The International Conference on Family Planning (ICFP) that took place in Kigali between the 12th – 15th November, 2018 in Rwanda brought to the forefront global issues facing progress on family planning. Countries recommitted to increasing funding, access to services and involvement of diverse communities in the family planning ecosystem. Themed “Investing for a Lifetime of Returns” the ICFP 2018 was co-hosted by the Bill & Melinda Gates Institute for Population and Reproductive Health at the Johns Hopkins Bloomberg School of Public Health and the Ministry of Health of the Republic of Rwanda. The Conference pitched family planning as a development “best buy”, if the world plans to make notable progress in achieving the Sustainable Development Goals (SDGs).
As of July 2018, the total number of women and girls using a modern method of contraception in the world’s 69 poorest countries had grown to more than 317 million. This is 46 million more users than in 2012. The use of contraception is growing fastest in Africa, with 24% of women of reproductive age now using modern methods. The number of women using modern methods of contraception in Nigeria grew by over 1.7 million, since 2012. Between July 2017 and 2018 in Nigeria, modern contraceptive methods prevented over 2 million unintended pregnancies, 735,000 unsafe abortions, and 12,000 maternal deaths. Despite this progress, only 13.8% of women aged 15-49 are using modern contraception in Nigeria, and 24.8% of married women in the same age group have an unmet need for modern contraception. These figures were revealed at the launch of the FP2020 Progress Report during the conference.
Key themes arising from the conference include:
The Rwandan Success Story:
Rwanda was highly praised for its investments in health and access to family planning. The Rwandan Prime Minister Dr. Edouard Ngirente said the country currently allocates 16% of its national budget to health, above the 2001 Abuja Declaration commitment where African countries committed to spend at least 15% of government budget on health. As of 2014-2015, 48% of all married women in Rwanda were using modern methods of contraception and the country’s modern contraceptive prevalence rate (mCPR) as at June 2018 was 30%, one of the highest in Africa. Ngirente said the country plans to increase its mCPR to at least 60% by 2024. Rwanda has put in place initiatives that make family planning services, information and long-lasting contraceptive methods readily available to its population. Rwandan Minister of Health Dr. Diane Gashumba stated that the government is committed to ensuring the availability of family planning services to 14,841 Rwanda administrative villages by the 45,000 community health workers in service.
Beyond family planning initiatives, Rwanda developed the National Early Childhood Development Program which focuses on early childhood health issues, established community-based health insurance across the country which currently benefits 90% of the population, increased female enrolment at all levels of its education system (currently at 50%). Women currently account for 50% of the country’s cabinet and 61% of Parliament positions.
Family Planning as an SDGs Best Buy:
The development world is three years into pursuing the 17 Sustainable Development Goals (SDGs), which are meant to be achieved by 2030. The director of The Bill & Melinda Gates Institute for Population and Reproductive Health, Jose “Oying” Rimon II, mentioned that research by the Copenhagen Institute on the SDGs showed that family planning was the best buy for achieving sustainable development.
“The first best buy is trade liberalization. The second best buy is family planning, access to contraception. For every $1 that one invests in access to contraception, one reaps the benefit equivalent to $120… We cannot achieve SDGs without family planning and access to contraception as a key component of it,” he said.
This 2015 Flagship SDGs report pointed out that Sub-Saharan Africa is in particular need of support as part of SDG implementation. Although the proportion of people living in extreme poverty in the region is estimated to fall by 2030, the absolute number may rise due to population growth. Maternal mortality and sanitation are expected to lag far behind the global 2030 target. Almost all future increases in slum populations at the global level are due to occur in sub-Saharan Africa.
Investments in family planning globally and in Sub Saharan Africa are critical and must continue to increase. Global donor funding has risen by 6% since 2016 —from US$1.20 billion in 2016 to US$1.27 billion in 2017—according to the FP2020 Progress Report. Bilateral donations in 2017 were led by the U.S. (US$488.7 million), the U.K. (US$282.4M), the Netherlands (US$197M) and Sweden (US$109.2M). For African countries, domestic government spending on family planning in 2016 was led by Ethiopia (US$21M), Kenya (US$19M), and Zimbabwe (US$18.1M). Nigeria’s domestic spending on family planning in 2016 was $8.5 million.
Youth Involvement & Harnessing the Demographic Dividend:
“We are not the future. We are the present!” This was the call consistently echoed by youth advocates attending ICFP2018, most notably Sadia Rahman, a youth leader from Bangladesh. Speakers, plenaries and breakout sessions highlighted the need to include young people in every aspect of family planning, not only to reach out to them as an important community but to harness their voices and engage their enthusiasm to push the movement forward. Youth-led sessions focused on the need for countries to include young people from the design stage of family planning interventions targeted at young people, to the need to acknowledge and celebrate efforts being championed by the youth in the family planning space. Youth advocates called for governments to increase funding and access to family planning services for young people and to create safe spaces where youth can engage, learn and share their experiences.
Ngirente in his address pointed out that the biggest challenge facing African leaders is how to harness its youth to ensure that the continent reaps the benefits of the demographic dividend. The demographic dividend is the economic growth potential that a country has when there is a shift in the population age structure. Demographic dividend arises when the population of those who are in the working age are more than those who are dependent. Better access to family planning can deliver a powerful ‘demographic dividend’ that can help transform economies, as birthrates drop and the ratio of adults to dependent children increases. With fewer dependents to support, a country can invest more in education, infrastructure, and other productivity-enhancing measures.
Besides youth involvement, the conference recognized the importance of collaborating with a range of communities if progress is to be made towards family planning objectives. Sessions at the conference showed how partnerships with communities of faith were helping to amplify the family planning message. Also highlighted were partnerships with the private sector in delivering on family planning services as well as initiatives to increase male engagement in family planning discussions. Engaging ministries of budget and economic planning is also critical for family planning advocacy, as countries tie into global trends such as the call for universal health coverage.
Empowering Women Through Rights-Based Family Planning:
Women getting proper information about access to family planning options, as well as exercising the right to use modern contraception, was a recurring theme at the conference. The consensus was that more work needs to be done globally to make this happen. Women need full information about different contraceptive options and their possible side effects in order to make an informed choice about the method that best suits their needs.
Dr. Natalia Kanem, Executive Director of the United Nations Population Fund (UNFPA), revealed that approximately 214 million women around the world who want family planning do not have access, and the amount of money it would cost to meet all women’s demands for contraception is $5.8 billion per year, more than what is currently being spent on family planning services. Beth Schlachter, Executive Director of Family Planning 2020, said women represent half of the world population, and that family planning empowers women and in turn allows them to contribute to the economy by joining the labour force, generating vast benefits across the society. The McKinsey Global Institute points out that if women were able to participate in the economy at the same level as men, it would add US$28 trillion to global GDP by 2025.
Rwandan First Lady Jeannete Kagame at a high-level panel “Women of Impact: Global Leaders Creating Positive Change,” said women’s roles, though vital, have often been taken for granted and this comes with a heavy cost to their health. “When provided with a conducive environment, and truly empowered to voice their opinions, they thrive. We have seen women morph into strong, insightful and intuitive key players, able to effectively impact positive and lasting change around them,” she said, adding that it was important to encourage women’s efforts to promote liberating family planning and sexual reproductive health services.
This year, the ICFP Conference recognized individuals who have made deep and enduring impact on the family planning and reproductive health field. President and CEO of the Association for Reproductive and Family Health (ARFH), Professor Oladapo Ladipo, and Co-Founder ARFH, Ms. Grace Delano, were given Lifetime Achievement Awards for their impact on family planning and reproductive health. ARFH was established in 1989 and is one of the first indigenous non-profit organisations working in the reproductive health space in Nigeria. The conference also held a FPitchFest, where 10 CEOs had the chance to pitch transformative family planning/SRH ideas to the audience, as well as gave awards for Excellence in Leadership for Family Planning.
Gates Institute Director Rimon believes that the family planning movement is achieving more than is being reported and urged for the current momentum to be sustained. The goal is to have 120 million additional users of contraception by 2020, one that seems unlikely to be met. Yet leaders at the ICFP 2018 agreed that the progress made is encouraging. To sustain the momentum will require the 44 countries within the FP2020 Partnership to continually dedicate funding for sexual and reproductive health services, to fine tune their strategies to reach adolescent and youth populations, and to broaden the network of collaborative partners behind the family planning cause.
Nigeria’s burgeoning youth population is a vital community that must be engaged if the country is to make progress towards FP2020 goals. The potential of young people to contribute to the family planning advocacy space should not be ignored in policy design and implementation. Investing in the youth includes promoting youth friendly centres for sexual and reproductive services, making sure that boys and girls receive quality secondary and post-secondary education and providing access to employment and an enabling atmosphere for businesses, so that young people can learn and earn, which allows them to save and invest for their future.
While the youth bulge also provides an incredible potential for the country to reap the benefits of demographic dividend, this potential will only be realized if the country takes serious steps towards slowing down the rate of its population growth that will potentially make Nigeria the third largest population by 2050, at an estimated 410 million people. At the current Total Fertility Rate (TFR) of 5.74 children per woman, the country must aggressively re-strategise its family planning messaging to sensitize communities on the need to plan their family sizes, an argument that should be linked to economic growth potential. We cannot effectively grow our economy if our population size keeps spiraling out of control. Minister of Health Professor Isaac Adewole echoed these concerns earlier this year, adding that Nigeria needs to invest an approximate $652 million over the next five years on “high impact” family planning.
In Nigeria’s religious and cultural context, the family planning agenda must include an active engagement with faith communities, traditional leaders and men, who are important decision makers and gatekeepers. Finally, Nigeria’s teeming population of women and girls need non-discriminatory access to sexual and reproductive health services, adequate information, and an understanding of their rights to contraceptive choices.
Nigeria’s annual rate of population change is at 2.7 percent. This is unsustainable. The evidence that family planning can be an economic game changer and development best buy is overwhelming. It is left for Nigeria’s family planning advocates, for Nigeria’s government, for Nigerians, to roll up our sleeves and go to work.