In 2014, will family planning be able to sustain the euphoria of London and Addis Ababa?

Young Ethiopians partake in traditional coffee ceremony at the International
Conference on Family Planning.

This was originally published on the website of Global Health TV on Feb. 19, 2014.

2012 was a watershed year for international family planning, with the UK government and the Bill & Melinda Gates Foundation holding the high profile London Summit on Family Planning where new commitments of $2.6 billion were secured, enough to provide contraceptives for 120 million more women and girls in 69 very poor countries by 2020.

In 2013, this effort morphed into a global partnership dubbed Family Planning 2020 (FP2020). The process received a further moral and financial boost in November at the 3^rd International Conference on Family Planning in Addis Ababa, where five countries made new commitments (Benin, Democratic Republic of Congo, Guinea, Mauritania and Myanmar) and FP2020 released its first progress report on successes realized since the London Summit. Ethiopia was chosen as the conference site because of its status as an emerging family planning success story in Africa.


Indeed, the U.S. Agency for International Development named these partnerships to advance family planning as one of the 2013 highlights in global health (with “Innovations in Contraceptive Technologies” as another).
But what will 2014 bring for family planning? I believe 2014 is the year that will show if those donors were really serious about their commitments and if we really have a shot at creating 120 million new users.

Despite the fact that the London Summit took place more than 19 months ago, it is still too early to know if donors will keep the commitments they made there. However, preliminary data from an analysis conducted by the Kaiser Family Foundation indicates that donor government disbursements for family planning increased in 2013, according to FP 2020. In most cases, though, we don’t know how much it increased.

Last year, the Kaiser Family Foundation also conducted an analysis of family planning assistance disbursed the prior year by the 24 governments that are members of Organization for Economic Cooperation and Development and Development Assistance Committee, which will serve as a baseline to track donor disbursements annually. We do know, according to FP 2020 and the Kaiser analysis:

• Increases in spending on family planning by the U.K. and the Netherlands in 2013 have already fulfilled their London Summit commitments.
• 29 developing countries have made commitments, including the five new commitments made at the Ethiopia conference.
• One-quarter of FP2020 commitment-making countries have launched detailed, costed national FP plans.
• One-third of commitment-making countries have increased their national budget allocations for FP services or supplies.
• Half of commitment-making countries have held national FP conferences to emphasize high-level political support and to accelerate progress on strategies.

At the conference in Ethiopia, I picked up on a few themes that I think will have to be addressed in order for FP 2020 to achieve its ambitious mission:

• Engaging with faith leaders: The family planning community must collaborate more closely with family planning-friendly faith-based organizations (FBOs) not just in word, but also in deed (including funding). Faith leaders were well represented at the London Summit and the Ethiopia conference but none was given a speaking role or any meaningful responsibility in organizing these events. Faith leaders have sought to participate in the governance structure of FP2020 to little avail. Many faith leaders are ready, willing and able to join this effort but it will not make a difference until the secular family planning community joins hands with them in a real partnership. FBOs can contribute both through their service delivery infrastructures (estimated to constitute 25-50% of total services in some countries) and by educating religious leaders and communities to increase acceptance and demand for family planning. A report published this month shows just how much FBOs are already contributing.
• Engaging young people: This is something that the family planning community has done well, at least at the Ethiopia conference, where I was struck by the number and engagement of young Africans. That engagement is less evident in FP2020 but it must continue, as current family planning leaders age and youth continues to occupy a large proportion of the FP2020 target countries’ populations. When we engage youth, we have to make sure our language is attuned to their needs. For example, the term “family planning” may be a misnomer, as Laura Hoemeke of IntraHealth suggested in this blog, because young people are not, in most cases, planning families. Hoemeke suggested that “future planning” might be a better term. The Lancet also made this point, in a different way, in this piece.
• Engaging the private sector: The commercial sector was present and engaged both in London and Addis Ababa but mostly this was in the form of a couple of large pharmaceutical company and one session at each event. Beyond that, they didn’t have much of a presence. The family planning community recognizes the importance of the private sector and I think we’ll be seeing more efforts to engage them. This is important for a number of reasons, not the least of which is that greater private sector engagement will help in making family planning sustainable.
• Targeting middle-income countries: Chris Purdy, the new president of DKT International, has questioned whether we will meet the goal of reaching 120 million new users by 2020 if we only target the world’s poorest countries, as FP2020 is aiming to do. This is because there are huge pockets of poor people who need family planning in middle-income countries like Indonesia, South Africa and Mexico. Purdy doesn’t believe we can reach 120 million new users without investing in these countries. He laid this out in more detail in his article in the Huffington Post, which was also published on the website of the Ethiopia conference, but it didn’t generate much reaction.

Family planning advocates have done an admirable job of putting their issues on the international agenda and mobilizing financial commitments in 2012 and 2013. In 2014, we’ll start to see to what extent those pledges are converted into cold, hard cash.