Meeting demand for family planning within a generation: the post-2015 agenda

Abstract

Expanding access to family planning has been a key aim of health and development programming for more than 40 years. During that time, significant gains have been made in reducing unmet need for family planning, increasing contraceptive prevalence, and preventing unintended pregnancies. Over the last two decades, however, the pace of these gains has slowed, especially in several countries in sub-Saharan Africa and South Asia. Not only does family planning enable individuals and couples to achieve their childbearing (family building?) goals, an ever growing body of research shows the wider beneficial impact of family planning on improving maternal and child health and survival, increasing economic well-being of individuals, families and communities, and empowering women. i , ii Today, the international community and many developing countries are aiming to accelerate progress, as made evident by the collective embrace of FP2020. Simultaneously, the world is reflecting on achievements reached and on gaps remaining in the years since the United Nations Conference on Environment and Development (Rio) of 1992, the International Conference on Population and Development (ICPD) of 1994, and the Millennium Summit of 2000, which established the Millennium Development Goals (MDGs). A post-2015 agenda is quickly coming into focus, aiming to merge the streams of Rio+20 sustainable development goals, ICPD Beyond 2014, and the post-MDG development agenda. Consensus is mounting on the vision and benchmarks for ending preventable child deaths, eliminating preventable maternal deaths, and creating an AIDS-free generation. Now is the time to put i By preventing unintended pregnancies, FP has reduced maternal mortality by 44 percent and could reduce it by another 29 percent if all women with unmet need for family planning became contraceptive users. Maternal deaths averted by contraceptive use: an analysis of 172 countries http://www.thelancet.com/journals/lancet/article/ PIIS0140-6736(12)60478-4/abstract ii By preventing closely spaced births, FP could save the lives of more than 2 million children every year.

Examining trends in family planning among harder-to-reach women in Senegal 1992–2014

“…While MCPR and unmet need for FP are routinely reported, the relevance of the percent demand satisfied for monitoring policies and programmes has recently been highlighted21, and it has been argued that since the denominator captures only women in need of FP, percent demand satisfied should be referred to as “family planning coverage”51. In contrast to the often-used wealth quintiles, we examined trends among four groups who are more easily identifiable to decision-makers, and thus can be used to recognise gaps in coverage and target strategies.…”

“…However, attention is rarely given to trends over time among harder-to-reach groups such as young or single women, with a few exceptions1820. Furthermore, reporting MCPRs is of limited value when comparing different groups of women considering the need for FP is likely to vary between them, and the percent demand satisfied has been proposed as a more useful indicator21.…”

The demographic impact and development benefits of meeting demand for family planning with modern contraceptive methods

“…Rather than specify a pre-set target of contraceptive use or an ideal family size, this indicator measures success by satisfying individual’s and couple’s own expressed desires for family planning through voluntarism and informed choice [8]. To our knowledge, this is the first study to quantify the demographic impact of achieving the family planning benchmark established by the new SDGs – to meet 75% of demand for family planning with modern contraceptive methods by 2030.…”

“…Total demand refers to the percent of women who wants to delay, space, or limit pregnancy in the next 2 years. The sum of MCPR, TCPR, and unmet need identifies potential demand for family planning [8,10]. …”

“…In light of all this, efforts to realize the family planning component of the SDGs can have any number of positive benefits. To monitor progress in family planning, a new indicator – percent of demand for family planning satisfied with modern contraception, hereinafter referred to as ‘met demand’ – as well as an associated benchmark (that this indicator reach at least 75% by 2030) have been adopted under the SDGs [8–10]. This indicator is appealing compared to other indicators (such as proportion using contraception) because, instead of trying to create demand for contraception, success is measured in satisfying the demand that is already projected to exist.…”