By focusing on health and mother and child survival, and sidestepping some of the more contentious issues, the 11 July London Summit on Family Planning led to financial pledges of an extra US$4.6 billion for family planning services in developing countries over the next eight years.
The money raised - nearly half of it from developing countries - will be enough, according the meeting’s organizers, to give 120 million more women access to effective contraception, which will mean, they say, 200,000 fewer women dying in pregnancy and childbirth, over 50 million fewer abortions, and nearly three million fewer babies dying in the first year of life.
The mother and child survival agenda received scientific backing from work just published in the medical journal, the Lancet, which attempted to quantify the benefits of effective family planning. It looked at the much higher maternal death rates among teenage girls, women over 40 and mothers who had already had a large number of children, and children very close together. The authors estimate that allowing them to delay, space or limit their childbearing, together with removing the need for unsafe abortions, could reduce maternal mortality by 30 percent.
On the whole, the London meeting stayed on message, although other agendas did creep in, with some of the Scandinavian participants in particular stressing the need to see family planning as a women’s rights issue. But it distanced itself from abortion, and association with state-imposed methods of population control.
Meanwhile, minds are turning to the 2015 end date for the Millennium Development Goals, and the negotiation of new goals thereafter. There was no reference to contraception in the original MDGs, or anything which could imply it, although a sub-clause on access to reproductive health was added in 2007. UN Population Fund Director Babatunde Osotimehin told IRIN he wants the next goal to be stronger and more explicit.
“It’s about empowering young people, it’s about educating them, it’s about comprehensive sexuality education, it’s about making service available and protecting the rights of people to make those choices. I would like it to say that reproductive health and rights are basic human rights.”
Evangelical churches “outspoken”
Faustina Finn-Nyame, country director in Ghana for Marie Stopes International, says family planning is still very controversial there, but Roman Catholics are not the problem. “They have basically not made any comments about this in Ghana. It’s the new evangelical churches that are far more outspoken about this sort of thing. I think all the formal churches understand the rationale behind this; they don’t want to be preaching necessarily in their congregations, ‘Go and get family planning’, but they are not speaking against it either.”
The real resistance is rooted deep in society, says Finn-Nyame. “Ghana is a very conservative community, and culturally people think you should have as many children as possible. Birth is good. Even if you can’t afford it, God will provide. So by using contraceptives you are showing a lack of faith in God, and also tampering with something which shouldn’t be tampered with.” Women do very much want to limit and space their families, she says, but it is hard for them to admit it openly.
It is a similar story from Sierra Leone, where Health Minister Zeinab Bangura says they have had to win over chiefs and traditional leaders who believe that only promiscuous women use contraception. She told the meeting: “We are using community leaders, we are using traditional birth attendants, whose voices the women listen to. People have to know the messenger, they have to trust the messenger, they have to believe the messenger, before they can believe the message.”
Joseph Katema, Zambia’s minister responsible for mother and child health, spoke to IRIN of the days when he worked as a doctor in rural areas. “There are a lot of myths,” he says, “surrounding family planning; for instance, that when you access modern family planning methods, and then you want to revert to your normal level of fertility, you cannot do that.
“There was a community… they had a health centre there but to give contraceptives was a problem, because the chief just said, ‘these contraceptives are making our women promiscuous’, and they banned my nurses and midwives from giving contraceptives. But I engaged the chief in that area, and convinced him of the benefits of family planning. And he was the gatekeeper. He called a meeting and spoke to his people and within a day women started coming.”
Now the pledges of the London meeting need to be translated into action. Britain’s development minister, Andrew Mitchell, said at the close of the meeting that he would be tracking commitments. “We will be setting up specifically a grouping,” he said, “which will monitor what is happening in the transparent way that the British government has championed, to make absolutely clear whether and how people are standing by the commitments they have made.”
Meanwhile, activists working on reproductive health issues have called for bottom-up tracking as well. Racheal Boma, of the White Ribbon Alliance which campaigns for safer motherhood says: “Governments must be held accountable to these Family Planning commitments. It is important that parliamentarians and civil society in countries are made aware of what their government has promised, so they ensure these big promises are fulfilled.”