Let’s begin with a hard truth: unplanned pregnancy is for many a matter of life and death. Every two minutes a woman dies due to pregnancy-related complications — a grim transformation of what should be one of the happiest times into one of the most dangerous.
For other women, unplanned pregnancy stands in the way of the future they want for themselves and their families. And because we know the health of mothers, newborns and children go hand in hand, unplanned pregnancy can have devastating long-term consequences for families, too.
It is little surprise that whenever I ask women living in the poorest countries whether they want the education and means to time and space their pregnancies almost every single one says they do. Yet within the same breath, they confide in me that they’re not doing anything about it — almost always for reasons beyond their control.
Sadi told me on a visit to Niger that she is desperate not to have any more children — but that her only option is to hope and pray.
Today there are more than 220 million such women around the world for whom gaining access to contraceptives is a matter of urgency. This is the magnitude of our challenge.
We took a big step toward addressing this unmet need in 2012, when the world committed to ensure that, by 2020, 120 million more women and girls in the poorest countries have access to the education, services and the method of contraception they want and choose to use. It is an ambitious yet achievable goal — and an important stepping stone to the ultimate vision of universal access to contraception.
Just one year after the pledge — thanks to the collective efforts of governments, NGOs, the private sector and others — an additional 8.4 million women and girls were using contraceptives. Nonetheless, the most recent data show us that our progress isn’t yet matching the scale of our ambition. Not only are we failing to move fast enough, we are falling further behind each year.
The good news is that we still have time to change that trajectory. But only if we act now. The data and evidence point to several opportunities to make up lost ground. Let me mention three that stand out.
Increasing the quality of services women receive
Women are more likely to use contraception when they have access to counselling, information about side effects and a range of contraceptive methods. Expanding the number and type of contraceptives available is critical. Data from the past 30 years show that when one additional contraceptive method is made available to at least half of a population, total use consistently increases by 4-8 percent.
At the same time, we need to do more to strengthen the capacity of the private sector to deliver high-quality services alongside public healthcare systems. Nearly half of all women in their reproductive years in Asia, and Latin American and the Caribbean, for instance, rely on the private sector for their family planning needs. In sub-Saharan Africa about a third do. Women deserve quality services no matter where they access their contraceptives.
Focusing our attention on the growing need for family planning among the urban poor
Today, more than half the world’s population lives in cities, and this proportion will grow to two thirds by 2050. While urbanization often increases proximity to information, job opportunities, and health services, the poorest rarely benefit.
But there is reason for optimism. Over the last few years, program and evaluation experts in four countries — India, Nigeria, Kenya and Senegal — have tested and identified a variety of high-impact solutions. These include renovating rundown clinics, myth-busting discussions, and radio, TV and billboard campaigns. In concert with many others, these programs have improved the quality of services, boosted demand, and increased access to contraceptive options for more women. Across six cities in Nigeria, for example, the percentage of women using modern contraception increased by 10.5 percent over a four year period. Across five cities in Kenya, they saw an 11.4 percent increase over the same time. That is progress to build on.
Understanding and meeting the reproductive health needs of adolescents
The largest generation of young people in history are about to enter their reproductive years, yet we aren’t doing enough to meet their unique needs. In sub-Saharan Africa, and South Central and Southeast Asia, more than 60 percent of adolescents who want to avoid pregnancy, are not using a method of contraception.
These are girls who have ambitions of completing their education and getting a job, and as a result making a significant contribution to more prosperous communities and countries. An unplanned pregnancy puts all that at risk. We know that complications related to pregnancy and childbirth are a leading cause of death among girls aged 15-19 in low- and middle-income countries. And we know that as many as 25 percent of girls in sub-Saharan African countries drop out of school due to an unplanned pregnancy.
Following where the evidence points will help us get back on track. And the International Conference on Family Planning in Indonesia in November provides a good opportunity for policymakers and experts from around the world to plan how to fill the critical gaps. This is the only way we will translate our ambition into action and make good on our FP2020 pledge.
When I think about what’s at stake, I think about Sadi and her six children. She told me how she dreamed that their lives would be different from hers. But the reality is her family grew so fast she and her husband could not afford to provide for them. Allowed the opportunity, she would have worked to give her children everything — given her circumstances, she struggles to give them anything.
There are millions of women like Sadi who know what’s best for themselves and their families — and they deserve the chance to act on it. We must not let them down.
Melinda Gates is co-chair of the Bill & Melinda Gates Foundation. Along with Bill Gates, she shapes and approves the foundation’s strategies, reviews results, and sets the overall direction of the organization. Together, they meet with grantees and partners to further the foundation’s goal of improving equity in the United States and around the world. They make many public appearances to advocate for the foundation’s issues.
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