Global commitment to providing contraceptive services: Where are we and what next?
Where Are We And What Next?
In 2010, the United Nations launched Every Woman Every Child as a global movement to mobilise and intensify action to address major health challenges facing women and children around the world, including improving access to effective contraception.
Building on this movement, in 2012 partners from across the world came together at the London Summit on Family Planning to support the right of women and girls to decide, freely and for themselves, whether, when and how many children they have. At this summit, more than 20 governments made commitments to address the policy, financing, delivery and socio-cultural barriers to women accessing contraceptive information, services and supplies. Donors also pledged an additional US$2.6 billion in funding. One outcome of this summit was the global partnership ‘Family Planning 2020’.
Family Planning 2020
Family Planning 2020 (FP2020) set an ambitious target of expanding access to family planning information, services, and supplies to an additional 120 million women and girls in 69 of the world’s poorest countries by 2020. FP2020 set the following principles to support the goal of reaching 120 million additional women by 2020:
- Protection of the human rights of women and girls including through policies and mechanisms to ensure informed choice of a broad range of high-quality, safe, effective, acceptable and affordable contraceptive methods; non-discrimination, and assurance that women and girls are fully informed, and not coerced by any means.
- Integration of family planning within the continuum of care for women and children (including HIV-related services); and development of mechanisms that address barriers to access to affordable and high-quality information, supplies and services for family planning, yet are adaptable and can be expanded to meet a broader set of unmet health and development needs of women and children.
- Universal access to voluntary contraceptive information, services and supplies, within the context of integrated programs to achieve sexual and reproductive health and rights and the health-related MDGs.
- Equity in policies and program design and implementation, such as the removal of policy and financial barriers and the development of public and private delivery mechanisms, so that the poorest and most vulnerable women and girls have ready access to affordable, high-quality family planning information, supplies and services.
- Empowering women to decide whether and when they wish to become pregnant as well as how many children they wish to have.
- Participatory development of country plans based on consultations with, and the views of, all stakeholders, especially poor and marginalised girls and women.
- Strong partnerships among and between a broad base of stakeholders—community, governments, political leaders, civil society organizations (including faith-based organizations), the private sector, donors and multilaterals—to help ensure high-quality service delivery, outreach to more disadvantaged groups, building community support and program accountability to the people served.
- Commitment to results, transparency and accountability to ensure countries and the global community track progress towards results, as well as monitoring and assessing protection of human rights and the extent to which the poor and marginalized women and adolescent girls are reached.
By 2018, 46 million additional women and girls were using modern contraception.1 However, the goal of achieving this for 120 million women and girls by 2020 will be missed. Additionally, demographic shifts in many FP2020 countries means that there will be large increases in the number of women of reproductive age, so expanding access to family planning is more important than ever.
Apter et al reflected upon the assumptions which underpinned the FP2020 strategy, and compared them against reality to learn lessons for beyond 2020, looking to the Sustainable Development Goal target of achieving universal access to family planning by 2030. See Figure 1 to learn about their findings:
Figure 1: Underpinning assumptions of the FP2020 strategy, adapted from Apter et al.2
|Assumption in FP2020||Reality||Lessons for beyond 2020|
|Funding from donors and governments would increase through advocacy.||Despite initial increases in funding for family planning services from donor governments following the 2012 conference, this peaked in 2014 and has since declined.||Resource mobilisation efforts need to reflect current agendas such as UHC by proposing family planning funding within overall budgets.|
|A coordinated partnership would improve accountability.||Without a clear independent body for accountability, this function never materialised, with advocacy prioritised over accountability.||Advocacy efforts need to be separated from accountability mechanisms. Adequate markers and an independent body need to be pre-determined to allow authority to be exercised.|
|Aligning family planning efforts would lead to efficiencies.||Attempts to coordinate programmes through coordinated implementation plans occurred in isolation from horizontal approaches to achieving UHC.||Working within the paradigm of UHC and the Global Financing Facility provides an opportunity to embed family planning within country strategies to support health of women and girls.|
In 2017, during the first days of the new administration, President Trump enacted an executive policy to enhance anti-abortion restrictions in U.S. foreign aid. The administration has since expanded the so-called “global gag rule” to prevent the provision of funds by the State Department, USAID and the Department of Defence to any non-U.S. based non-governmental organisations which provide abortion services. This includes information, counselling, referrals or advocacy for the liberalisation of abortion laws. The policy applies to $8.8 billion of global health funding annually, including programmes already underway.3 This policy has historically caused disruptive and unpredictable peaks and troughs in funding, due to the consistent withdrawal and re-enactment of this policy dependent on the political party in power.
A report from the International Women’s Health Coalition based on interviews with civil society organizations, health service providers, anti-abortion groups, and government agencies found the policy is causing funding gaps, increasing reporting burden on organisations, and is harmful to the health of women, especially those from marginalised communities.4 Organisations such as the “She Decides” initiative have been created to attempt to fill funding gaps created by this policy. However, such initiatives will not fully mitigate fully the financial implications and cannot counteract the clear normative signal the global gag sends.
© London School of Hygiene & Tropical Medicine 2019