DIRECTOR'S MESSAGE: MAKING THE ‘LAST MILE” CLOSER THAN WE THINK

The family planning and reproductive health community is full of bold imaginators and impatient optimists. When Margaret Sanger first challenged Walter Pincus, the “inventor of the pill” to create a new contraceptive, a method that could work anywhere in the world and that didn’t require the knowledge or consent of the male partner, cynics thought the feat beyond imagination:

“..Looking for an inexpensive, easy to use, and completely full proof method of contraception…should be something biological…a woman could swallow every morning with her orange juice or while brushing her teeth, with or without consent of the man…something that could make sexual intercourse spontaneous, with no forethought or messy fumbling, no sacrifice of pleasure; have children later in life… something that could work everywhere from the slums of New York to the jungles of Southeast Asia…”[1]

But that’s how the pill, the greatest invention of the 20th century, was created - through creativity, imagination, and science for the social good. As we face our next decade of challenges in the family planning community, we must remember that what feels impossible can be done, but we must think boldly.

When I first started my career in reproductive health many years ago, there was a certain tangible “magic” within the family planning community. We worked hard, and we had fun. I watched in awe as fearless pioneers - like Mechai Viravaidya, Thailand’s Cabbages and Condoms entrepreneur, Haryono Suyono of Indonesia’s pacesetting National Family Planning Coordinating Board, and Fernando Tamayo of ProFamilia Colombia who said that people would pay for affordably priced contraceptive services - launched bold ideas and charted courses of action which were then beyond imagination.

With the close of 2019, we have reached the Family Planning 2020 goal year, the year we aimed to enable an additional 120 million more women and girls to access voluntary family planning methods. At the outset, we knew the goal would require new thinking and novel approaches to achieve such an ambitious target. But we are capable of making the last mile closer than we think because we are capable of new ways of innovating, new ways of collaborating, and new ways of accelerating family planning progress.

Since the 2012 London Summit, there are 53 million more women and girls using modern methods of contraception across 69 focus countries according to FP2020’s most recent report. And this achievement is one that the family planning and reproductive health communities should champion proudly. It’s no small feat, especially given the political climate in many donor and implementation countries, to achieve such remarkable progress.

But 53 million is less than half of the 120 million women and girls we collectively pledged to help. We have one more year to increase our achievement. Yet many of the reports coming from the global family planning community recently seem to paint a glass half-empty picture about our progress, but I remain hopeful - hopeful that we are making progress more quickly and will be better positioned to achieve universal access to reproductive health in many more poor countries by 2030.

In fact, a study released in May 2019 in The Lancet Global Health supports this belief. Led by researchers at Johns Hopkins Bloomberg School of Public Health, the study shows that women in many sub-Saharan African countries are using modern contraception at a faster rate than previously projected. For all women in the study, the trendline over at least four points in time using Performance Monitoring Data (PMA2020) average at an annual rate of change of 1.92%, with the average rate of change for married women even higher at 2.25%. Both numbers exceed the doubling of the .7% annual average in the 69 poorest countries before FP2020 to 1.4% benchmark set at the 2012 London Summit on Family Planning.

Another study released at the end of last year revealed 120 million additional family planning users will be reached by 2023. Almost half (17) of the 41 poor countries who pledged commitments to FP2020 are projected to achieve the SDGs benchmark indicator of 75% demand satisfied by 2030. With bold imagination and business unusual approaches we can expand the numbers beyond 17.

This research is not alone in its findings. The Challenge Initiative (TCI) for healthy cities, an initiative led by the Gates Institute working in 14 countries and 160 cities and local governments are showing real time data using health management information systems that shows significant contraceptive uptakes in most geographies and even reversing declining trends in some of the toughest areas in the world. These real time changes are ahead of the changes that may ultimately be detected by surveys over time.

As of December 2019, data from local HMIS in 160 areas show that TCI contributed to a 47% overall increase in annual family planning client volume compared to a 12-month baseline period prior to TCI implementation. I believe we are progressing faster than we think when it comes to enabling more, as well as younger and more vulnerable, women to access voluntary, modern methods of contraception in countries where the need is the greatest.

Even in Francophone West Africa which has historically demonstrated the least progress in family planning uptake, we are now seeing tremendous gains with the establishment of the Ouagadougou Partnership (OP). Since OP’s creation in 2011 among 9 Francophone West African countries (Benin, Burkina Faso, Côte d’Ivoire, Guinea, Mali, Mauritania, Niger, Senegal, Togo), 1,167,000 pregnancies, 374,000 unsafe abortions, and 4,300 maternal deaths were avoided as a result of the 1,306,000 additional contraception users in the region.

The challenge now is what we can do to harness the momentum of the past eight years and further accelerate this progress to reach those populations who are marginalized, the most elusive to reach, those who we sometimes define the “last mile.”

And as we work hard to reach those who historically are underrepresented in family planning outreach, because of their geographic distance to health centers, we must also make a concerted effort to help those who may be hardest to reach in many different ways other than distance, especially those living in urban slums.

As the global family planning and reproductive health community seeks to align our strategies, goals, and vision for the next decade, I am optimistic that we can not only achieve the marks we set for ourselves but can also advance progress towards the United Nation’s Sustainable Development Goals (SDGs). Reaching universal reproductive healthcare access underpins achievements of all the other SDGs.

And as we continue to improve family planning information, education, and services, we do so in an environment hostile not only to reproductive health, rights and justice, but to global aid in general. Just last week, the Trump administration released a new budget proposing $3 billion in cuts from its global health programs.

While these cuts are unlikely to fully materialize, they come in the midst of two deadly global health epidemics, the coronavirus in Wuhan, China and the ongoing Ebola crisis in the DRC.

So as we continue the New Year, begin a new decade, and mark the conclusion of the FP2020 goal year, we do so with appreciation for all that we have accomplished since the 2020 London Summit on Family Planning and with clear optimism for a way forward.

That’s what inspired us to plan and host the Future of Family Planning Convening, a special two-day gathering that brought together representatives from crucial family planning sectors to explore "business unusual" ideas that have the potential to reshape the family planning and reproductive health agenda to ensure universal access by 2030.

I encourage you to learn more about the convening outcomes by taking a deep dive into The Future of Family Planning Convening Report, and to contact us if you are interested in funding an idea presented in the report or partnering with any of our participants to bring them to life.

The report produced dozens of fresh, innovative ideas, including “Humor Me,” an international comedy competition that identifies comedians representing different countries across the globe, which came from the Social Media and Social Movements working group. The event will provide a platform for locally selected comedians to share funny stories and create a dialogue around sexuality and sexual and reproductive health in a fun, light-hearted way. Talking about these often “off-limits” subjects in an entertainment setting can help people break through the taboos and awkward conversations and normalize controversial issues. And since people love to share funny content online, the stories and messages told on stage will have high potential for going viral.

Another convening favorite, voted by the attending audience, was “Women-focused & Women-centered Insurance Packages,” from the Universal Health Coverage working group. Women understand their own needs best. For this reason, local women groups, especially in the informal sector, will lead the design of an insurance package that addresses their needs. This would help achieve greater equity in accessing maternal and child health and family planning services. It could also help leverage sustainable domestic funding, as it taps into local resources and capacity strengthening. This idea could launch easily if specific communities of women are targeted–women business groups, women in the informal sector, etc.

These creative, business unusual ideas are exactly what we need to propel us into the next decade of family planning progress and beyond.

I look forward to hearing the bold ideas, creative solutions, and novel research findings at the next International Conference on Family Planning, being held in Pattaya City, Thailand from 1-4 February, 2021. This year’s theme, “Family Planning & Universal Health Coverage: Innovate. Collaborate. Accelerate.” underscores our belief that family planning should be a core component of universal health coverage. Not only is access to family planning and reproductive health services a pillar of good personal health, it is also a critical component of a country’s economic health.

As we redefine the “last mile” and broaden our reach, I am positive in the next decade we can achieve our family planning - and our broader Sustainable Development Goals - to make the world healthier and just for all. What feels impossible can be done, but we must remember to think boldly about solutions to our world’s most pressing problems. Now is not the time to play it safe, but rather to “swing for the fences” as Bill and Melinda Gates put it and use our collective momentum to thrust us into a new and bold era of progress – and possibility.

Will you join us?

Sincerely,

Jose “Oying” Rimon II

 


[1] Jonathan Eig, Birth of the Pill, 2014, p. 4

Date:
Monday, February 24, 2020 - 10:15
Category:
News