The Promise of Integrated Family Planning: Stronger Health Systems, Stronger Communities

The Promise of Integrated Family Planning: Stronger Health Systems, Stronger Communities

Cross-posted on the 2011 International Conference on Family Planning.

Zakia, a nurse in Afghanistan, has become a leader in her health center. After participating in an MSH leadership development program, Zakia led a team of nurses in increasing awareness about family planning, resulting in a doubling of the use of contraceptive pills and an eight-fold increase in the number of condoms distributed in two years. “Everyone here no longer thinks of problems as obstacles in our way, but challenges we must face,” Zakia says. MSH supported this achievement through a variety of initiatives in Afghanistan, including improving the availability of pharmaceuticals and training community health workers who bring basic health care services to remote villages. Empowering local people through integrated programming that strengthens the health system as a whole is an increasingly popular and effective model for expanding access to life-saving family planning services. Although contraceptive use around the world has been rising for decades, unmet need is still staggeringly high and the cost to society is devastating.

Investing in Family Planning Makes Sense

Last month, the world population reached seven billion. To mark this event, the United Nations called on world leaders to renew their commitments to meet the challenges of a growing population—ensuring the health of people and the environment. The growing population also highlights the challenge of inequality, both socio-economic and gender-based: Although Africa is not the most populous region of the world, it is on the way to contributing close to half of all population growth over the next few decades because of unmet need for family planning. Today nearly one-third of all women, primarily in rural areas of low- and middle-income countries, lack access to modern family planning methods. These 215 million women want no more children or want to space their children using modern contraception, but cannot. For these women, family planning is unavailable, unaffordable, or prohibited by patriarchal norms.

The cost to society of unmet need for family planning is devastating: Each year, nearly 350,000 deaths occur from complications of childbirth or pregnancy, 99 percent of them in low- and middle-income countries; 70,000 deaths result from complications of more than 20 million unsafe abortions; and 28 million unplanned babies are born. Unmet need for family planning also results in inefficient use of health spending: For every dollar spent on family planning and reproductive health programming, $1.40 is saved by averting unwanted pregnancies, abortions and miscarriages, complications of high-risk pregnancy and delivery, and use of emergency supplies and services. If all current unmet need for family planning was met, $5.1 billion would be saved in essential maternal and newborn care.

The evidence is clear that expanding access to family planning makes sense, yet in recent years the fight against infectious diseases has drawn funding and attention away from family planning. MSH and others in the international community are supporting a global effort to reinvest in family planning and reproductive health through integrating these services with HIV & AIDS and primary health care services at all levels of health systems.

Integrated Family Planning and Health System Strengthening

We now understand that family planning has a dramatic effect on maternal and child health, as well as fighting the spread and devastating effects of HIV—women are more likely to contract and spread HIV if they do not have access to contraceptives. By integrating family planning services with other essential health services, including primary care and HIV & AIDS services, we can maximize the synergies among health initiatives. Some would even argue that helping HIV-positive women avoid unintended pregnancy through modern family planning is a more cost-effective way to preventing new infections than classic approaches to preventing mother-to-child transmission of HIV.

By integrating family planning, we can help organizations maximize their investments in health while also allowing people, information, and funding to flow more easily among collaborating groups. Integration enables providers to treat the health needs of individuals and families more efficiently, regardless of the initial reason a patient seeks care. This strengthens the entire health system. Indeed, strengthening health systems is key to meeting the need for family planning. It will take strong political commitment, country ownership and leadership, multi-sectoral collaboration, and both health and non-health interventions. As outlined by the U.S. Global Health Initiative, critical non-health interventions include advocating for legislation and policies that fight gender-based discrimination, exploitation, and abuse.

To expand access to integrated family planning services, we must work with decision-makers at all levels to create policies that protect women and girls and allocate resources to support family planning and reproductive health programs. We must build the capacity of health care workers to deliver a diverse array of family-centered services and we must build the capacity of governments and organizations to support those workers. We must strengthen commodity security to ensure that providers and clients have access to a reliable supply of contraceptives and family planning and reproductive health commodities. We must promote performance-based financing, strong monitoring and evaluation, and the use of best practices and innovative technologies. We must help governments and service delivery organizations transform redundant and incompatible systems into a shared set of information, resources, and processes. And we must engage communities in supporting and leading these efforts.

In Malawi, MSH supports a network of community health workers trained in family planning and HIV integration. These agents—men, women, and youth—provide clients with a range of contraceptive methods, link them to facilities, and offer them information and education through community events. In two years, 1,000 community health workers reached more than 700,000 people with family planning and HIV messages and helped more than 90,000 people learn their HIV status through door-to-door testing. In 2009 alone, this effort resulted in an increase in couple years of contraceptive protection from 20,000 to 39,000.

Empowering Individuals, Families, and Communities

The community health workers in Malawi, like Zakia and her team of nurses in Afghanistan, have taken ownership of the effort to expand access to family planning. And they have been empowered by their success. The women and men they serve have also been empowered to plan their families and protect their health. This is the promise of integrated family planning and stronger health systems.

Jonathan D. Quick, MD, MPH, is President and Chief Executive Officer of Management Sciences for Health. Dr. Quick has worked in international health since 1978. He is a family physician and public health management specialist.