If you are a woman of reproductive age, there is a 64 percent chance that you use some form of contraception. In Europe, this figure is 80 percent, while in the United States, latest statistics reveal that there is approximately a 62 percent chance you are using contraception. While lower, the U.S. fares much better than the least developed countries, such as Chad, Rwanda and Cambodia, which have an average contraception rate of 40 percent.
Benefits of family planning
Family planning is arguably one of the most important public health advancements in the last century, and it is defined as a woman’s ability to decide if and when to have children. Family planning services include counseling, education, access to contraception, and access to safe abortion. The positive effects of family planning are evident in a reduction in the worldwide fertility rate from 3.7 to 2.4 since 1980. Voluntary family planning reduces the number of unintended pregnancies, as well as maternal and newborn deaths. When a woman has the ability to make choices about contraception, her children are much more likely to be healthier, better nourished.
The positive effects of family planning are perhaps nowhere more evident than in the developing world. Today, more than 300 million women in the 69 poorest countries use modern contraception. This figure has increased exponentially in the past few decades due to growing attention from international institutions, such as the United Nations Foundation and the Bill and Melinda Gates Foundation, and national initiatives like Ethiopia’s Health Extension Program. As a result of more women using modern contraception, it is estimated that approximately 82 million unwanted pregnancies, 25 million unsafe abortions, and 125,000 maternal deaths are averted annually.
When women in developing nations have the ability (access and right to contraception) to space out their pregnancies by at least three years, their babies are twice as likely to reach their first birthday. There is also evidence of the anti-poverty effects of family planning. For example, women who space out their pregnancies are more likely to advance their education and earn an income to support their families. Expanding access to family planning also has implications on a national scale. No developing country in the past fifty years has improved its economy without expanding access to contraception. This shows how access to family planning, while important for granting women agency, is also a key factor for national development.
Mini case study: Ethiopia
Ethiopia is a testament to the positive impacts of voluntary family planning and the broader benefits of the service. From 2000 to 2014, Ethiopia moved from a contraception rate of 6.3 percent to 34.2 percent. One of the most significant reasons for this increase was the government-funded Health Extension Program (HEP), which provides women in rural areas with access to family planning services. The government funding comes largely from external donors, notably the Gates Foundation. The HEP invested in 38,000 health extension workers, mostly young women, who were based at 17,000 health posts, to bring family planning services, including contraception and education, to rural areas with unmet needs.
Accompanying the increase in family planning services in Ethiopia has been a decrease in child mortality rates, as well as a decrease in the percentage of people living below the national poverty line. While voluntary family planning is not solely responsible for the gains made in Ethiopia, it has certainly been a large factor. The Ethiopian government recognizes the broader effects that voluntary family planning has had on the country’s development, as Ethiopia’s First Lady, Roman Tesfaye, stated: “…to be engaged in the economic sphere, to create income, to contribute to family health and well-being and to the country’s development, we must have family planning services.”
While major gains have been achieved in voluntary family planning in recent years, additional challenges remain. There are significant barriers for women in developing countries, including lack of access to services, personal opposition or opposition from partners/community leaders (typically on religious grounds), and a lack of knowledge about family planning and its benefits. Currently, there remain over 214 million women in the developing world who want to space out their pregnancies but do not have access to modern contraception as a result of the aforementioned challenges. This figure will likely grow in the coming years due to recent policy changes in the U.S. government that block government funding for groups that offer abortion services or counseling to women in countries that receive U.S. assistance. This is known as the “global gag rule” and was reinstated by U.S. President Trump, ultimately creating a $600 million funding gap. This is a major setback for voluntary family planning; however, an international response from countries including the Netherlands, Norway, and many more, have pledged to fill in the void created by the order.
One woman who has benefitted from family planning services is Zainabu, whose story comes from Marie Stopes International, which provides monthly outreach visits to her village. Zainabu and her husband live in Sierra Leone with their nine children and were previously part of the 80.1 percent of couples in the country who never used modern contraception. In rural Sierra Leone, access to even basic health services is limited. While Zainabu is proud of her large family, she is aware of the dangers: “I want to stop, giving birth can be dangerous” (referring to the one in eight women who die in Sierra Leone during childbirth) “…by stopping having children, we’ll be able to give our attention to the ones we have.”