emphasis on young girls.

“It’s really positive when you think about the first Family Planning Summit where adolescents and girls didn’t get a look in, but now there’s real attention to that,” according to Nicola Jones from the Overseas Development Institute, who added that focusing on this group is crucial given the expected population bulge, which will lead to the highest number of fertile young people ever recorded.

Katja Iversen, chief executive officer of Women Deliver, agreed, adding that her organization is “happy to see the … growing youth engagement in FP2020. If we want to increase young people's use of voluntary contraception, we need to involve them to discuss how best to do it.”

Jones said a focus on reaching married girls and also preventing child marriage was lacking in the report. Considering that more than 80 percent of adolescent pregnancy occurs in marriage, then “obviously preventing child marriage in the first place would be a key step,” she said. Even if FP2020 does not work on this issue directly, it should work with other partners and “pay more attention” to the issue, she added.

But she praised the report for being more rigorous in its data and analysis compared with previous years, which she said was “an impressive advance.”

Fatimata Sy, director of the Ouagadougou Partnership, which is made up of nine francophone countries in West Africa, spoke during Monday’s briefing about the importance of data and analysis in getting countries on board and helping to guide implementation efforts.

She said that while a lack of comparable and reliable data has been a huge challenge in the past, FP2020 has been working with its evaluation partner, Track20, to boost its monitoring and evaluation capabilities in country.

“The difference has been revolutionary,” she said, adding that “now for first time we are able to carefully estimate how many new users … have [been] added each year in countries.”

Donor funding ‘unstable and uncertain’

Donor financing makes up approximately 60 percent of spending on family planning according to the report, with the rest contributed by country governments, individual consumers, civil society, and private sector partners.

Jason Bremner, FP2020’s data and performance management director, described the donor funding landscape as “unstable and uncertain” going forward.

According to data from the Kaiser Family Foundation, bilateral funding for family planning declined in 2016 for the second year in a row, and reverted back to 2013 levels at $1.19 billion.

Although funding from the U.S. decreased in 2016, it still accounted for 45 percent of donor contributions. But Schlachter said the full effects of the “global gag rule,” reinstated by President Donald Trump in early 2017, are likely to start being felt next summer.

“We are going to start seeing shortfalls in the following year, particularly by next summer,” she said, as major organizations such as Marie Stopes International are no longer eligible for U.S. government funding under the rule. This is the point at which “breakages in the system” will become apparent, Schlachter said, such as funding for the most marginalized populations, unless “other donors don’t step in to make up the shortfall.”

While France, Norway, the United Kingdom, and U.S. decreased funding for family planning in 2015, Australia, Denmark, Germany and the Netherlands increased their contributions.

FP2020 beyond 2020?

A number of new members joined FP2020 during and after this year’s London Family Planning Summit. Chad, Haiti, and South Sudan made commitments for the first time, while Canada stepped up as a new donor. A host of civil society and private sector partners also joined.

However, according to ODI’s Jones, FP2020 needs to diversify much further if it is to accelerate progress and attract additional funders and members. “Broader thinking outside the health sector would be really welcome,” she said, adding that the partnership needs to think more about how it can “reach out into other sectors.” For example, schools can be used to “unpack discriminatory norms,” which are a key barrier to contraceptive use, she said, and more work could be done with faith leaders.

Jones also said greater use could be made of mechanisms such as cash transfers as a means of helping increase access to family planning.

Responding to a question from Devex as to whether the partnership would continue beyond 2020, especially considering the SDG agenda runs until 2030, Schlachter said she was “very hopeful” and that the partnership was demonstrating “the impact of country-led partnerships supported by global process and what they can produce.”

She said the team would be looking closely at post-2020 opportunities but that the ultimate decision depends on the availability of funding.

The Bill & Melinda Gates Foundation has been a key backer of FP2020 from the beginning. It announced additional funding of $375 million over the next four years, a 60 percent increase on its previous family planning budget, at the summit earlier this year.

In a press release sent to mark the report, Dr. Chris Elias, president of global development at the Gates Foundation and co-chair of the FP2020 Reference Group, appeared to emphasize his institution’s support for the initiative, saying “the way ahead is clear” and that FP2020 will “keep a sharp focus on rights, accountability, the financing landscape, and the evolving global pathway that links FP2020 progress to universal access to reproductive health by 2030.”

Dr. Natalia Kanem, executive director of the United Nations Population Fund and also co-chair of the FP2020 Reference Group, said “the family planning community is united, resilient, and ready to meet the future.”

Read more Devex coverage on reproductive health.