Bill & Melinda Gates Foundation

It's Time to Keep Our Promises to Women and Girls

November 08, 2013

Today, many of us are aware that around the world 220 million women and girls in developing countries lack access to the contraceptives, information and services they need to prevent unintended pregnancies. Some of us know this because we care profoundly about the needs of those women—indeed, the mission of the organisation I belong to is to serve them.

 We have a very big promise to keep: ensuring that 380 million women are able to use the contraception of their choice, for as long as they want to.Others may be aware because last summer the world’s governments, donors and women’s organisations came together in London to make a promise to 120 million of those women that together we would bring contraceptive choices to them by 2020.

Many of us are reconvening at next week’s International Conference on Family Planning in Addis Ababa, Ethiopia and will surely be asking: how will we keep our promise? And, what will we have to do to deliver full access and full choice to these women? 

The progress so far and challenges ahead

Strategic partnerships secured a 50 percent price reduction on contraceptive implants for the world’s poorest countries, making longer-term methods such as implants more affordable and accessible to women who want them. Funding is being prioritized, with $2.6 billion of new donor money committed already. And countries are championing the cause themselves and driving progress to advance the FP2020 goals. 

These goals are big and achievable, but the challenges ahead are enormous. The most obvious: the majority of women we need to reach are in some of the poorest countries in the world, with huge logistical challenges to accessing the underserved communities in which they live. 

Some less obvious: countries that are taking their place at the world’s economic table and transitioning to a "middle income" status such as India, Indonesia and Vietnam, may not benefit from the efforts of FP2020 if and when donors leave in the coming years.

Maintaining choice and contraceptive access

One of the most surprising and to my mind worrying statistics I have come across recently is that 38 percent of the 220 million women we need to support have actually used contraception before. That means that for whatever reason, having once been able to control their fertility, these women have had their access to contraception blocked. We have failed them.

The promise we’ve made is all inclusive. It isn’t only about reaching 120 million more of the poorest and most vulnerable women, but also about sustaining contraceptive access for the 260 million women who are already using family planning.  

According to our estimations: 2.5 billion pill cycles, 14.5 billion condoms, 90 million IUDs and 6 million implants will be needed and used by the 260 million women who are already using contraception by 2020.

We have therefore a very big promise to keep: ensuring that 380 million women are able to use the contraception of their choice, for as long as they want to.  

How will we do this?  

The goal is very ambitious. Indeed, reaching an additional 120 million women by 2020 would mean contraceptive prevalence rates (CPR) growing faster than recorded in nearly all of the 69 FP2020 countries. This is not to say there are not that many women with an unmet need, but whether it is realistic that we can scale up fast enough to get services to them.

Accelerate funding

I believe we can meet the goal of FP2020 if we accelerate funding and efforts to scale-up proven interventions, and hold ourselves accountable to those women already using contraception, as well as those who are still without access.   

Firstly, we need resources and partnerships that will allow us to reach all of the women who are in need of family planning. Increasing access and maintaining that access still needs a steep change in the level of resources actually being invested in family planning.  

We need to see that the financial resources pledged at FP2020 flow if our ambition is to be realized. We have a good idea of what it will take—indeed, the many pledges made last summer at the London Summit were based on detailed estimates of need. 

The importance of measurement 

Secondly, for FP2020 to succeed, we must improve the way we count the women we reach. Women who are already using contraception need to count—and be counted—so that our attention is not skewed by efforts to reach the additional 120 million women.

 We will not build an accurate picture by only counting services chosen by women who are using contraception for the first time in their lives.Marie Stopes International’s Impact 2 model is helping get that measurement right, build an accurate picture of the need, and ensure services are delivered to all women who want them. We will not build an accurate picture by only counting services chosen by women who are using contraception for the first time in their lives.

Taking this a step further, if structures are built to reward programs for only reaching women who have not used contraception before, many who are in need of contraception and wish to continue using it may be left behind. 

Deliver for women on their terms

Finally, for FP2020 to succeed in spirit as well as fact, we must ensure that the women we reach have full access and full choice. By which I mean we deliver services for women on their terms, reflecting their choices: whether to use contraception or not, whichever method of contraception they like, whenever, wherever and from whichever provider they choose.

We owe it to them to do so.

See a photo gallery on the top 10 reasons why family planning matters here and below

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