The future of family planning

Submitted by Kintu about 10 months ago

'By the middle of the twenty-first century, many of the most successful national family planning programs will almost certainly have disappeared, rendered obsolete by their very success' say the editors of a special edition of Studies in Family Planning, a peer-reviewed journal published by the Population Council.

National family planning programs, which have been instrumental in accelerating global fertility decline, will probably go out of existence in most of the world's regions by 2050, say the editors.

They say the future family planning frontier will be sub-Saharan Africa and the success of future programs here will depend largely upon stronger political leadership, donor-country assistance, and the development of programs that meet the needs of all segments of society, not only currently married women.

“Although family planning programs will tend to disappear, contraception will not,” the authors conclude, noting that with a future global population of perhaps ten billion around 80 percent of those in a potentially reproductive sexual union will be practicing contraception, more than double the present absolute number.

“An open-ended demand will be expressed for better contraceptive methods and, mostly from the private sector, for the best practice in reproductive health care,” they say.

A persisting unmet need for family planning can undermine the achievement of all Millennium Development Goals and compromise global efforts towards human development.

Although more than 500 million couples in the developing world are satisfied family planning users, another 200 million seek to delay or avoid having a birth but are not using contraception. The United Nations estimates that by 2050 this demand will grow by 40 percent as record numbers of young people enter the prime reproductive ages.

In some African countries, the level of unmet need for family planning exceeds the level of contraceptive use.

While an extensive base of research on and experience with family planning programs has accumulated over the past forty years, its recent volume is much lower. The economic impact of reproductive change, such as on poverty or national savings with shifting dependency burdens, needs updating with emerging data.

Likewise, full potential of contraceptive practice in preventing unsafe and unnecessary abortions, maternal and neonatal deaths, or the transmission of HIV to newborns warrants more research.

Two recent trends in HIV-related health services in Sub-Saharan Africa introduce new questions about what this may mean for women’s and men’s fertility preferences and contraceptive behaviour.

The first trend is the expansion in anti-retroviral treatment for people living with HIV, in particular drug treatment for HIV-positive pregnant women - to lower the risk of HIV transmission to newborns - and anti-retroviral therapy for HIV-positive people in general - to improve quality of life.

The second trend is the increasing availability of HIV testing in the region and in particular, the availability of rapid HIV tests combined with increased support for and implementation of opt-out testing in some countries.

The expectation of governments and providers is that if more individuals are aware of their HIV status then the use of contraception, including the condom to prevent partner infection, may become more widespread.

On the other hand, increased availability of ART may boost people’s motivation to have children as the drugs enhance the health and survival of people living with HIV and prevent mother to child transmission of the infection.

Little is currently known about how individuals will react to these HIV-related service trends. There is, therefore, a need for research to tease out these program and policy relevant relationships.

It is my hope and wish that the innovative approaches exhibited in this international forum for scientific and programmatic exchange will enable the sharing of available findings and identification of knowledge gaps, as well as using new knowledge to transform development policy and continue to challenge participants to examine their personal values and how they relate to improving family planning.

I hope stakeholders have been guided through the "Social Analysis and Action” approach that enables communities to identify and explore social conditions that perpetuate health challenges.

I hope this forum has helped participants to explore how health and development programs can be more direct in working through socially-defined constructs such as gender and sexuality and instead focus on building skills through the use of innovative tools and methodologies.

Keywords: family planing HIV/AIDS Contraceptive

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