FAMILY planning programmes started in developing countries in the 1960s. Originally the rationale for promoting family planning was to reduce rapid population growth in order to match the resources with the population numbers.
Many countries adopted policies and programmes supporting contraception. International funding for these programmes increased from $168m in 1971 to $512m in 1985. As a result, the proportion of married women using a contraceptive method rose from less than 10% to about 60% between 1960 and 2000 and the average number of births per woman dropped from six to about three. But these figures varied significantly among the regions, with Sub-Saharan Africa with lowest contraceptive use (22%) and highest fertility rate (5.5) in the world.
Throughout this period, family planning for population control was the centrepiece of various controversial discourses among academia, politicians, religious leaders, programme managers and development practitioners.
Some institutions clearly took a position against contraception as a principle. Coercive programmes in some countries to reduce the numbers and prevent population growth added more fuel to these discussions.
In 1994, the fifth International Conference of Population and Development (ICPD) in Cairo, Egypt replaced the dominant demographic-economic rationale for family planning programmes with a broader agenda of women’s empowerment and sexual and reproductive health and rights.
The ICPD agenda was ambitious and aimed at empowering women, through moving attention from numbers of people, population growth and coercive programmes to a more comprehensive language of reproductive health.
However, the new language did not succeed in improving funding and performance of family planning programmes. Funding for these programmes dropped from $560m in 1995 to $460m in 2003 and use of contraceptive methods rose with a slower pace or stalled. Some other issues, such as HIV/AIDS, were seen as the new problems, leaving high fertility as yesterday’s problem.
Therefore, the broader spectrum of benefits from family planning programmes have not prompted more support and surprisingly not only failed to convince the opposition, but also missed part of its financial support.
Although some of the benefits of family planning such as poverty reduction, gender equality and human rights are still being challenged by some schools of thought, it is astonishing that even its health benefits are not being appreciated properly.
All stakeholders should be accurately informed about the health benefits of the programme: family planning can globally prevent 90% of abortion-related deaths and 32% of pregnancy-related deaths; so it can simply and cost-effectively save the lives of mothers and children. If no other reason can convince the policy makers, saving the lives of mothers, wives and sisters alone is the best argument for family planning. In other words, life or death of a pregnant woman is simply a political decision.
To illustrate the importance of these political decisions, Iran and Sri Lanka are the best examples. After Islamic revolution in Iran, all family planning programmes were suspended for about a decade, but when the religious leaders (who are also the main policy-makers in the country) recognised the health benefits of family planning and its role in saving the lives of women, they issued fatwa in 1989 and authorised the use of all contraceptive methods.
Today after 18 years, 74% of Iranian women use a contraceptive method (similar to some Nordic countries) and the maternal mortality ratio is 76 per 100,000 live births.
If one challenges this example by quoting oil resources and economic strength of Iran, then Sri Lanka could be another good example, where the country succeeded significantly to increase contraceptive use (70%) and reduce maternal mortality ratio (99) with limited financial resources.
In Uganda, four out of 10 pregnancies are unintended; 1.6 out of 10 pregnancies end up with abortion and 16 pregnant mothers die everyday because of pregnancy-related causes.
The latest figure for maternal mortality ratio is 435 deaths per 100,000 live births and only 23.7% of women use contraceptive methods.
Fertility rate in Uganda is 6.7 children per woman, which is even higher than the average fertility in Sub-Saharan Africa (5.5). These figures clearly indicate the urgency of addressing the needs for family planning programmes. This requires extensive community mobilisation, political support, increased funding for family planning programmes, massive expansion of services and increased availability and accessibility of various contraceptive methods. Emphasis could be particularly on rural communities, unmarried youth and women receiving post-abortion care.
In 1916, Margaret Sanger was arrested for opening a family planning clinic in New York. One century later, we should try to ensure family planning is still considered as a current national priority in most of developing countries.
The writer is the Deputy Representative, UNFPA-Uganda
