Dispatch

30 June 2009

The Unfinished Agenda of Family Planning

UNITED NATIONS — Funding for and attention to family planning has been declining for the past decade. At the same time, 200 million women still lack access to contraception, the largest youth generation ever is coming into its prime reproductive years and the women in poorest and least developed countries have the highest unmet need for family planning.

That was the background for a meeting of technical experts convened this week by UNFPA to discuss continuing inequities in family planning. It was one of three consultations organized to mark the 15th anniversary of the International Conference on Population and Development and to identify remaining challenges and new directions for implementing its bold vision. While the opening session, “The Unfinished Agenda,” addressed ongoing hurdles to wider access to contraception, several of the key participants affirmed that in spite of the current financial crisis, this can be a time to re-energize the role of voluntary family planning in development.

Exercising the right to plan their pregnancies, a cornerstone of the ICPD agenda, can be especially crucial to women who are young, impoverished or living far from health services that could ensure a safe delivery. Yet these are the very people who disproportionately lack access to contraception, according to Nuriye Ortayli, a UNFPA technical adviser. Presenting data collected from Demographic and Health Surveys, Dr. Ortayli demonstrated that while there has been a gradual leveling off of inequities in many middle-income countries, disparities remains high in much of sub-Saharan Africa, where more than 60 per cent of women who would like to avoid pregnancy lack access to appropriate means of contraception. “Unmet need for contraception is increasing fast in least developed countries,” she said.

Stan Bernstein, also of UNFPA, described some of the reasons that family planning has fallen behind on the international agenda. In part, he said, family planning has been a victim of its early success in the 1990s. “With so much early progress, it was thought that nothing new was needed, that the problem had been solved,” he said. Moreover, family planning was considered within the broader issue of reproductive health, and both, were downplayed in the initial framework for the Millennium Development Goals, he noted. Further, placing family planning solely in the context of health meant that it received “a portion of a portion that is too small,” he said.

Recent UN estimates show that meeting ICPD commitments for family planning will require $2 billion annually from donor countries, Mr. Bernstein noted. Current funding levels are a fraction of that and have declined 45 per cent from 2001 to 2007, he added.

Gita Sen, a Harvard professor of public health, emphasized the importance of considering family planning within a rights-based framework of sexual and reproductive health that “takes full account of people’s needs, choices and agency, and provides them with the wherewithal for making their own decisions.” She placed emphasis on the specific family planning needs of young people, migrant workers, people living with HIV and those affected by humanitarian crises. 

If programmes are not sensitive to the needs of people, she added, they will not be successful. “Trusting in girls and women is the key to where we need to go,” she noted in a press conference following the meeting.