In family planning, no one-size-fits-all approach

By Kellie Sloan 26 September 2014

Rokhaya Thiam Dansee with her newborn, Badar, at the Croix Rouge health post in Pikine, Dakar, Senegal, on April 27, 2013. Photo by: Bill & Melinda Gates Foundation

EDITOR’S NOTE: On World Contraception Day, it’s important to know where we stand — and where we need to make more progress. Kellie Sloan, newly appointed director of family planning at the Bill & Melinda Gates Foundation, addresses six questions based on feedback from the international development community.

What’s your vision for the family planning program at the Gates Foundation? As the new director of family planning, what new accents are you hoping to set?

Our strategy is focused on driving forward the momentum needed to reach our ultimate goal: universal access to voluntary family planning. While this is our North Star, the FP2020 goal — increasing access to contraceptives for 120 million women by the year 2020 — is what I feel we, collectively, must hold ourselves accountable to in the near term to accelerate this momentum.

In my new role, my sight is set on identifying areas in which we are uniquely positioned to play a catalytic role. To uncover these opportunities, I have asked my team to cut ties to conventional mindsets, up our collaboration quotient, and foster greater transparency and accountability. We will also turn to our partners to ask what catalytic role they think we should be playing.

While there are many areas in which I feel we can have a greater impact, I am particularly excited about two potential opportunities: building a body of evidence on how to reach youth with family planning services, and sparking a data revolution. In my mind, the two go hand in hand.

Women and girls ages 10-24 represent more than 45 percent of the population that will be of reproductive age by 2020. Surprisingly, very little evidence exists on what strategies work for reaching young people. I am committed to generating evidence that increases our understanding of the behaviors and attitudes of young women so we can design programs that meet their needs. Understanding how to reach this demographic is critical to achieving our ultimate goal of universal access.

Similarly, to understand what is working and what isn’t, we need a rapid data collection and turnaround system that provides quality data to inform family planning programs and policy. With support from our foundation, the Performance, Monitoring and Accountability 2020 program is using mobile technology to collect nationally representative data on a more targeted set of family planning indicators semiannually across select countries in Africa and Asia. Previously, survey-based indicators on family planning were available much less frequently. If this model is successful, we need other donors to help us take it to scale in other countries.

From new medical technologies to groundbreaking drugs to designing more effective health systems, innovation will be critical as we address current and emerging health challenges. What innovative solutions in the area of family planning are you most excited about, and why?

Right now, I am particularly excited about a new contraceptive technology, Sayana Press, that health workers can administer in women’s homes and other convenient settings. The product delivers a lower-dose formulation of a widely used contraceptive — Pfizer’s Depo-Provera — through a pre-filled, auto-disposable injection system, which allows for subcutaneous (under the skin), rather than intramuscular (into the muscle) delivery. The idea is that, by making the delivery system smaller, easier to transport and easier for lower-skilled health workers to use, Sayana Press can expand access to family planning, particularly in hard-to-reach areas.

It also has the potential to, one day, be labeled for self-injection. This would be a game changer. It’s an opportunity we are exploring with our partners in the most appropriate way, in a few countries and settings.

I am eager to see the impact Sayana Press will have on increasing access to new users in countries where it is being introduced. A pilot project to examine the cost-effectiveness and demand for Sayana Press launched in Burkina Faso in July, and similar projects are launching in Senegal, Niger, Uganda and Bangladesh.

Can you give us an example of how partnerships supported by the foundation are helping to ensure more women have access to family planning services?

I think our support of the Ouagadougou Partnership — through IntraHealth, together with a host of donors and multilateral agencies — is a great example of how partnership is driving progress on family planning in countries across Francophone West Africa. The true value of this partnership is its ability to align family planning efforts in the region, and facilitate the dissemination and diffusion of high-impact practices that will increase contraceptive access. For example, the partnership recently provided support to replicate Senegal’s informed push distribution model in Togo, which has dramatically reduced the rate of contraceptive stockouts in both countries.

The Gates Foundation has been an innovator when it comes to finance, for instance in the way it has supported pledge guarantees to share risk. Can you talk about the role innovative financing can play in expanding access to contraceptive methods?

When it comes to family planning, there is no one-size-fits-all approach. Choosing a method of contraception is a deeply personal decision every woman must make for herself, based on her lifestyle and needs. It is, therefore, critical that she has access to a variety of methods.

Through a unique public-private collaboration, the Implant Access Program has helped to make contraceptive implants — a previously less accessible option — more available to women by removing cost and access barriers. In fact, the partnership made Bayer HealthCare’s Jadelle and MSD’s Implanon and Implanon NXT available to women in the world’s poorest countries at price reductions of approximately 50 percent through 2018.

There has been tremendous progress since the program launched in 2013. The total number of implants procured across the 69 FP2020 countries, plus South Africa, have tripled — growing from 2.4 million units in 2011 to a projected 7.7 million units to date in 2014. The global community has already realized a cost savings of more than $140 million. To ensure these impressive figures translate to access, more than 11,800 health workers have been trained on counseling and service provision, and IAP organizations have improved forecasting and supply planning systems to ensure no woman ever leaves a clinic empty-handed.

In what way can the post-2015 agenda ensure broad access to family planning? Should we continue to strive for universal access to family planning services and commodities?

There are so many seemingly insurmountable global issues to solve: climate change or food security, for example. I believe it all starts at the family level. This next development agenda must place a high priority on building stronger, healthier families if we hope to overcome some of the greatest challenges of our time. Countries with widespread access to family planning save on government service expenditures, place less stress on the environment and produce healthier families that are able to provide for the needs of their children. More importantly, every woman and girl, no matter where she lives, should have access to lifesaving tools that protect her health and well-being, without coercion or discrimination. As deliberations around the post-2015 agenda continue, we are working to ensure family planning continues to be prioritized, and that women’s and girls’ issues are at the heart of a global vision for 2030.

On a scale of 1 to 10 — 1 being the least and 10 being the most — personally and honestly, how happy are you with the progress we’ve made since the 2012 London summit on expanding access to family planning services to women and girls? Where do you think we will be by the year 2020?

I’d place progress at around 7.

That said, I am extremely confident that the FP2020 goal is achievable. We are still in the early stages of implementation, but we’ve already seen some remarkable progress. The best part is the fact that developing countries are stepping up and taking ownership of their family planning programs. They are engaging in dialogue at the national level, hosting local summits to develop solutions for barriers women say they face in gaining access to contraceptive information and services. We also now have access to better, more frequent data, so we can measure impact and help countries monitor and manage their performance.

In early November, FP2020 will release its second annual report, at which point in time new data will give us a much clearer picture of how these and other achievements have translated to progress against the 120x20 goal. Let’s celebrate the progress we’ve made — it’s been substantial. Then let’s use this data to identify where the gaps are and hold ourselves accountable to addressing them.

Now that I’ve shared my vision for our family planning program, I believe we need the community to push our thinking on what unique role the foundation can or should be playing in this space. I would like to invite the Devex community to share its perspective. All ideas are welcome!

This article is part of a series by the Bill & Melinda Gates Foundation that culminates on World Contraception Day. Check out more stories about global health and other important issues at the Impatient Optimists blog.

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About the author

Kellie sloan profile
Kellie Sloan

Kellie Sloan is the director of family planning at the Bill & Melinda Gates Foundation, where she leads efforts for creating innovative ways to improve family planning outcomes in developing countries. She was previously director and chief of staff to the president of global development. Before joining the Gates Foundation, Sloan held senior-level positions at Starbucks Coffee Company and worked as an international strategy and business consultant.


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