By Dr. Joyce Mumah – Technical Lead, Monitoring and Evaluation, WISH2ACTION
The International Conference on Family Planning (ICFP) 2022, the world's largest gathering of family planning and reproductive health, was held in Pattaya City, Thailand, from November 14 to 17, 2022. The conference attracted thousands of scientists, researchers, advocates, donors, and policymakers (including high-level politicians) from various countries to discuss, debate, showcase, and make a case for why funding family planning still provides a good return on investment.
The WISH2ACTION programme made several presentations on how the project interventions target the hard-to-reach, showcasing both the successes and challenges in achieving and measuring health equity. In addition, we presented on improving quality of care and a value-for-money framework.
During the conference, it was announced that the global population had reached 8 billion people. We all clapped acknowledging the announcement, but this highlighted the work ahead of us. Inequities in access to services persist and remain stark. The unmet need for family planning (FP) and unsafe abortion remains a challenge for many countries; unintended births remain high, religious and cultural norms still play a role in access and use, attitudinal resistance remains a significant barrier, and transitions between methods still exist.
Why, then, is a gathering like ICFP important? Beyond a trip to a beautiful country (If you have not been to Thailand, plan to visit if you can!), it was a great reminder of the positive work that has been done, but a charge for how much more work is still needed to ensure that no one is left behind.
Geographical and socioeconomic inequities persist.
On average, African women have five children and a substantial unmet need for modern family planning services. Although total fertility is projected to decrease to approximately 3.1 children per woman by 2050 in Africa, there are sharp differences based on socioeconomic status, age, and region[i]. High adolescent birth rates remain an issue and many women from poor households are less likely to use contraception than women from wealthier households. Approximately one-third of women in the poorest wealth quintile worldwide have an unmet need for FP[ii]. Improving access to services and commodities among the poorest and most marginalized is crucial to improving these disparities and health equity.
Talking about access is necessary when discussing information, geographic proximity, acceptability, and affordability. However, focusing on access alone is insufficient, as sustained contraceptive use remains an issue. In many countries, discontinuation among users of short-acting and traditional methods remains high. Therefore, though it is important to focus on the unmet need for family planning, evidence suggests empowering women who are already using contraception (any method) not only to continue using but, through use, enable them to achieve their own reproductive choices and intentions[iii]. Limiting the number of women who have used a method and stopped for reasons beyond their control will be as effective as educating clients who have never used a method to pick up a method for the first time or after a long timeiii.
Using a multisectoral approach to address multiple and intersecting vulnerabilities
One thing that was clear is that, in tackling sexual and reproductive health and rights (SRHR), programmes and policies must consider the complex, multiple, and interacting factors that influence sexual and reproductive health and the overall well-being of individuals, regardless of geography. It may sound cliché but using a multisectoral and integrated approach to address the intersecting vulnerabilities that increase adverse outcomes, especially among adolescents, is important for sustainable and long-term programming. Working with multiple sectors beyond health, including financial, gender, education, labor, etc., are promising strategies for achieving high-level impact in FP/SRH programming.
We can’t sugar-coat it; these multi-pronged approaches are expensive! A conference like ICFP that brings many actors to the table, including development partners, donors, and policymakers, is, therefore, an important avenue not only to discuss these different approaches but also to show value from the different studies presented that approaches that address the multiple determinants of SRH are better in terms of scalability and sustainability. Don’t get me wrong, single-pronged approaches have value and place but are often limited in how they can be scaled or sustained in the long term.
Fully depending on donors, however, is not sustainable. Public-Private-Partnership (PPP), though another trendy word, presents a unique opportunity to enable both the public and private sectors to maximize resources and effectively deliver quality services to clients needing them most. At the WISH2ACTION Programme, the cluster approach, which is the IPPF’s PPP approach, goes beyond infrastructural projects to also provide innovative and diverse channels through which services are delivered to the most marginalized clients.
Finally, we heard a lot about digital health and the numerous solutions that are being implemented, especially to reach young people in sub-Saharan Africa, as well as support for health system strengthening for the acceleration of universal health care. However, a new WHO article based on a scoping review showed that these interventions need better coordination, need to avoid duplication, and need adaptation to be scalable or sustainable. It is important, therefore, for policymakers in sub-Saharan Africa to create and adopt standards and interoperability frameworks to stop the lack of coordination and create a more sustainable and less disjointed environment for digital health interventions[iv].
In all, any long-term change will require not only building the capacity of local systems and institutions to work and provide quality services, strengthen health systems, and improve health outcomes but also a shift in systemic leadership and health governance that moves from a top-down to a bottom-up approach to ensure local solutions (At scale) to global issues.
[i] United Nations. World fertility patterns. 2015. https://www.un.org/en/development/desa/population/publications/pdf/fertility/world-fertility-patterns-2015.pdf
[ii] Mary Mederios Kent. PRB. 2010. Engaging the Poor in Poverty Reduction: What is the Role of Family Planning?
[iii] Jain et al. Reducing Unmet Need and Unwanted Childbearing: Evidence from a Panel Survey in Pakistan. Studies in Family Planning 2014 45: 277–299.
[iv] Karamagi HC, Muneene D, Droti B, Jepchumba V, Okeibunor JC, Nabyonga J, Asamani JA, Moussa T, Kipruto HK. eHealth or e-Chaos: The use of Digital Health Interventions for Health Systems Strengthening in sub-Saharan Africa over the last 10 years: A scoping review. J Glob Health 2022;12:04090.