Albert Einstein is quoted as saying that if he had one hour to save the world, he would spend fifty-five minutes defining the problem and only five minutes finding the solution.
For me, this quote highlights the importance of exercising an appropriate level of rigor in understanding any situation before making decisions of how to move forward. That is what we have tried to do in preparation for the London Summit on Family Planning on July 11—we needed to start with a thorough understanding of why so many women around the world have the desire to plan their families with modern contraceptives but do not do so.
Our analysis identified a number of barriers to contraceptive use that should not be surprising to anyone who has worked, lived or traveled in low-income settings. But the binding themes of these existing barriers in my view are collaboration and information.
I could give you a list of the bullet points of barriers, but I prefer to give you a realistic look at what these barriers mean in low-income settings.
If no one is talking about family planning, then no effort is made to provide accessibility to modern contraceptives.
Poor collaboration in recent years means that donors have not been aligned and, as such, there has been inadequate, inconsistent and unpredictable funding for family planning programs globally. This also stems from inadequate political commitment, both globally and at the country level.
If Ministers of Health are not talking about the importance of family planning, neither are the provincial health leaders, or the doctors, or nurses, or the community. And if no one is talking about it, then no effort is made to provide accessibility to modern contraceptives.
Insufficient collaboration among donors, procurement agencies, countries and manufacturers means that the oral contraceptive that a woman in the Tete province in Mozambique usually uses is not available from her local community health activist during her next visit or even from the closest health clinic, which may be 20 miles away. However, it most likely is available in storage at the warehouse in the country capital of Maputo. But that is not helpful to the woman in Tete.
That imperfect collaboration also means there are a limited supply of quality products and a lack of access at the local level to a variety of methods a woman can choose from. The best possible option for each woman may not yet even exist; much less reach the most distant areas. And with the recent insufficient investment in new methods, it will be difficult to offer a variety of contraceptive needs for all women.
The other recurring theme of existing barriers is the lack of information at all levels – global, national, and community level – about the health benefits of planning and spacing children and the available methods to do that. This perpetuates misconceptions and cultural barriers that prevent women from planning their families.
The current lack of information sharing does not allow for best practices to diffuse to other programs and areas in order to improve services. That means a successful approach in Uttar Pradesh, India using community activists to actively promote and distribute modern contraceptives could be replicated to other states in India or beyond its borders to other countries, but it doesn’t have the commitment or funds to support it at this point.
Ironically enough, the themes of the barriers can also be the solution. Improved collaboration among partners can lead to increased policy and funding commitments, investments in research and development for new contraceptives that meet needs not currently met, and improved procurement and product delivery. Improved information and information sharing means a woman understands her choices and has options available to her, and the entire global community has the information we all need to hold each other to account for our roles in giving women, girls and men everywhere the opportunity to plan their families.
Identifying and even creating the current barriers to use took much longer than the proverbial fifty-five minutes. And our goal to have an additional 120 million women who say they want contraceptives to gain access to those modern contraceptives, over the next eight years, is nowhere near five minutes! But understanding the problem and barriers to planning a family is the first step in establishing an ambitious yet achievable goal and mobilizing the global community behind it.