More than 200 million women in the developing world who want to avoid pregnancy are not using a modern contraceptive method. The reasons include perceived or actual side effects, lack of availability and information, cost, and socio-cultural obstacles.
Participants at the London Summit on Family Planning, held in July 2012, set a goal to respond to this unmet need for contraception. They launched an initiative to reach an additional 120 million women and girls in the poorest countries by 2020 with voluntary access to high-quality family planning. Commitments totaling US$2.6 billion have been made by national governments, civil society, and the private sector as part of the initiative, known as Family Planning 2020 (FP2020).
The Population Council supports the goal of expanded access to family planning. A new Council report—The Unfinished Agenda to Meet FP2020 Goals: 12 Actions to Fill Critical Evidence Gaps—summarizes evidence from a wide range of sources on what factors shape family planning programs. The report proposes components of a new research and action agenda to bridge gaps in evidence; and provides an extensive annotated bibliography to serve as a knowledge base for future research. Ian Askew, Council director of Reproductive Health Services and Research, and Martha Brady, Population Council senior associate, co-authored the report.
“After a decade of waning investment in family planning, we are now witnessing a resurgence in interest, energy, and resources. This is an opportune moment to address the unfinished family planning agenda with attention to quality, equity, and choice,” said Brady.
“More than five decades of research have shaped family planning programs and contributed immensely to the rapid increases in contraceptive use in many developing countries,” said Askew. “Despite this success, continued investment in high-quality research is essential if all women are to benefit equally from having full access to these life-saving services.”
Evidence Gaps: Identifying What We Don’t Know
The Unfinished Agenda reviews published evidence on interventions to increase access, quality, and use of family planning. The authors consulted with family planning experts to sort the evidence into three broad areas: 1) social determinants of family planning demand and use, 2) health system determinants of family planning demand and use, and 3) dynamics of family planning demand and use.
Evidence indicates that the most influential social determinants of family planning use are typically girls’ and women’s social status and decisionmaking ability, level of education, marital status, age, and place of residence. They argue that considering inequities—particularly those resulting from poverty, sex, age, and marital status—is critical to identifying the most disadvantaged, vulnerable, and underserved populations with unmet need. These are the populations for whom family planning programs and investments should be prioritized.
The authors note that national health systems largely determine the institutional structures through which family planning is financed, delivered, and accessed. However, as not-for-profit and commercial organizations become increasingly important sources of information and services, an adequate understanding of how people access family planning can only be obtained by looking beyond just national health systems.
Research to inform future family planning investments should focus on the “total market”—that is, all involved sectors—so that all people are able to access affordable, quality services. The authors also stress the need for more and stronger evidence to better understand how to strengthen health systems, thereby improving access to quality services.
Additional evidence is needed to understand the determinants of demand for and use of family planning so that programs can be tailored to meet the needs of specific groups, such as married and unmarried adolescents, marginalized ethnic populations, urban slum dwellers, and people living with HIV and AIDS.
Filling the Gaps: Proposed Actions
To fill the major knowledge gaps, the authors recommend 12 actions that should be prioritized by those investing in and undertaking research on family planning:
- Conduct research that identifies the needs of the most vulnerable or underserved individuals
- Evaluate interventions to reduce inequities and vulnerability
- Understand the dynamics of contraceptive decisionmaking and use
- Meet the needs of married and unmarried adolescents
- Improve and sustain the quality of family planning services
- Expand effective models of integrated services
- Serve rural communities more efficiently and equitably
- Reach the urban poor
- Shape contraceptive markets to improve access
- Expand access and increase affordability through innovative financing
- Develop strategies for advocacy and accountability
- Build capacity and improve research to generate evidence on family planning
The Road to Access for All
The challenges ahead for family planning programs will be to increase access while reducing inequities in people’s ability to use a method of their choice. A large amount of evidence exists that can inform responses by health systems and others to reduce unmet need for family planning; more efforts are needed to translate this evidence so that policymakers and managers can improve and expand their programs. However, sufficient evidence is lacking in the 12 areas identified above, for which further research should be conducted to ensure equity in access so that all girls and women can be equipped with the knowledge, skills, and technologies to demand and enjoy their reproductive rights, including family planning.
Askew, Ian and Martha Brady. 2013. The Unfinished Agenda to Meet FP2020 Goals: 12 Actions to Fill Critical Evidence Gaps. New York: Population Council.
United States Agency for International Development