World Contraception Day, celebrated every September 26, is an annual reminder that governments should be doing more to meet the demand for modern family planning services among their populations. By 2030, governments must ensure universal access to sexual and reproductive health services if they are to meet the Sustainable Development Goal (SDG) 3 (healthy lives and well-being for all). Yet, globally, nearly 1 in 10 women still have an unmet need for contraception; in low- to middle-income countries, it can be as high as 1 in 4.
Contraception is beneficial for whole societies—not just for women. Estimates vary as to how much money is saved by investing in family planning, but the United Nations Population Fund calculates that every $1 invested in family planning can save governments $6. That means more money that can be reinvested into the broader health system or other government priorities. At the same time, support for family planning complements other SDG 2030 targets. For example, preventing unintended and high-risk pregnancies can reduce maternal mortality and under-5 mortality. Also, greater contraceptive use reduces teen pregnancy, facilitating educational attainment for women and reducing the number of women and children living in poverty.
As population dynamics shift, governments face evolving challenges in providing social, public, and health services. Climate change often puts further pressures on low resource governments, that face a disproportionate threat from a warming atmosphere coupled with burgeoning populations. An unmet need for family planning can hobble national climate responses and exacerbate community vulnerabilities. Family planning is so crucial to climate adaptation that a group of 200 scientists and researchers ranked access to modern contraception seventh out of the 100 most substantive solutions to global warming. Managing population dynamics, reducing the effects of climate change, and improving health and education are critical to allow countries to meet economic and social development goals. So, how can countries meet their SDG targets, and what factors are critical to their success?
The U.S. Agency for International Development (USAID) works through youth hubs in Nigeria to provide family planning and other services to young people. Photo: USAID Nigeria Youth-Powered Ecosystem to Advance Urban Adolescent Health.
Build Family Planning into the Budget
It may sound obvious to budget for health services. But given that family planning can be politically charged, and governments have numerous competing health priorities, getting adequate funds for reproductive services can be tricky. Policy makers can succeed by speaking the lingua franca of their treasury departments. In short, family planning saves money.
Health policy makers should also earmark funding to a specific family planning budget line, so that contraceptive services continue during health crises and shocks. Research highlights that during conflicts, pregnant women face greater pregnancy complications, despite the fact that in emergencies the fertility rate can remain stable. Reducing unintended pregnancies by maintaining family planning services can lighten the load on hospitals and service providers and the burden on women and families.
Engage with Communities, Sensitively
In addition to being a politically charged issue, family planning involves deeply personal decisions. People make contraception decisions within the context of prevailing cultural norms, religious practices, family expectations, and of course their individual desires and dreams. In societies where women lack agency, cultural norms and community expectations can exert an outsize influence, pressuring women to have children early.
Governments and development partners have a responsibility to offer information, services, and choices to women and families in ways that increase their agency while being respectful of existing norms and values.
For example, Nigeria has a high teen pregnancy rate, with nearly one-third of adolescents facing an unintended pregnancy. To access contraception, most young people must go to pharmacies in their communities where they are likely to be seen by friends or relatives. Accordingly, many of them forsake contraception to avoid being the target of judgment or gossip in their community. To tackle these issues, the USAID-funded and DAI-led Nigeria Youth-Powered Ecosystem to Advance Urban Adolescent Health program teamed up with the Lagos State Ministry of Health to develop youth hubs that provide contraception in supportive environments. The hubs are “hang-out zones” that offer games, education, and counseling services to attract teens and teach them positive life skills. Thus far, the program has educated more than 10,000 young people through sexual health and life skills courses and more than 2,000 teens have become new contraceptive users. By providing adolescent-friendly family planning services, education, and skills, the program assists young Nigerians to develop agency and make healthy choices for their future.
Forge Public-Private Partnerships
Finally, to increase access to contraception, governments should build public-private partnerships. Family planning has one of the longest histories of public-private partnerships in the health systems arena and works best when driven by a total market approach, which coordinates public, private, and civil society service providers to reach the whole population.
Within a total market approach, private sector actors often play the supplier role. For example, partnerships between contraceptive manufacturers, social marketing companies, governments, and private pharmacies provide access to family planning for people willing and able to pay. Development actors have supported private pharmacy franchises to provide high-quality products while increasing the demand for contraception through branding efforts and quality assurance. Private pharmacies are critical sources of information for their customers and are often the first stop for households seeking family planning options.
Businesses can also provide contraception services to their workers. Photo: Borgen Magazine/Unsplash.
Businesses and large employers can also act as service providers. For example, the VF Corporation, one of the world’s largest apparel manufacturers, developed clinics at its factories in Indonesia. These clinics provide primary healthcare, family planning, and maternal and newborn care for their factory workers, 70 percent of whom are women. The DAI-led program will reach 18,500 employees by the end of 2022 and has led to a 450 percent increase in clinic attendance.
Although family planning can be both a politically and emotionally charged issue, engaging with the topic sensitively and providing accurate information for youth and couples can help people make better decisions for themselves, their families, and their futures. Governments that recognize the fiscal benefits of investing in family planning and leverage public-private partnerships are more likely to meet both SDG and economic development goals.
Jacqui Moller Larsen is the Senior Practice Lead for Health Equity. Stephen Rahaim is the Senior Global Practice Leader for Global Health Market Solutions, and Megan Howe is the Senior Communication Advisor for Global Health. The article also has contributions from Ishani Patel, Associate Global Practice Specialist.