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:

Our Bodies, Our Lives

Too often, women having access to contraceptives is considered some sort of luxury item – something that is optional, a matter of a choice, not something that should be made easily and readily available at an affordable, or even subsidized price. But the thing about contraceptives is that they aren’t just a tool for preventing unwanted pregnancies (and in the case of condoms, STDs) – they are a tool for women and girls to take control over their own bodies, and therefore their lives.

As someone who has lived in the United States for the past 6 years, I have followed the sexual and reproductive health debate in the U.S. with interest and also horror. I’ve watched women’s bodies – my body – becoming a political war zone, ripped open and apart by pundits and politicians on both sides, for one main reason: because for as long as there has been history, there have been people (mostly men) who believe they have the right to make decisions about women’s bodies and women’s reproductive and sexual choices over the women themselves.

Obviously, this isn’t an American issue. Women and girls around the world lack access to basic sexual and reproductive health services and contraceptives – services, information and tools that would allow them to make decisions about preventing unwanted pregnancies, protect themselves from HIV and other STDs, and choose when and with whom to start a family. These aren’t small issues – these are huge decisions and choices that can determine a person’s future and course of life in one instance. For millions of women, especially in developing countries, these can be issues of life and death. And yet, the issue of ensuring that all women and girls, everywhere in the world, have access to proper sexual and reproductive health services, sexual education and contraceptives has not been prioritized as central not only to women’s and girls’ health, well-being and empowerment, but for sustainable development, economic growth and progress in general.

Luckily, there is light at the end of the tunnel. This week at the UN Sustainable Development Summit, the world officially adopted the 17 new Sustainable Development Goals (SDGs), a new and bold agenda that, unlike its predecessor the MDGs, is truly global – meaning, the SDGs are an agenda for all the UN member countries, not just developing countries. This is the first improvement, given that many of the issues in the SDGs – including sexual and reproductive health – are not just problems in developing countries, but remain as challenges in large parts of the western world as well.

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The second piece of great news is that under SDG 3: Ensure healthy lives and promote well-being for all at all ages, two of the targets are directly related to women’s health and maternal health, namely:

  • By 2030, reduce the global maternal mortality ratio to less than 70 per 100,000 live births.
  • By 2030, ensure universal access to sexual and reproductive health-care services, including for family planning, information and education, and the integration of reproductive health into national strategies and programmes.

This is a big improvement from the MDGs, where the issue of reproductive health was much more vaguely addressed and sexual health literally missing. While the new Goals are currently simply a new roadmap, and their effectiveness will be assessed by the world’s collective ability to not only meet them, but preferably surpass them, this is a good starting point. Now we are all accountable – every single nation – and there are no more excuses for ignoring women’s and girls’ basic right to sexual and reproductive health services, including access to reliable and affordable contraception. This isn’t just about controlling our bodies, it’s about taking control over our entire lives – and it’s about time that the control will be placed in the hands of the women themselves. Without that, there can be no empowerment, no gender equality, no emancipation for women – and no sustainable development.

26th of September was World Contraception Day, celebrated annually and aimed to ensure that each pregnancy in the world is wanted. Girls’ Globe is currently in New York, and we’ve been asking women and girls what their preferred method of contraception is and why. Find out what they said by checking out our Instagram. Learn more about our partnership with Natural Cycles and their #LifeChangingOptions campaign here. 

Featured image: Lindsay Mgbor / DFID

Availability and Affordability of Contraceptives is Access

“I am 17 years old and a mother of two. I was impregnated by my then ‘boyfriend’ who was my schoolmate and older than me from a wealthy family. He showered me with gifts some of which my single mum who worked as a casual laborer and had 6 children could not provide. When I learned I was pregnant, I didn’t know what to do. The man who was responsible denied being the father and asked me to have an abortion because he was too young to be called a father. I was too scared to tell my Mother and abortion was not an option for me either. I was too stressed and young to think straight.

I met an old man who had a wife but was willing to take me with my baby. I eloped with him and started a life together. After I delivered my baby life changed drastically. It was difficult to take care of my baby and my husband could not provide for us. He claimed he gave me shelter and that I should feed myself and my infant. I started washing people’s clothes with my baby on my back to raise money for my upkeep. I went to my local clinic to be guided on what method of family planning I would use as I was not ready to have another baby but was turned away that I was too young. I went back the second time again to be told that there was no one to attend to me. I did not give up and went back five times with no success.

I got pregnant again! Not because I wanted but because I was denied my rights. I was mad, upset, angry and cursed the day I was born. I did not have gainful employment as a young mother and providing basic needs to my child was a nightmare. I was depressed and it’s during this tough season that I met a social worker who introduced me to a charity organization that was empowering teenage mothers. We were taught life skills including reproductive health and also using contraceptives to limit the number of children. I could finally access contraceptives and started using injections. I am now back to school and continue giving advice to other young women with hopes that they will follow and learn my lesson. Our governments and health institutions need to understand that reproductive health including family planning is our constitutional right and that they need to increase financial allocation towards women and children’s health.”

– Magda – Kenya (I met Magda in one of the slums of Nairobi during a field visit)

World Contraception Day (WCD), celebrated on 26 September, is a worldwide campaign with a vision for a world where every pregnancy is wanted. Launched in 2007, its mission is to improve awareness of contraception to enable young people to make informed decisions on sexual and reproductive health. Observation of this day raises public awareness of the means of contraception. Sex education programs are targeted at young people, including minors. Awareness of contraception and reproductive health will help avoid unplanned pregnancies, abortions and spread of sexually transmitted diseases. Investing in family planning as a component of good reproductive health has benefits that go beyond the obvious prevention of pregnancy and reduction of disease burden, the social and economic benefits for global development goals should not be overlooked.

While contraceptive use has risen to relatively high levels in many areas of Asia, Latin America and the Caribbean, it remains low in much of sub-Saharan Africa. Only about 1 in 4 women of reproductive age in Africa use a modern method of family planning and this proportion is substantially lower in many countries of the region. These numbers, however, do not indicate a lack of interest in family planning among women in the region. Young women in the region lack access to or are not using an effective method of contraception. Reasons for this vary from each country but most are related to lack of supplies, poor quality of services and cultural and political barriers. The most affected group is young women living in poverty, those living with HIV/AIDS and those of post abortion care.  In Uganda, 41% of women who want access to contraception fail to get it. The unmet need in Rwanda is 38% of women; Kenya’s is 25%.

Giving  women in sub Saharan Africa the opportunity to time their pregnancies and space out their children through effective, low-cost contraception is key to turning around these heartbreaking numbers. Not only does access to family planning information and contraception improve the health of mothers and children, it also improves the economies of their households. When a woman has fewer children and more time to work, harvesting crops or growing her business, she brings more resources into the home so her children can be fed and go to school. Young women in sub Saharan Africa especially face multiple barriers to accessing contraceptives including lack of information, social stigma, provider bias, lack of confidentiality and policy restrictions. What they need is information and skills to make informed choices. In some societies young women have limited control over their contraceptive choice. They lack the power to negotiate contraceptive use with their partners and decisions are made for them mostly by their parents, spouses or partners. Teenage mothers particularly face barriers that include societal pressure to have children, fear of spouses and lack to transport to health service providers.

In most cases conversations about contraception tend to be religiously and politically charged. Some people believe that giving women access to contraception is encouraging promiscuity, even though most of the women who use oral contraception are married. Civil society organizations should continue to actively advocate for and invest in increasing access to family planning information and contraceptives as this will result in fewer women and girls dying in pregnancy and childbirth, fewer unintended pregnancies, fewer abortions, and fewer infant deaths.

I am a woman and I have a right to access information and services that will enable me to know when it is time to grow a family and when it is time to wait and also how long I should nurse my baby.

#LifeChangingOptions campaign aims to ensure all women and girls, everywhere in the world, have access to contraception Learn more here! 

Featured image: Lindsay Mgbor/Department for International Development