Getting it right on family planning

More than 250 million women worldwide would like to be using modern contraceptives but are not. This figure is particularly egregious if we consider the leaps in scientific innovation and increase in supplies of safe and effective contraception the world has seen in recent years. 

Too often, policymakers treat family planning as optional or secondary to other public health work. In fact, the proportion of women whose need for family planning has been satisfied by modern methods increased by only 2% in 10 years.

Today, half of all pregnancies are unintended, in part due to stigma, low levels of trust, and a lack of information. And many groups, including youth, unmarried people, and LGBTQI+ individuals, too often find they cannot legally obtain contraceptive methods at all. 

At the United Nations Population Fund, or UNFPA, we see the impact first-hand. Contraceptives prevent unintended pregnancies, reduce the number of unsafe abortions, and lower the incidence of death and disability related to complications of pregnancy and childbirth. 

Contraceptive use also brings about numerous benefits at individual, family, and societal levels. Every additional dollar invested in family planning and ending preventable maternal deaths would yield US$8.40 in benefits by 2050, according to UNFPA estimates. 

Beyond supporting economic growth, family planning also drives health and gender equality. UNFPA works with countries to universalize access to quality family planning care because, time and again, we have seen that personal choice and access are fundamental to ensuring people can realize their reproductive goals. 

Yet still many countries fail to put individual rights at the center of policymaking. As UNFPA’s 2023 State of World Population report showed, anxiety about demographic change is increasingly spurring countries to pursue population policies that set fertility targets, even though history shows that these policies do not achieve desired objectives and undermine women’s rights and choices.   

For example, policies may push the use of contraceptives because they view women as having “too many” children, or discourage it for women perceived as having “too few.” In some cases, family planning programs have been driven by notions of national or ethnic superiority, which, in the most extreme cases, has resulted in coercive measures such as forced sterilization.

Fortunately, we know how to meet people’s needs for family planning. First, it has to be defined and financed as an essential health service available to everyone. 

Second, we must move beyond our conventional understanding of family planning. Effective family planning is more than handing out contraceptives and providing counseling. It starts by understanding what women want. We need to seek a nuanced understanding of how many children people want to have, when they want to have them, and what services they need to support them. It requires factoring in issues such as infertility, which is on the rise around the world. 

Third, family planning has to be inclusive and tailored to the needs of diverse groups; with information and services provided through channels that are most likely to reach them. Adolescents remain overlooked in many family planning policies, and adolescent birth rates are often high as a result. 

Finally, we must move away from policies that promote fertility targets. There is no such thing as an “ideal” population number. Policies that set fertility targets undermine people’s rights and choices. We need to start talking about family planning as a cornerstone of empowerment that drives overall human progress. At UNFPA, we have seen how the impact of policies aimed at protecting reproductive rights and health can go further, supporting economic empowerment and reducing gender-based violence. 

At its core, family planning is about individuals realizing their rights. It touches on some of our most important choices. As health care practitioners and policymakers, it is our duty to ensure that people can exercise their right to choose how many children to have and when to have them. Doing this will transform health care and advance equality, dignity, freedom, and human possibility — this is the best investment we can make for ourselves and future generations.

 

This opinion piece was first published on Devex, as part of the 8 Billion Strong partnership.