Contraceptive Funding in Crisis

On this World Contraception Day, some 214 million women and girls in developing regions have an unmet need for modern contraception. These are women and girls who want to avoid a pregnancy but are not using a modern method of contraception. While the reasons for this are multiple, the costs and availability of contraception remain major barriers. 

Access to contraception is a basic human right. Governments affirmed women’s right to have access to safe, effective and affordable methods of contraception of their choice 24 years ago, at the International Conference on Population and Development in Cairo. In 2015, in the landmark Sustainable Development Goals, governments pledged to ensure universal access to family planning by 2030.

Yet, three years on, global funding for contraceptives is in crisis. There is a major gap between needs for funding for contraceptives and the resources provided by both domestic and donor governments. In low- and middle-income countries out-of-pocket payments by individuals account for more than 80% of all spending on contraceptives. Domestic governments only provide around 8% of spending, while donors fund 10%.   

Out-of-pocket spending is an inequitable form of financing health services. Those least able to afford it carry most of the cost burden. The impact on household finances exacerbates inequalities and pushes people further into poverty. The gender implication is huge. Women and girls rely heavily on access to contraceptives and reproductive healthcare, and yet many do not have the financial means.

Demand for contraceptives is expected to increase, which will further widen existing funding gaps. Estimates of the difference between today’s spending on contraceptives and the cost of meeting projected needs in low- and middle-income countries in 2020 show an additional funding gap of US$290m if current trends in use continue. Unless domestic or donor government finance increases substantially, most of this gap will have to be met by relying on user fees.

Domestic governments have the main responsibility for ensuring access to contraception, yet donors continue to play an important role, particularly in the world’s poorest countries. In the 31 lowest income countries, donors currently finance 65% of all contraceptives, while domestic governments fund 7%. Individuals’ out-of-pocket spending accounts for 28%.

Yet, while donor funding remains essential, it has faced a downward trend in recent years. Funding from the United States, the largest family planning donor, has been fairly stable but is now at risk. Funding pledges made by European and other donors in 2017 in support of the She Decides initiative and at the July London Family Planning Summit are promising, but it is too soon to tell whether they will bring a reversal in longer term funding trends

Domestic governments must live up to their responsibility to increase their funding and ensure access to contraception and healthcare. Yet, donors must also continue and step up their support. Millions of women and girls depend on it.

Raffaela Dattler, Financing for Development Advisor, IPPF

Learn more about contraceptives and how they work here.

Universal Access to Midwives is a Human Right

“I think, the need during pregnancy, birth-giving, when you have an unintended pregnancy and the need for you to choose yourself when and if to have a family, is universal. And equal access to evidence-based care is a human right,” says Marie Klingberg-Allvin, who has spent the last fifteen years as a midwife and conducting research on sexual and reproductive health and rights (SRHR) in low-resource settings.

In her keynote speech at the Nordic Midwifery Congress, Marie Klingberg-Allvin mentioned the fact that there are still 300,000 maternal deaths, 2.1 million newborn deaths, and 2.6 million stillbirths that occur every year. These deaths are preventable and if every woman had access to sexual and reproductive health care and services, including contraception and safe and legal abortion, and evidence-based maternal health care through a midwife and emergency obstetric care, most of these deaths could be prevented. Listen to her explain the linkages between midwives and human rights.

 

NJF

Girls’ Globe is at the NJF Congress in Gothenburg, Sweden. Follow the conversations here on girlsglobe.org and through the hashtag #midwives4all on Twitter and Instagram. Learn more through the following links:

Let’s Talk: the Importance of Sexual Education

When I was in the seventh grade we started having classes about sex. Everyone thought this was an awkward thing to talk about and no one really understood why we had to do it. Everyone knew that we were supposed to wait until we felt ready and use a condom, right?

few weeks ago I visited an upper secondary girls’ school in Tanzania and one of the girls came to me with a question. She was 17 years old and asked me what I thought about sex before marriage. Since sex is something that  you shouldn’t have before marriage according to the prevailing norms and and religious views in Tanzania, I felt quite uncomfortable. I didn’t want to step on her toes and say something “wrong”. So I told her that in Sweden, having sex before marriage is quite common and nothing that is considered weird or abnormal. I was a little nervous of how she would react since it is a tricky and very personal question.

This girl continued to tell me that just a few days before I arrived to the school they had a class about sex. My first reaction was that this was a positive thing, since it is an important topic to talk about. She went on to tell me that the whole class had been about not having sex before marriage. The teachers were standing in front telling these young women that it was almost forbidden to have sex before they have found their husband. And when they do have sex, it will be only to bring children for their man. She also told me that she didn’t listen to a single word they said and that she had already had sex.

This is where the problem lies: this seventeen year old girl was very smart and had good grades but she didn’t know anything about having safe sex. No one have ever told her about using protection since they can’t even think about her being sexually active before marriage.

In Tanzania alone, 1.4 million people are living with HIV and in Africa as a continent as much as 26 million people are suffering from this disease. This is a huge and terrifying number and it is definitely time to react. In Sub-Saharan Africa women represent 58% of all people living with HIV or AIDS and for women in their reproductive years this is the most common reason of death. Looking at teenage girls, pregnancy is the most common reason why they die, either because of illegal abortions or from complications during childbirth.

The failure to provide young people proper sex education and information about and access to contraceptives in countries like Tanzania is resulting in devastating consequences. I believe it’s safe to say that every single person in the world agree that we need to eradicate HIV and AIDS and also lower the number of teenage girls dying from pregnancy, and of course decrease the number of unwanted and unplanned pregnancies in the first place. Proper sex education is crucial for us to achieve this goal, and a necessary part of securing young women’s future life and living as well. We can’t close our eyes from the fact that some young women – probably more than we think – will have sex before they get married even if the norms and religious views of the country tell them otherwise.

After my talk with this young girl I realized that my teachers talking to me and my classmates about sex when we were in seventh grade wasn’t a bad thing at all. But I also realized that I have grown up in a society where the norm is to use protection when having sex if the goal isn’t to conceive. I have been raised with information about safe sex, contraceptives and the risks of unprotected sex.

So maybe I sat there in seventh grade giggling when my teacher showed us a condom, but at that time I didn’t knew how grateful I should be about knowing those things. I didn’t realize that there were other girls around the world not knowing that condoms even existed – or, if they did, not having access to them. We need to realize that sex is a part of young people’s lives, and while some girls and boys will choose to wait until they are married, many more won’t  – and we need to teach them how to prevent diseases and unplanned pregnancies.

Additionally, even when women do get married, they should still have the necessary information and tools to postpone pregnancy until they themselves decide, with their partners, that they are ready to have a child.

Teaching youth about sex isn’t the same as encouraging them to have sex – and the consequences of failing to provide girls and boys access to sexual education and contraceptives are much too severe and negative for us to accept any longer.

Zika Virus: The hypocrisy of telling women to delay pregnancy

Featured image: Marcos Freitas/Flickr, Creative Commons

If you’ve been paying attention to the news, you’ve probably seen headlines about the Zika virus outbreak which began in Brazil and is now spreading to other countries in Latin America. The virus is spread through mosquito bites, and common symptoms of the disease include rash and joint pain. The disease is usually mild, and rarely requires hospital treatment.

That is, unless you’re a pregnant woman. After the outbreak in Brazil, authorities have reported numerous cases where the virus has caused severe malformalities in babies whose mothers were infected while pregnant, including microcephaly, which is a condition where the baby is born with an abnormally small head and severe brain damage. As a result several countries in the region, including Brazil, El Salvador, Jamaica, Colombia and Honduras, have urged women not to get pregnant and advised foreign pregnant women against traveling to the region until further notice. El Salvador’s Deputy Health Minister has taken the most extreme stance so far – urging women in El Salvador to postpone pregnancy until 2018.

Advising pregnant women to not travel to these countries while the outbreak is happening makes perfect sense. This is something that individuals can control – we can choose to change, postpone or cancel our travel plans to countries where the Zika virus is present, to protect our own health and that of our unborn children. But, advising women living in these countries to delay pregnancy is a whole other matter – because for most of them, decisions related to family planning and their reproductive health are not in their control. That is why such advice and recommendations are likely to have little if any real impact, unless they are also accompanied by changes in the availability and affordability of sexual and reproductive health services and contraceptives – as well as a drastic change in attitudes towards contraception use and family planning. The discussion can also not happen in a void, but must be grounded in a broader debate about the complexities and challenges related to subpar availability of family planning services and contraceptives to both women and men in Latin America.

Not only do women in Latin America lack access to sexual and reproductive health and family planning services and often have no access to contraceptives, many of them also lack the necessary knowledge to be able to control if and when they get pregnant. Latin America and Caribbean has an estimated 1. 2 million unintended pregnancies just among adolescents every year. Nearly half of sexually active young women in the region have an unmet need for contraception – making it near impossible for them to control their reproductive choices and reliably avoid an unwanted pregnancy. As the region is predominately Roman Catholic, the church’s condemnation of contraceptives seems to be quite a contradiction to the recommendation for women to delay pregnancy. So far, the statements made by government officials have also categorically ignored the role and responsibility of men in all of this – after all, it usually takes two people for a woman to get pregnant. As long as women cannot conceive a baby alone, they should not be expected to bear the responsibility of avoiding unwanted pregnancies alone either. What’s making the situation even worse is the fact that in most of these countries, abortion is either fully illegal or very hard to obtain – leading women’s rights groups to call for changes to existing abortion laws and bans, particularly in the extreme case of El Salvador where abortion is banned even in a case of fetal deformation.

Releasing reliable and factual information about the Zika virus is absolutely crucial for pregnant women to be able to take necessary precautions to minimize their risk of getting infected, but providing that information is only a tiny part of the efforts that need to be undertaken to protect women and their babies from the disease. Without the tools – sexual education, family planning services and contraceptives – telling women to “delay pregnancy”, is, in all honesty, total hypocrisy. It’s like telling a person standing in the rain to “not get wet”, and not give them an umbrella – despite the fact that you’re holding the umbrella in your hand. We know what women need to control their reproductive choices. We know what women need to decide if, when and with whom to get pregnant. But as long as these things are not made available unplanned and unwanted pregnancies will continue to happen, which should not only be considered a problem because of the Zika virus but in general. Having control over our bodies is not a matter of necessity because of the outbreak – it’s a basic human right that all women should have access to, at all times. The Zika virus is merely reminding us of the multiple devastating things that can happen when women are stripped of their basic right to control their bodies and reproductive choices.

Further reading: