In a previous article, I wrote about how it was possible for one doctor to perform hundreds of tubal ligations in one day – but probably not honor the rights of the patients. The next column was about putting human and reproductive rights first and foremost. Today’s column focuses on one country where FP2020 is making amazing improvements in the lives of women and children.
FP2020 is the nickname of the ambitious program started in 2012 at the London Summit on Family Planning. Its goal is to reach 120 million women of the 225 million who are unable to access modern contraception but wish to regulate their fertility. These are women in developing countries who currently have little or no access to reproductive-health care. Typically, they have high fertility rates and high rates of child deaths, illegal abortion and maternal mortality. Often, these women are the poorest of the poor, have little schooling and are subservient to men. Many of these women live grim lives.
A very high percentage of people in wealthy countries already use family planning; indeed, that is part of how we became wealthy. It is time to share that knowledge and technology with our less fortunate brothers and sisters. Unfortunately, where access to family planning is limited, infrastructure is also challenging – transportation, sanitation and communication are often poor. Reaching these people will be difficult.
Providing full reproductive-health care for every woman in the world who does not currently have access to those services would cost a whopping $40 billion annually – about the same amount as the U.S. military spends in a month. The lives saved by such an investment would make that money very well spent, however. Reaching all people in developing countries with family planning and with maternal and newborn care would prevent 79,000 maternal deaths, 26 million abortions and 21 million unplanned births each year.
The cost of providing just family-planning services for these people would be about $9 billion a year. Because moms will be healthier, improved birth spacing alone would prevent over a million infant deaths globally each year!
Funding is a major challenge for FP2020. The programs are jointly supported by developing countries and by donor (wealthy) countries. In addition, generous funding has come from foundations; the Bill and Melinda Gates Foundation is a major source of financial support as well as being a prime mover. Assistance also comes from the UN and the U.S. Agency for International Development, among many other organizations.
One of the FP2020 programs is in the Democratic Republic of the Congo. This beleaguered country has had a miserable history of colonialism, dictators and civil war. Average income there is less than $2 per day. Only 53 percent women are literate, and only one in 20 married women uses a modern method of contraception. Indeed, a 1933 law makes contraception illegal! The average woman bears more than 6 children in her lifetime, and the country will double in population every 23 years – exacerbating many of its economic and political problems.
Despite these challenges, FP2020 is seeing successes in the DRC. One project was to map existing family-planning resources, using a sophisticated system of data collection with cellphones. They now know where there are trained family-planning personnel and which pharmacies have pills or injectable birth control. Fortunately, all sites offer condoms.
Women in the DRC have been relying on traditional methods of family planning for years, with too many unintended pregnancies – more than a million in 2013. Contraceptive implants (such as Nexplanon) were introduced in 2014 with great success. So far, the program has recruited almost 200,000 new users of modern contraception.
What FP2020 has meant to women in the DRC is telling. More than 300,000 unintended pregnancies were averted in 2013. Calculations suggest that 1,481 women’s lives were saved, and 76,000 unsafe abortions were prevented by the use of modern contraception.
FP2020 offers hope for the future, especially for people in countries such as the DRC. I am optimistic that FP2020 can help women and families lead healthier and happier lives and will be a model for the future of family planning. And, I expect it and future programs will be built on respect for the people they serve.
Richard Grossman practiced obstetrics and gynecology in Durango. Reach him at email@example.com. © Richard Grossman MD, 2015