Elsevier

Contraception

Volume 90, Issue 6, Supplement, December 2014, Pages S14-S21
Contraception

Review article
Family planning since ICPD — how far have we progressed?

https://doi.org/10.1016/j.contraception.2014.06.025Get rights and content

Abstract

The 1994 International Conference on Population and Development (ICPD) was a pivotal global event. It established voluntary family planning as a fundamental human right. We describe the progress made and challenges faced by the family planning field in the 20 years since ICPD. We present case studies from three African countries to highlight factors affecting the evolution of family planning during the past 2 decades. Measurable progress has been made in the key family planning indicators over this interval. However, improvement has slowed in recent years, and demographic forecasts predict a greater unmet need for effective contraception in the future. With a rights-based lens, we need to better understand the nuances of fertility intentions as we offer women and couples contraceptive choices pertinent to their stage of life. With a public-health lens, we need better metrics to reflect the realities of contraceptive effectiveness. Now is the time to build on two decades of family planning progress after ICPD.

Introduction

The 1994 International Conference on Population and Development (ICPD) was a pivotal global event. It shifted the world from one concerned with population growth to one committed to reproductive rights and justice. It placed female empowerment at the center stage of our development goals for the new millennium. It created a platform to help women and men have greater access to both modern contraceptive methods and also affordable, convenient family planning (FP) services [1].

ICPD also established voluntary FP as a fundamental human right [2]. This underlying premise enables women and couples to determine the timing and spacing of their pregnancies. With this control over their own fertility desires, women can help improve both their health and career aspirations. During the past two decades, evidence has demonstrated the contributions FP can make to global health and development, including achievement of the Millennium Development Goals (MDGs) [3], [4].

Our article describes the progress made and challenges faced in the 20 years since ICPD. We present case studies from 3 African counties to highlight factors affecting the evolution of the FP field.

Section snippets

Improved indicators of FP success

Over the past 20 years, two main metrics have been used to measure FP success — contraceptive prevalence and unmet need. Both have demonstrated improving trends. Worldwide, overall contraceptive prevalence increased between 1990 and 2012 [5], [6]. In parallel, the unmet need for FP decreased globally. These trends were largely driven by changes in developing countries (Fig. 1). Temporally, much of the increase in contraceptive prevalence, both worldwide and in developing countries, occurred in

Maintaining political will and global funding for FP

Many factors continue to challenge the progress made in FP since ICPD [20]. These include sustaining the political commitment and community engagement to support the long-term value of FP at the individual and national levels. Political will for FP programs can be fragile. Not only is FP a politically polarizing issue, but some leaders establish their base on pronatalist positions. Continued emphasis on and evidence for the benefits of FP and reproductive choice on economic development will be

Case studies — Ethiopia, Rwanda, Malawi

Three countries in Africa have achieved more effective FP programs than others: Ethiopia, Malawi, and Rwanda. According to DHS reports, use of modern methods among married women of reproductive age increased 2.3% in Ethiopia (2005–2011), 2.4% in Malawi (2004–2010) and a dramatic 6.9% in Rwanda (2005–2010). All three countries have made important progress in improving contraceptive method mix — the usual methods offered in most African FP programs: condoms, pills and injectables — by making

Conclusion

Since ICPD, measurable progress in access to FP services has occurred worldwide. However, the CPR improvement has slowed in recent years, and demographic forecasts predict an even greater unmet need for effective contraception. Given the centrality of FP to achieving both the MDGs by 2015 and the global development goals thereafter, the FP 2020 initiative is a crucial strategy. With a rights-based lens, we need to better understand the nuances of fertility intentions as we offer women and

References (31)

  • J. Ross et al.

    Use of modern contraception increases when more methods become available: analysis of evidence from 1982-2009

    Global health: science and practice 2013

    (2013)
  • M.M. Ali et al.

    Causes and consequences of contraceptive discontinuation: evidence from 60 demographic and health surveys

    (2012)
  • Global Health Workforce Alliance

    World Health Organization

    A universal truth: no health without a workforce

    (2013)
  • S. Malacher et al.

    Provision of DMPA by community health workers: what the evidence shows

    Contraception

    (2011)
  • World Health Organization

    WHO recommendations: optimizing health worker roles to improve access to key maternal and newborn health interventions through task shifting

    (2012)
  • Prepared for ICPD @20 Supplement in Contraception.

    Presented at the ICPD @20 Conference, Mexico City, October 2, 2013.

    May 2014.

    View full text