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Long-Acting Reversible Contraception in the Context of Full Access, Full Choice

2013 Statement from the Bellagio Group on LARCs

NEW YORK (18 December 2013) — In November 2013 at the International Conference on Family Planning in Addis Ababa, Ethiopia, the Population Council convened the third meeting of international experts to discuss ways to expand contraceptive choice and accelerate progress toward the Millennium Development Goal of universal access to reproductive health services by increasing access to highly effective, long-acting, reversible contraceptives (LARCs).

The Bellagio Group shares a commitment to leadership in increasing access and choice in contraceptive information, services, and supplies. Participants include service providers, donor representatives, researchers, procurement specialists, manufacturers, and public health specialists.

This commitment is grounded in the belief that access to high-quality, effective, and voluntary contraceptive information, services, and supplies improves health, expands opportunities, and improves family and community welfare. LARCs are a vital part of the method mix, but are often inaccessible to many women, especially adolescent girls. Working together, the global community and national public, private, and civil society partners must ensure that LARCs are fully available alongside other contraceptive methods so that universal access is achieved through informed choice, voluntarism, and equity.

In Addis Ababa, the Bellagio Group reached a consensus on the following statement and recommendations for action.

In recognition of the theme of the 2013 International Conference on Family Planning, Full Access, Full Choice, the Bellagio Group reaffirms its commitment to expanding access to highly effective, long-acting, reversible contraception for women and adolescent girls within the full range of contraceptive choice.

The Bellagio Group was first convened in 2012 by the Population Council, the International Federation of Gynecology and Obstetrics (FIGO), and the Reproductive Health Supplies Coalition. The Group called for greater access to LARCs within a contraceptive framework that advances rights, promotes quality of care, assures equity, and responds to the needs of the most vulnerable populations in developing countries. Since then, significant progress has been made, including:

  1. An increased commitment to the rights and voices of women and adolescent girls within national family planning and reproductive health programs.
  2. Greater priority placed on equity in contraceptive access and ensuring that young people and those who are the most marginalized and live in the most difficult circumstances are given the greatest attention and care.
  3. Expanded access to a wider range of contraceptive methods and related services (e.g. counseling, insertion, and removal) through efforts to reduce costs and increase the broad availability of LARCs as part of a comprehensive range of method choices.
  4. Expanded access to various types of healthcare providers in the public and private sectors who have acquired the skills needed to deliver effective contraceptive options to women and adolescent girls.
  5. More effective integration of LARCs into commodity supply chains and greater awareness of and demand for all contraceptive choices.

Recommendations for Action

Despite progress to date, LARCs remain out of reach for many women and adolescent girls—especially the poorest and most marginalized. The Bellagio Group asserts that if all women, men, and young people do not have a full and informed choice of contraceptive options, they do not have full access.

To expand choice and access, the Bellagio Group calls on global and national family planning communities to focus on the following priority areas:

  1. Ensuring that all women, men, and young people have equal access to the full array of short-term, long-acting, permanent, and emergency method choices for delaying, spacing, and limiting pregnancies.
  2. Educating women, adolescents, and their partners, providers, and policymakers about the potential utility of LARCs as high-quality, effective, and voluntary post-partum and post-abortion contraceptive options.
  3. Enabling full choice of contraceptive methods for young women by ensuring that LARCs are included in counseling on contraceptive options and that products and trained providers are available to young women choosing this option in both public and private settings.
  4. Identifying, evaluating, and implementing innovative strategies for financing and enhancing the sustainability of contraceptive products and services.
  5. Employing a total market approach with public, commercial, and non-for-profit providers to give women, men, and young people full access to affordable and acceptable contraceptive options.
  6. Developing rights-based and total market metrics that are accepted and used nationally and globally to ensure protection of rights, enhance equity, chart progress toward universal access, and hold policymakers accountable for creating an environment conducive to meeting the reproductive health needs of all.

The Bellagio Group will continue to operate as a think-tank for effectively tapping into a wealth of knowledge shared by respected experts. The group strives to find innovative solutions that expand contraceptive choice and accelerate universal access to reproductive health services by increasing availability of LARCs.

Bellagio Group Members
Sabaratnam Arulkumaran, FIGO
Gloria Asare, Ghana Health Service, Ghana
Ian Askew*, Population Council
Pam Barnes*, EngenderHealth
Aron Betru*, Pledge Guarantee for Health
Paul Blumenthal*, Stanford University
Campbell Bright*, UNFPA
Klaus Brill*, Bayer Healthcare
Julia Bunting*, IPPF
Peter Donaldson*, Population Council—Chair
Eric Dupont, UNFPA
Anibal Faúndes, FIGO
Chastain Fitzgerald*, WomanCare Global
Turkiz Gokgol, Susan T. Buffett Foundation
Victoria Hale, Medicines360
Karl Hofmann*, PSI
Roy Jacobstein*, EngenderHealth
Koen Kruytbosch*, Merck/MSD
Julia Lowe, Bill & Melinda Gates Foundation
Baker Maggwa*, FHI360
Roland Edgar Mhlanga, Ministry of Health, South Africa
Nomi Fuchs-Montgomery*, MSI
Basab Mukherjee*, FIGO
Beatrice Mutali*, Merck/MSD
Saundra Pelletier, WomanCare Global
C.N. Purandare*, FIGO
Scott Radloff*, Gates Institute
Kshama Roberts*, Merck/MSD
Jill Sheffield*, Women Deliver
John Skibiak*, Reproductive Health Supplies Coalition
Jeff Spieler*, USAID
Harriet Stanley*, EngenderHealth
Alan Staple, The Clinton Foundation Health Access Initiative
Sally Stephens*, Medicines360
John Townsend*, Population Council
James Trussell, Princeton University
Shahida Zaidi, Former FIGO Vice President

*Denotes those who participated in the third meeting of the Bellagio Group in Addis Ababa, Ethiopia.

About the Population Council
The Population Council confronts critical health and development issues—from stopping the spread of HIV to improving reproductive health and ensuring that young people lead full and productive lives. Through biomedical, social science, and public health research in 50 countries, we work with our partners to deliver solutions that lead to more effective policies, programs, and technologies that improve lives around the world. Established in 1952 and headquartered in New York, the Council is a nongovernmental, nonprofit organization governed by an international board of trustees.

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Media contact
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