John Townsend on the future of family planning: It’s all about building back

John Townsend, Population Council vice president and director of the NGO's reproductive health program. Photo by: Population Council

For John Townsend, contraception is like food: It’s in every culture and there are different ways to have it.

Townsend is the vice president at Population Council overseeing its program work on reproductive health and family planning. The nonprofit is known for developing the very first long-acting birth control implant, Norplant. This November marks 30 years since the product won its first approval in Finland.

Although providing access to contraceptives remains a challenge, family planning use has gone a long way from half a century ago. Townsend estimates that back then family planning prevalence was about 5 percent; now it’s close to 60 percent globally.

Expanding further, though, requires more than just investment, particularly in the least-developed countries.

“The standard story is about the economist who assumes that once the analysis is done, people will make those investments,” Townsend told Devex. “Well, I think in the least developed countries, those things are much more cumbersome, both because of entrenched interests and because they don’t’ have efficient systems to provide care.”

We spoke with Townsend as global leaders met in New York to deliberate guidance for the development framework after 2015, which he hopes would eventually include expanding coverage on lifesaving commodities such as contraceptives. Here are a few excerpts:

What do you see would be the biggest game changer in the area of family planning?

I think there are a couple of things that are on the road.

I think we will be looking increasingly at postpartum services – if a woman is coming into a facility as increasingly they are or even having a birth at home, understanding the benefits of spacing the birth for her health and the child’s health and survivability. That’s a concept that we did research on probably 35 years ago, so we know it’s feasible but the systems weren’t set up. Things were pretty much in silo. The maternal health and child health people were in one silo and were quite differentiated, and family planning was another, and everybody was trying to work like this. I think we’ll see increasingly integration and the first place would probably be around maternal, postpartum family planning, improving the survivability of the child.

I think we’ll probably see, in the toughest places, more mobile services, so with push toward equity, making sure services get out to people and we’ll see it for a couple of reasons. One, you’ll see fast uptake which is what everyone wants to see, including governments. And it’s something that you could do in many different ways. So mobile isn’t necessarily sending a mobile hospital van. In some places, it’s done with somebody on a moped or a bicycle or a cart, making sure services get out there. That will clearly increase dramatically.

I think you’ll see more public-private [models] like social franchising that’s been a model that’s been good for food. We could buy Peruvian chicken here in New York as easily as we can get anything else. So understanding how franchises work and what motivates them and what’s the benefit of providing … services in general, and family planning specifically [would be another potential source of innovation].

What’s your advice to traditional donors on how to strengthen reproductive health in the developing world?

The advice that I’d give them is, think about what’s needed by 200,000 [women and girls whose lives could be saved during pregnancy and childbirth by 2020 if they have access to affordable reproductive health services]. Don’t think about your last loan cycle.

We really have to think about what do we need to do to get to scale required for the next 50 years, or 70 years. Some of these things are predictable. We know that we’d be more urban. We know the workforce would be more differentiated. … We have to figure out what are those things [that will happen in the future] and build back what we need to do. I think that’s something that’s difficult to predict in the future in many areas but in the area of family planning and population growth, we have pretty much confidence of the scale of it. So we have to figure out how we build back from there.

Do you expect more collaboration with the Catholic Church on reproductive health under Pope Francis, who many deem to be more open-minded about social issues?

I don’t think so. He says, “Who am I to judge?” I think those were his words. And I think he’s looking for individuals to begin to use their conscience.

I don’t see the Catholic Church moving quickly. It took them almost 400 years to declare one of the founders of our global view [Galileo] as not innocent but not guilty or insufficient evidence [of heresy].

So I think we’re best served when religion deals with issues that relate to people’s identity, cohesiveness, protection. And we have a church in many countries that provides lots of health care when the public sector is not doing it.

To the extent that they [the Catholic Church] limit people’s choices is not a good idea. To the extent that they allow people, together with their own religious faith, their sources of information around health, they make their own decision that’s compatible with U.S. law and international ethics and good practice.

Eliza Villarino contributed reporting.

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    Rolf Rosenkranz

    Rolf Rosenkranz oversees a talented team of in-house journalists, correspondents and guest contributors located around the globe. Since joining Devex in early 2008, Rolf has been instrumental in growing its fledgling news operation into the leading online source for global development news and analysis. Previously, Rolf was managing editor at Inside Health Policy, a subscription-based news service in Washington. He has reported from Africa for the Johannesburg-based Star and its publisher, Independent News & Media, as well as the Westdeutsche Allgemeine Zeitung, a German daily.