The Unmet Need for Family Planning - Countdown 2015 Europe

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as condoms and oral contraceptives, as well as referrals forlong-acting or permanent contraceptive methods. A nationalprogramme evaluation in 2001 found that 20% of women inrural areas serviced by the Lady Health Workers were usingmodern contraceptives, whereas only 14% of women inother rural areas relied on modern contraceptive methods.This programme shows how community-based distributionof contraceptives can promote access among populations inwhich geographical distances or stigma around contraceptiveuse might otherwise prevent it (Center for Reproductive Rights/UNFPA 2010).EgyptIn a 20-year period, from 1980 to 2000, the percentage ofwomen in Egypt using contraceptives rose from 24% to 56%,and the average number of children born alive to a womanduring her lifetime dropped from 5.3 to 3.5 births. Strong familyplanning programmes, political commitment and donor supportcontributed significantly to this success.However, in many rural areas, such as Upper Egypt, theadoption of family planning programmes was less successful,as misinformation about the potential harms of contraceptivesand beliefs that family planning is against Islam were prevalent.A pilot programme in the Minya governorate, which had one ofthe lowest contraceptive prevalence rates in Egypt, focused onencouraging cooperation between local mosques and femalephysicians at village health clinics. The programme helped toturn the situation around, with contraceptive use rising from 23%to 48%. Training local religious leaders and giving them a role inaddressing unmet need helped to redress stigma, myths andsuspicion around contraceptive use (USAID).Family planning and sustainable developmentGuinea-BissauIn Guinea-Bissau, women’s organizations have initiated asuccessful pilot project, which involves partnerships with thegovernment to provide reproductive health services in areaswhere women collect salt. The women’s organizations providereproductive health and family planning services, along withchildcare, counselling for how to start a business and microcreditservices. This is great example of community cooperationthat links with government services.Youth-friendly servicesNepalThe World Wildlife Federation (WWF) implemented anenvironmental conservation project in Nepal but recognizedthat it couldn’t achieve the programme goals without the fullparticipation of women in the project areas. It realized that manywomen were often pregnant, sick, anaemic or suffering fromother reproductive-health-related problems.WWF launched a small pilot project to provide family planningservices. It found that more young people began usingcontraceptives, and women’s health improved. WWF’s mainproject is now doing well, and it has contacted Vaestollito as wellas the Family Planning Association of Nepal to help strengthenthe family planning component of its project.IndiaIn several states in India, non-governmental organizations havelaunched a pilot project setting up Community InformationAccess Centres to disseminate information about sexual andreproductive health and rights to adolescents, and take uprights issues at community level. These centres are specificallydesigned for adolescents, and provide space for the participationof vulnerable young people, parents and community and religiousleaders. This project aims to improve the quality of and accessto youth-friendly sexual and reproductive health services, aswell as to increase knowledge, skills and awareness related tosexual and reproductive health, including HIV, particularly amongvulnerable young women and men.The project is community-based, but with a strong emphasis onpromoting adoption and scale-up by state governments underthe umbrella of youth ‘Plans of Action’. Meetings with the Ministryof Sports and Youth Affairs and the Department for Women andChildren have led to a commitment to scale up in 12 districts ofJharkhand and West Bengal. This will enable the project to reachover 10 million young people and 3600 service providers.In addition, advocacy efforts have led to significant improvementsin young people’s access to appropriate services: 67% of youngpeople surveyed reported feeling more comfortable attendingservices.28 www.countdown2015europe.org
Taking a rights-based approachParaguay••In just six years, the use of modern contraceptive methodsincreased dramatically, from 48% to 61% percent throughoutParaguay, and from 41% to 55% in rural areas.••There was a particularly significant increase in the use ofmodern contraceptives for the youngest and oldest marriedwomen – the groups with the highest rates of maternalmorbidity and mortality and adverse pregnancy outcomes.These changes have been attributed in part to the introduction ofa constitutional protection guaranteeing every individual the rightto decide the number and spacing of their children. There wasstrong political commitment to implement this right, includingearmarking funds for contraceptive commodities, and private–public partnerships. Combined with initial donor support, this ledto an expansion of contraceptive services and a wide range ofcontraceptive choices (USAID/DELIVER 2006).GuatemalaIn 2005, Guatemala passed legislation to ensure universal access toall contraceptive methods. Despite multiple legal challenges, the lawwent into effect in October 2009. The Universal and Equitable Accessto Family Planning Services Law establishes the goal of achievinguniversal access to modern contraceptives throughout the countryand includes strategies for addressing various barriers to access. Inaddition to guaranteeing access to contraceptive methods, the lawincludes provisions that ensure free and informed decision-making,adequate contraceptive information and counselling, providertraining, and sexuality education in both primary and secondaryschools. To help meet these goals, the law incorporates elements of ahuman rights-based approach. For example, it focuses on vulnerablegroups, including adolescents and individuals living in rural areas,who lack access to basic health services. Additionally, the law callsfor national surveys to identify the unmet need for family planning andrecommends the development of tools for monitoring the provision ofcontraceptive services and evaluating progress in removing barriersto access (Center for Reproductive Rights/UNFPA 2010).ColombiaDespite opposition from the Catholic Church, the Colombiangovernment worked with civil society to support reproductivehealth services, including access to contraceptives. This jointwork led to an increase in contraceptive use among marriedwomen from 20% in 1969 to 66% in 1990. The unmet needfor contraception fell as low as 11%, and maternal mortalitydropped from more than 240 deaths per 100,000 live births toan estimated 120 deaths per 100,000 live births in 1990.In 1991 the country’s new constitution recognized health as a basicright and led to significant health reforms, such as establishinguniversal health insurance that included family planning coverage.Since then the unmet need has dropped even further to 6%, andcontraceptive use has increased to 78% among married women.In 2010, a constitutional court decision led to further improvementsin the health insurance benefits package for family planning (Singh,Darroch et al. 2009).Family planning successesIndonesiaThe average number of children Indonesian women had duringtheir lifetimes in the 1960s was six per woman, and at least twoof these six children were expected to die before reaching schoolage. In response, the government launched its family planningprogramme in 1967, with an emphasis on spacing children anda focus on community participation and encouraging couplesto think about how, whether and when to have children. Thishelped to strengthen perceptions that smaller families wereacceptable and desirable. Now figures show that families haveabout 2.6 children per couple, and more than 60% of marriedcouples practise birth spacing, most through the use of moderncontraceptives (USAID).TogoUnmet need for family planning remains high in Togo, where theproportion of women of reproductive age who are using (or whosepartner is using) a modern contraceptive method at a given pointin time is only about 9%. This problem has been compounded bycuts in donor funding for contraceptive commodities.To improve access to contraceptives, the Ministry of Health, incollaboration with multiple stakeholders including the Ministryof Finance, launched a strategic planning process in February2004. The Ministry of Health advocated with the Ministryof Finance to create a budget line item for contraceptivecommodities. Before the strategy was finalized in September2005, the Ministry of Finance recognized the significance of theresource gap and declared its intention to create a line-item forcontraceptive purchases and in the interim, allocated CFA50million (US$95,000) to the Ministry of Health for the purchase ofcontraceptives (RHSC 2009).www.countdown2015europe.org29
Page 1 and 2: The Unmet Need for Family Planning:
Page 3 and 4: Toolkit introductionSixteen Europea
Page 5 and 6: Category map (index)Use this map to
Page 7 and 8: How family planning can help develo
Page 9 and 10: 1.3 Consequences of unmet needNot m
Page 11: Paris Declaration on Aid Effectiven
Page 17: In some countries, for example, fam
Page 20 and 21: 4.2 Facts and statistics: benefits
Page 22 and 23: more remote areas are most likely t
Page 24 and 25: 5. Frequently asked questionsQ I th
Page 26 and 27: 6. One-minute talking points and co
Page 31 and 32: 8. Cut-and-paste tables, graphs and
Page 33 and 34: Contraceptive prevalence rate, glob
Page 35 and 36: $1 spent on FP saves $4Internationa
Page 37 and 38: 9. Other tools and resourcesGeneral
Page 39 and 40: ReferencesAshford, L. (2003) Unmet

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