Global Family Planning: What Comes Next?

Global Family Planning: What Comes Next?

A Conversation in Dakar Held in Honor of MSH’s 40th Anniversary

Global Family Planning: What Comes Next?


At a satellite session at the 2011 International Conference on Family Planning on November 30 in Dakar, MSH asked five panelists to discuss successes in family planning, and what still needs to be done. The conversation was moderated by MSH’s Issakha Diallo and held in conjunction with a celebration of MSH’s 40th anniversary.

Dr. Halida Akhter, MSH’s technical lead on global family planning, kicked off the discussion. Akhter reminded the audience that concerns facing the health of women and girls were of paramount importance and that providing choices and empowering women were essential toward saving lives -- an agreement that 179 countries made at the International Conference on Population Development (ICPD) over 15 years ago.

“Now, it is 2011 and we are still talking about the same things and too many women are still dying," said Akhter, who served as Vice Chair of the 1994 conference. "We have not gone to the next level of action. Why have we not saved more lives?”

Women’s empowerment and country ownership are now cornerstones of the US Global Health Initiative (GHI)  and maternal mortality rates have decreased, Akhter noted, but there is still more that needs to be done for women’s sexual and reproductive rights.

“There is no time to waste when a mother still dies in childbirth. Infants have more than ten times the likelihood of dying if their mother dies. The commitments that governments made in 1994 at the ICPD must be kept and should be the basis of discussion for this meeting here in Dakar.”

Dr. Faustin Yao of UNFPA noted that for the first time since the AIDS epidemic began, “the stars are aligned” -- all agencies working on HIV/AIDS, family planning and sexual and reproductive rights are all present at the same meeting.

"It is also the first time we are all speaking the same language of integrated services,” said Yao.

So many of the 7 billion people in the world are young women — the largest cohort in history, he said. “When we talk about ‘unmet need’ for family planning, whose needs are we really talking about?”  asked Yao.

“We know what young women need to know to protect themselves from unwanted pregnancies and from HIV, but we in order to be successful we will need to tackle root causes and social norms.“

Dr. Yao mentioned two levers for change: (1) Involving men in the process will be key. In conservative Niger, they raised their contraceptive prevalence rate when men were actively involved in the solution. (2) In Rwanda, the Minister of Health made each district responsible for every death of a woman in childbirth. When leaders became accountable, change occurred, he said.

Jill Sheffield, executive director of Women Deliver highlighted achievements and areas that need more work. First, she said, evidence shows that we are some doing something right on health and nutrition for women. We should applaud that.

Second, “there is major agreement on solutions to reducing maternal mortality. Improving and strengthening health systems and mobile technologies to support service delivery are just starting -- and only held back by our own imagination," said Sheffield. "But unless investments are made by governments in health, we will not reap the dividends.”

Third, “We don’t talk enough about young people, aged 10-24. They are in the billions. Most are without access to information about sex. How are they going to make life choices?” she asked.

Fourth, “the maternal mortality decline is a triumph—not fast enough-- but family planning was a key factor in making that happen.”

Fifth, “I wish we all had better skills working with the media on issues related to family planning, population, and sexual and reproductive health. We need better stories on the front pages and not buried in the women’s sections or nutrition sections. We just need to do better.”

Lastly, “family planning practitioners were left out of the Millennium Development Goals (MDG) dialogue and we must be part of the new development architecture post-MDGs in 2015,” she said.

Dr. Hedayetallah Mushfiq of MSH in Afghanistan, the US-AID funded Tech-Serve project, spoke about the successful use of condoms and injectables in rural communities in Afghanistan and that it can be done. “Despite many community health workers being illiterate, they have been able to provide contraceptive pills and condoms. Injectables have been available at health facilities.”

Marguerite Farrell of USAID highlighted successes in family planning in Malawi and Zimbabwe, among others. She mentioned the positive experiences with vasectomies and the political will of Ethiopia and Rwanda to champion family planning and the advances in mobile outreach.

“But in order to reach the demographic dividend we have to invest in education and invest in national health systems,” Farrell said. "We also should note the important role of the private sector in family planning—and that many contraceptives are accessed from pharmacies or from private physicians. Social franchising and vouchers have been helpful."

A member of the audience asked the panelists for a good one or two word message for policymakers. Farrell said “access”—access to full mix of contraceptive methods; access to trained providers, and access to commodities. Yao responded: “invest” in family planning and “educate young women." Women shouldn’t be giving birth at 14 years, he said.

40 more years

Following the panel, participants offered toasts in honor of MSH’s 40th anniversary. Daniel Pellegrom, President of Pathfinder International, praised MSH’s founder Ron O’Connor and saluted the 40 years of collaboration.

Victoria Jennings of Georgetown University said:

“I agree with Jill Sheffield when she says MSH has made a difference in the world. MSH was strengthening health systems when others were only thinking about service delivery. MSH has long had a systems perspective. I’ve long been aware of your work in country and your leadership and management focus. We had Dr. Jonathan Quick, MSH’s CEO, at a Georgetown lecture, and it was clear from that lecture that MSH puts a human face on health systems and makes individuals lives better. A toast to MSH and 40 more years.”

Farrell said she had first heard of MSH while she was a student at Harvard School of Public Health and she had heard MSH founder Ron O’Connor speak about the health system in Afghanistan. She also learned about family planning and fertility through other MSH staff and reading MSH’s publications.

Farrell said she learned about implementing capacity while serving as USAID's overseer of the MSH-led Leadership, Management and Sustainability program.

“The Challenge Model that MSH used was an important yet easy to use tool. I was very impressed and am happy that I have got to know MSH and was even happier when they received an Associate Award in Afghanistan taking me full circle back to when I had met Ron. With that project, they had raised the contraceptive prevalence rate in Afghanistan when there was no access at all. I salute MSH and wish you 40 more years.”

Barbara Ayotte is MSH Director of Strategic Communications and is currently attending the 2nd International Family Planning Conference in Dakar.