Global contraceptive use rising but more progress needed to reach target

A DKT Nigeria counselor talks to a group of women in a low-income neighborhood of Lagos, Nigeria about their contraceptive options. Photo: David J. Olson

This was originally published on Global Health TV on January 30, 2018.

By July 2017, more than 309 million women and girls were using modern contraception in 69 focus countries identified by Family Planning 2020 (FP2020), a movement created in 2012 by four core partners, 38.8 million more than in 2012.

This information came out in FP2020’s annual report “The Way Ahead, 2016-2017,” released in December. It reported that use of modern contraception in these 69 countries from July 2016-July 2017 prevented 84 million unintended pregnancies, 26 million unsafe abortions and 125,000 maternal deaths. This is all great news.

It came with some less-than-great news. FP 2020 has set the goal of reaching 120 million new users in the eight years between 2012 and 2020 – or 15 million every year. By that measure, we should have reached 75 million new users by mid-2017, and 38.8 million is only 52% of that.

Clearly, we have a lot more work to do to reach the 120 million target.

One of the things that can help us make more progress towards is new and renewed commitments. At the 2017 Family Planning Summit in London, 75 commitment-makers stepped forward with commitments – including 25 partners making commitments for the first time.

Beth Schlachter, executive director of FP2020, says the 120 million target is still relevant, though unlikely to be met by 2020. But she said that “we are an estimated 30 percent over the progress level that would have happened had there not been the FP2020 partnership.”

Schlachter says the S-Curve pattern of modern contraceptive growth presented in the report is a good way to spot opportunities for future growth. The S-Curve divides the 69 countries between 15 countries with “high prevalence and growth slowing and leveling off,” 13 countries with “low prevalence and slow growth” and 41 countries where rapid growth can occur. It is in these 41 countries – half of which are in sub-Saharan Africa – where rapid growth is likely to occur which can propel us to the 120 million target.

But the international family planning community also faces new challenges.

A Kaiser Family Foundation report released in December found that donor government funding for family planning fell in 2016 for the second year in a row, dropping from $1.34 billion in 2015 to $1.19 billion in 2016. Much of this decrease was due to exchange rate fluctuations and the timing of donor disbursements but 22 percent of it came from actual cuts in funding from donor countries including the U.S. and the U.K., the two largest donors.

Related challenges have come from the Trump Administration —the re-imposition of the Global Gag Rule, or the Mexico City Policy, trying to cut U.S. funding for family planning to zero and cuts in support for the U.N. Population Fund (UNFPA).

However, congressional appropriators ignored Trump’s request to zero out international family planning and reproductive health (FP/RH) programs in his proposed Fiscal Year (FY) 2018 budget request and so the U.S. government is still operating at FY 2017 levels requested by the Obama Administration and signed by the Trump Administration, according to Craig Lasher, senior fellow at Population Action International. The House of Representatives has appropriated $461 million and the Senate $622.5 million for FP/RH for FY 2018 but those amounts will have to be reconciled in a final budget bill (the FY 2017 appropriated level for FP/RH was $607.5 million).

In the meantime, says Lasher, there have been a growing number of reports of funding shortfalls at the field level in some countries across health and development sectors.

The reinstatement and expansion of the Global Gag Rule, which occurred on Jan. 23, 2017, is starting to make its impact known. One organization that has been particularly hard hit is Marie Stopes International, which estimates that 2 million women it would otherwise have served will be denied sexual and reproductive health services as a result of the order. Poor communities in Madagascar, Zimbabwe and Uganda are already feeling the effects of the expanded policy. The International Planned Parenthood Federation says that it stands to lose $100 million and that its member organizations are feeling the impact in 29 countries.

The significant contribution of social marketing should also be highlighted. In 2017, the social marketing organization DKT International released its annual report on contraceptive social marketing statistics showing that 97 contraceptive social marketing programs in 59 countries delivered 74.9 million couple years of protection (CYPs) in 2016. This is 9.4 million CYPs more than the 65.5 million CYPs generated in 2012, when FP2020 was launched.

DKT President & CEO Chris Purdy says that the focus should be on stimulating demand for modern contraception. “I continue to believe that the emphasis needs to be on education and behavior change,” he said. “The supply chain will rise to meet demand, but investments to increase uptake among women and men are needed.”

Schlachter says the key to reaching 120 million is better alignment of resources and working together to shape ambitious and achievable programs at the country level and getting partners to unite behind them.

This FP2020 press release summarizes the report.