By Christopher Purdy, Phil Harvey
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| A health worker provides counselling on family planning to women in Oromia, Ethiopia. Photo by: DKT Ethiopia / CC BY |
Use of modern contraception is increasing in developing countries, including in historically low-performing regions such as West Africa. However, contraceptive adoption must rise further in order to reach the ambitious goal of 120 million more family planning users by 2020 set by the Family Planning 2020 movement.
In this complex global policy area there are numerous trends that will play out in 2017 — and beyond — that need to be monitored. We outline the major issues to watch out for below:
1. A focus on FP2020 goals — increasing quantity and quality.
For the first time, the number of women and girls using modern contraception in FP 2020 priority countries exceeded 300 million. However, according to this recently released Family Planning 2020 report, progress is behind target and significant work remains to be done to accelerate efforts in the remaining few years.
As the quantity of family planning users has increased in recent years, other elements appear to be improving as well. This study by Palladium suggests that FP2020 and donor inputs may be having a positive impact on policies, service delivery, and family planning access as well. Other efforts, such as SPARQ, are furthering our understanding of how quality impacts family planning uptake. By measuring women’s in-clinic experiences and determining obstacles to providing them with quality care, this initiative aims to identify strategies to improve care and replicate models more broadly.
Of the 69 priority countries, 20 of them contain 80 percent of the women with unmet need. India alone contains one-third. Focusing resources on these countries as well as areas with particularly high fertility (such as West Africa) will be important if FP2020 goals are to be met.
Look for an increased emphasis on service delivery, commodities, and financial commitments from governments, donors and nonprofits.
2. The Trump effect.
There will be a great deal of uncertainty on reproductive rights and healthcare with the incoming Donald Trump administration.
We anticipate an immediate re-institution of the Mexico City Policy, which requires any non-U.S. NGOs receiving U.S. federal funding to refrain from performing or promoting abortion even with private monies. Some non-profits will be forced to comply; others will stop accepting U.S. government funds. U.S. based organizations are exempt from this policy and many of them will try to fill the gap. However, women overseas may end up with fewer options.
There may also be reductions in U.S. government monies for family planning globally. Already, a great amount of uncertainty is worrying family planning groups. If so, organizations will require additional support to continue the work they do. Planned Parenthood has reported a surge in donations since Trump’s election. We expect this trend to continue.
While it remains unclear what Trump’s personal position is on abortion and family planning, he has surrounded himself with advisors hostile to Roe v. Wade and reproductive rights. However, in September, Trump expressed support for making birth control available over the counter in the U.S. and he has supported abortion access in the past.
We expect a conservative justice to be appointed to the U.S. Supreme Court, but overturning Roe v. Wade seems unlikely any time soon. Furthermore, a majority of Americans are clearly in favor of keeping abortion legal.
Similarly, while changes to the U.S. Affordable Care Act (Obamacare) are expected, health care, including family planning services, will probably continue ‘as is’ for the foreseeable future.
3. The abortion pill — use is increasing.
We continue to see increased understanding and use of the abortion pill by women choosing to terminate unwanted pregnancies. In the USA, Reuters recently reported that the abortion pill is used nearly as often to terminate pregnancies as the surgical (vacuum aspiration) method. Availability of mifepristone and misoprostol (the drugs that terminate pregnancy with 98 percent effectiveness) is on the rise in the rest of the world as well. Sales of combination packs of mifepristone and misoprostol sell in the millions in India each year, for example, and misoprostol alone continues to enjoy brisk sales almost everywhere.
In addition, websites such as ‘how to use the abortion pill’ provide accurate information on how to use these drugs in more than a dozen languages. For those in developing countries without direct access to medical abortion, they can obtain it online, through websites such as Safe2Choose, Women on Web and Women Help Women
4. Condoms are here to stay.
The annual global condom market may have reached as high as 20 billion condoms. That's a big increase over the last couple of decades. Additional government funding, assisted in part by the Global Fund, PEPFAR, and other HIV-related sources, has spurred consumer interest while innovations in the condom market have contributed to increasing both supply and demand. In 2015, social marketing programs alone delivered over 2.3 billion condoms. The increasing number of colors, aromas, shapes and lubricants for condoms is helping this trend along.
5. Some ‘new’ contraceptives (and how we use them).
While the injectable contraceptive called Sayana Press is not exactly new, it is still in the early stages of marketing and sales in most countries. It has been hailed as a “game changer,” because of its ease and simplicity of administration.
Importantly, the United Kingdom has approved Sayana Press for self-injection. Nigeria has also approved it conditionally for self-use. During 2017, PATH is conducting research on self-injection of Sayana Press in collaboration with ministries of health in Senegal and Uganda. Meanwhile, through websites such as “Inject Sayana Press,” women are learning how to use the simple subcutaneous injection method with a tiny single-use injector.
There have been new and improved manifestations of old contraceptives, such as the Caya contoured diaphragm, a new barrier device that prevents sperm from entering the uterus.
Vasectomy also seems to be making a comeback, with the launch of World Vasectomy Day in Kenya on Nov. 18, billed as “the world’s largest male-oriented event in family planning event in history.” This crowd sourcing campaign is raising funds for a pilot program in Kenya. Sterilization, both female and male, remains by far, the most popular modern method of birth control worldwide.
6. Young people are key.
There are now more young people in the world than ever before. In the world’s 48 least-developed countries, children or adolescents make up a majority of the population. To reach them, we need new language, new approaches and new technology — apps that remind them to take a pill or get an injection, access to online information such as Bedsider.org tailored to their demographic, and creative use of social media.
Expect more family planning programs to target young people. There may be pushback from conservative groups and governments as well.
7. The Zika effect.
The rapid rise of the Zika virus in the Americas was a major global health story in 2016 and was linked to sexual health in two ways.
First, it elevated the importance of contraception and abortion to prevent the birth of babies with birth defects caused by Zika. Indeed, Pope Francis suggested that women exposed to Zika may be permitted to use contraception, a major departure from Catholic doctrine. He did not extend that thinking to abortion. Second, it was revealed that Zika can be transmitted sexually as well as by mosquitoes, providing even more reasons to use condoms.
While early fears of a wide-scale epidemic appear to have been unfounded, Zika served as a reminder that strong global reproductive health programs are equally important for global health.
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