Where next for Family Planning?

Good evening,

It is a pleasure to join you tonight at this informal forum.

It is not often that I get the chance to travel all the way down under and I am very happy to be here in Melbourne. I am looking forward to attending the Breakthrough Summit tomorrow, to meet with government officials and to interacting with you tonight.

I would like to thank the Burnet Institute for hosting us tonight. And I would like to thank Compass and the Australian Council for International Development for organizing this informal discussion.

Liberation of Family Planning from Population Control

I will make a few remarks on the topic “Where next for Family Planning?” the title of a recent Lancet article by Davidson R. Gwatkin of the Results for Development Institute, Washington, D.C.

This article is significant for two reasons. First, it articulates clearly how the International Conference on Population and Development, held in Cairo in 1994, has freed family planning from the stigma of “population control” and positioned it strongly in the discourse of human rights. ICPD re-focused the discourse on reproductive health calling for satisfying unmet need and unfulfilled demand for family planning. Mr. Gwatkin clearly says that "family planning can now be seen as a prospective contributor to rather than a potential enemy of human rights". He also points out that the distribution of unmet need across economic groups is “considerably larger among people who are poor than among better off couples... Such differences across economic groups mean that the lack of family planning poses not simply the issue of gender inequity that has long been recognized but also one of economic inequity". And finally, Mr. Gwatkin asserts that family planning “programmes can not be efficient unless they go where the demand is and they cannot be equitable unless they reach the disadvantaged segment of their potential market."

I fully agree with this articulation of the dramatic change that ICPD brought to the discourse on family planning, as an essential component of the right to reproductive health. It is also an essential component to the empowerment of women.

The second reason for the importance of this article is that it was published just before the International Family Planning Conference that took place in Kampala, Uganda, in November of this year. This global conference brought together thousands of experts, researchers, policy-makers, programme managers and health practitioners. This gathering was the first of such kind in well over a decade and it is a sign of changing times. It is even more significant that it is held in Kampala, Uganda, a country whose leadership was not only shunning family planning but also promoting a pronatalist political discourse and policies. However, at this conference, the First Lady clearly spoke about the role that family planning plays in slowing down population growth thus allowing a focus on the people themselves and their wellbeing. This is a clear change of heart and mind and it is a positive development because it voids the fear of “population control” that is sometimes expressed by some leaders and groups of advocates. Family planning is thus recognized as a positive intervention that has both social and economic benefits. I encourage you to join all the voices that are supportive of family planning as part of a human rights agenda of empowering women and ensuring the wellbeing of people.

Family Planning as Success Story

By galvanizing greater commitment to family planning as part of a comprehensive package of sexual and reproductive health supportive interventions, we can reduce poverty, improve maternal health, advance women’s empowerment and gender equality, and make greater progress towards achieving all eight Millennium Development Goals.

It is great that so much attention was paid at the Kampala Conference to integrating interventions for family planning and HIV and AIDS as both an efficient and effective measure to reach women and young people in their communities and within their own context. And it was gratifying to see such commitment from government partners, especially the United States at the Kampala conference.

We know that family planning has been one of the biggest development and public health successes of the second half of the 20th century. It has saved millions of lives of women and children and changed the face of the world. And it established networks at the community level to reach the most vulnerable and the poorest. It is a model of community mobilization, empowerment and demand creation that must be reinvigorated to provide the comprehensive package of reproductive health services for women and young people at the community level within the context of primary health care.

Today 63 per cent of women of reproductive age in developing countries use a method of family planning. That is an impressive achievement considering that in 1960, that number was just 10 per cent.

Family planning is the best documented practice to reduce maternal mortality. It is critical in preventing unintended pregnancies and unsafe abortions.

By ensuring access to modern contraceptives, we can reduce maternal mortality by up to 40 per cent. The benefits of family planning, bolstered by a comprehensive package of reproductive health, are quite substantial. Each year, modern contraceptives prevent 2.7 million needless infant deaths and the loss of 60 million years of healthy life.

Family planning, as a dual protection method, is also instrumental in lowering mother-to-child transmission of HIV. Currently over 90 per cent of HIV-infected infants and young children are thought to have been infected by their parents. Meeting the need for family planning among HIV positive women, and in communities where there is a generalized HIV epidemic, will allow HIV positive women to make decisions about their own fertility and also to prevent transmission to the infants.

Family planning, supported by other reproductive health interventions, prevents several other morbidities associated with pregnancy, including obstetric fistula, reduces the need to address complications resulting from unsafe abortion, which about 20 million women undergo each year, mostly in developing countries.

Family Planning and Empowerment of Women

But voluntary family planning is not only about services, it is also about empowerment – allowing women to have choices in their lives, especially the right to determine the number and spacing of their children. This is the very basic right without which MDG 3 on empowerment of women cannot be achieved. If a woman cannot determine her fertility – when to have children and how many, she cannot make decisions about any other aspect of her life. We can reach the targets of women parliamentarians at the national level or women in decision making bodies at various levels, yet empowerment of poor women does not take place because they are not making the most basic decision about the timing, number and spacing of their children. The link between the MDG 3 on empowerment of women and MDG 5 on improving maternal health lies, first of all, in the right of women to sexual and reproductive health including family planning.

When women enjoy equal rights and opportunities, they have the means to participate in society and contribute to peace and security, creating a better life for all.

When women are healthy and empowered, they are able to deliver for their families, communities and nations. Their newborns are more likely to survive and their children to thrive.

Benefits of Family Planning

Family planning is one of the most cost-effective interventions in development.

We know that the returns on family planning for communities and nations are much greater than what it costs to provide. Investment in contraceptive services significantly reduces public spending on health and other services because it ensures that women have the time to regain their wellbeing and to develop their capacities. Furthermore, over the long run, having smaller families, which is the choice of most women according to various studies, will result in slower population growth.

However, despite all that has been achieved, family planning is still an incomplete agenda. Today, more than 200 million women want to use safe and effective family planning methods, but are unable to do so because they lack access to information and services or the support of their husbands and communities. An estimated 75 million women in developing countries have unintended pregnancies each year.

We must also remember that family planning services are needed for women and girls at a higher risk of unwanted pregnancy and STIs, including HIV, such as women in situations of conflict and crisis.

Rape is a weapon of war, and women risk becoming pregnant against their will if emergency contraception is not readily available. Violence against women, coerced sexual activity and child marriage are all situations of abuse where family planning, within a comprehensive package of reproductive health services, has a role to play.

UNFPA and Closing the Gap for Unmet Need

UNFPA sees family planning as a cornerstone of reproductive health. We support programmes that improve access to and affordability of family planning services, offer a broad selection of choices, reflect high standards of quality of care, are sensitive to cultural conditions, provide sufficient information about proper use or possible side effects and address women's other reproductive health needs, all within an integrated package of reproductive health at the community level.

UNFPA is committed to supporting efforts to close the gap between the number of individuals and couples who use contraceptives and those who would like to do so, by reaching the goal of universal access to reproductive health. Thanks to our committed partnerships with governments, sister UN agencies, and civil society, the tide is turning.

And after years of responding to ad-hoc requests from countries for technical assistance and supplies for family planning, UNFPA developed the Global Programme to Enhance Reproductive Health Commodity Security. The Global Programme supports countries to develop national capacities in planning for their own reproductive health needs, allowing them to move towards more predictable, planned and sustainable country-driven approaches to securing supplies, and ensuring their use as well as implementing an efficient logistics system.

No Resources, No Programmes and Services

To move ahead, we must match this growing momentum with growth in resources.

During this decade, funding for population and reproductive health has remained at the same level while funding for other areas of health, especially HIV, has increased substantially.

More specifically, funding for family planning, which stood at 55 percent of the total assistance for population programmes in 1995, is now estimated at 4 percent.

There is an urgent need to reverse this trend and generate greater political commitment to family planning, as an essential component of reproductive health and a prerequisite to empowerment of women and gender equality. Otherwise, the target of universal access to reproductive health will not be reached and achieving the goal of the empowerment of women would be weakened.

In the Family Planning Conference in Kampala, the U.S. government announced a new 12 million dollar initiative that will benefit Uganda, Ethiopia, Nigeria, Senegal, Tanzania and Kenya. The support of the Obama administration for reproductive health is a welcome development.

Funding from private foundations has also gone up in recent years. In fact, the Bill and Melinda Gates Foundation was one of the conveners of the Conference in Kampala and they have been supporting a number of family planning initiatives.

However, the funding gap still is too large. The estimated global need for reproductive health, including family planning and maternal health is 23 billion dollars per year; it is equivalent to about 6 days of global military spending. Less than half is being made available and most of it is from domestic resources.

To make greater progress, much more must be done to mobilize funds, both domestically and internationally. And we must place MDGs 4 and 5 to reduce child mortality and improve maternal health at the centre of global health initiatives, health system strengthening and funding mechanisms. A health system that can deliver for women and children is a health system that will benefit all.

It is clear that leadership and resources will mean the difference between success and failure.

Being able to freely and responsibly determine the number, timing and spacing of one’s children and having the means to do so is a human right, and this right is central to advancing women’s empowerment and equality between men and women.

So Where Next for Family Planning? Protect, expand, scale up, support, resource, and integrate in sexual and reproductive health programmes at the community level to meet the unmet need of 200 million women who want to exercise their right to make decisions about the timing, spacing and number of their children.

Thank you.