Protecting Fragile Progress in Family Planning

Around the world, from Asia to Africa, tens of millions of women have gained access to contraception in the past 5 years, making it possible for them to avoid unsafe abortions, unintended pregnancies and maternal deaths. This progress, reported last month by Family Planning 2020, a global partnership launched in 2012 with the goal enabling an additional 120 million women in the world’s poorest countries to access voluntary contraception by 2020, is encouraging. But without continued global support, these numbers could fall off, with immeasurable consequences for millions of women and girls and the economies that sustain them.

According to FP2020’s progress report, 309.3 million women and girls in the world’s poorest countries use a modern method of contraception, as of July 2017. That means 38.8 million more women and girls are using contraception now than in 2012, the year of FP2020’s launch.

This increase has positive consequences. Between July 2016 and July 2017, use of family planning averted 26 million unsafe abortions, prevented 84 million unintended pregnancies, and avoided 125,000 maternal deaths. In our view, millions of child deaths have also been prevented: if births were spaced a minimum of 24 months apart—easily achievable with longer-acting reversible contraception—estimates suggest the infant mortality rate would fall by 10%, and by 21% for children 1 to 4 years old.

More than half—21.9 million—of these additional contraception users are in Asia, and just under half—16 million—are in Africa. The modern contraceptive prevalence rate (MCPR) among all African women jumped from 19.5 percent in 2012 to 23.4 percent in 2017; it is growing fastest in Southern and Eastern Africa.

We believe that this story of spectacular progress in Africa—in such countries as Ethiopia, Kenya, Uganda, Malawi, Rwanda, Senegal, and even Nigeria, where family planning uptake has been slow— has not been told. If the progress of contraceptive practice continues to accelerate in sub-Saharan Africa and impacts birth rates to scale, we believe the demographic change will be profound. It could be akin to what happened in the 1980s and ’90s, when the economies of the East and then Southeast Asian regions unexpectedly grew faster than any other parts of the world, consistent with declines in fertility.

The cost savings to families and nations from not having to support a youthful population allowed judicious investments in human capital quality (health and education) that harnessed and brought about what is known as the “demographic dividend,” a concept coined by Harvard economists David Bloom and David Canning. They showed that the demographic dividend process has contributed about 30% of the increases in per capita GDP compounded annually for 30 years (see One Billion People, One Billion Opportunities: Building Human Capital in Africa).

In fact, World Bank data show that between 1960 and 1980, the per capita GDP of sub-Saharan Africa was about double that in East Asia and the Pacific, between $450 and $550 (figures are corrected for inflation). Yet starting in the 1980s, East Asia and the Pacific saw spectacular economic growth, while sub-Saharan Africa stagnated. The implication is, if Africa can mirror East Asia’s path of fertility decline, it too may see spectacular economic growth in the next thirty years.

Yes, we are bending the curve toward our goal of reaching 120 million more family planning users by 2020, but we still have a long way to go. Despite the recent wins, we are not on track to meet this goal.

And while the rest of the world—especially sub-Saharan Africa—demonstrates achievements in country-led programs, the US administration is in full retreat on foreign assistance for family planning.

Despite the clear evidence that investing family planning brings about a lifetime of returns, the current US administration has proposed zeroing out the State Department’s and USAID’s budget for international family planning. In analyzing best buys to help achieve the global Sustainable Development Goals (SDGs), the Copenhagen Consensus Center, an independent think tank, identified access to contraception as second only to trade liberalization, and ahead of reducing tax evasion. For every $1 invested in family planning, the analysis says, society reaps $120 in lifetime benefits, such as reduced maternal and child deaths and increased per capita income.

For a relatively small investment by the US government of about $600 million a year, the Senate Committee’s proposed level of support, millions of lives could be saved, and millions of unsafe abortions and maternal and child deaths could be averted. This $600 million investment could, according to the Copenhagen Consensus analysis, reap benefits of $72 billion to the poorest countries of the world.

If not for the Senate, the current US administration would have eliminated international family planning assistance in the 2018 budget. The discord will continue in the years to come unless executive and majority legislative leadership accept the broad base of scientific evidence for family planning, as 166 other governments around the world already have.

Jose “Oying” Rimon II is director of the Bill & Melinda Gates Institute for Population and Reproductive Health, in the Department of Population, Family and Reproductive Health at the Johns Hopkins Bloomberg School of Public Health.

Amy O. Tsui is a professor and senior scholar of the Bill & Melinda Gates Institute for Population and Reproductive Health, in the Department of Population, Family and Reproductive Health at the Johns Hopkins Bloomberg School of Public Health.

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