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African Leaders Renew Their Commitment to Family Planning

Millions of women will benefit if leaders deliver on their promises.
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President Yoweri Museveni of Uganda, speaking at the London Summit on Family Planning. Photography by DfID

On July 11, at the London Summit on Family Planning, leaders from 18 African countries made unprecedented commitments ­- financially and politically - to strengthen their family planning programs. The Summit, sponsored by the British government and the Bill and Melinda Gates Foundation, with support from UNFPA, the United Nations Population Fund, focused attention on the ongoing lack of family planning services for millions of women in the developing world and garnered extraordinary global support and resources to enable 120 million more women to use contraceptives by 2020. The Summit exceeded its target, raising pledges of $4.6 billion over eight years. And this call to action came not a moment too soon.

Unmet needs

In Sub-Saharan Africa alone, approximately 53 million women have an unmet need for modern contraceptives, meaning they want to avoid pregnancy but are not using a modern method. A new study by the Guttmacher Institute and UNFPA shows there has been minimal progress in addressing the contraceptive needs of African women during the past four years. What’s worse, in the 39 poorest countries in the region, the number of women with an unmet need has actually increased since 2008.

Among all sexually active women of reproductive age in Sub-Saharan Africa, 42% want to avoid pregnancy but only 17% are using a modern contraceptive. Across the continent, progress in meeting the demand for contraceptive services has been uneven. The situation of married women—who represent the bulk of women with contraceptive needs—is telling. Between 2008 and 2012, the proportion of married women using modern contraceptives increased from 20% to 27% in East Africa and from 54% to 58% in Southern Africa. However, in West Africa and Central Africa, there was no progress during that time, and contraceptive use among married women remains low at 9% and 7 %, respectively. 

A matter of life and death 

Not being able to plan their pregnancies can have devastating consequences for women. In 2012, more than 160,000 are expected to die in Sub-Saharan Africa from pregnancy-related causes - 62,000 of them did not want to be pregnant in the first place, a sobering statistic. The benefits of improving and expanding family planning programs in Sub-Saharan Africa would be dramatic: There would be 14 million fewer unintended pregnancies; maternal deaths would decline by 29%, saving the lives of 48,000 women; and infant deaths would drop by 555,000 annually. Plus, if women spaced their births by three years, which many would like to do, deaths among children aged five and under would drop significantly.

So, what will it take to make these dramatic gains a reality? Currently, approximately $381 million is spent each year on contraceptive care in Sub-Saharan Africa. Expanding coverage to all women who want to use family planning but lack access to contraceptive services would require an increase of $2.3 billion. This sounds like a lot, but this investment is modest in relation to the remarkable returns it would achieve. What’s more, it would actually lower total health-related costs. Every dollar invested in family planning services in Sub-Saharan Africa saves $1.30 on maternal and newborn health care - money that could be invested in other critical areas.

In addition to improving public health, satisfying unmet need for modern contraceptives would bring a host of other benefits. Enabling women to control their fertility and time their births means better chances for higher educational attainment, increased employment opportunities, and enhanced social and economic status. Family savings and investment would rise, spurring economic growth and reducing poverty. These advances at the family level would in turn make social and economic development goals easier to achieve, benefiting society as a whole.

Evidence from Ethiopia, Malawi and Rwanda shows that, with strong government commitment, significant gains can quickly be made in meeting women’s contraceptive needs. In Rwanda, contraceptive use among married women increased from 9% in 2005 to 44% in 2010, a truly impressive achievement. If the commitments made at the London Summit are realised, and similar ones follow, this kind of progress could potentially become the norm, not the exception.

Now it is up to all of Africa’s leaders and the international community to do their part through a sustained commitment to improving the provision of contraceptive services. Not only do women want to time and space their pregnancies to achieve healthier outcomes and better lives for themselves and their families, it is their human right to do so.

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Comments

Museveni is hardly a poster boy for contraception. Janet Museveni has been pushing abstinance only programmes for over a decade, and anti-gay activist Martin Ssempere is allowed to author HIV related policy documents, despite his habit of holding condom-burning rallies at universities. Museveni certainly instituted some progressive public health policies in the nineties, but times have changed.