Three Sweet Dreams and a Nightmare
By Jay Gribble
The other day, I attended a meeting on rights-based family planning and the question arose as to what we would like donors to know and support. We all felt like kids in candy stores at the prospect of influencing donor purse strings. Given the state of play in global family planning, I think there are plenty of things I would ask for. Efforts like FP2020 have helped galvanize efforts around the world, and we are seeing progress on many fronts. But to translate national and global goals into reality, I have three dreams I’d put forward to donors: sustained commitment to high-quality, voluntary family planning, inclusion of family planning into universal health coverage (UHC), and increased country ownership of family planning program efforts.
Efforts that focus on the voluntary nature of family planning have re-emerged as a way to ensure that we don’t focus too much on the number of new users. One hundred and twenty million new users is a tall order, and there’s the risk that programs could lose the focus on meeting individual’s needs and focus on national targets. Rights-based family planning is a broad concept, subsuming quality, access, choice…and much more. One important aspect of it is its attention outside the facility to reach communities with information about what they are entitled to receive as citizens. Rights literacy is important not only in family planning, but in health, education, and any aspect of the social contract between governments and their citizens to allow people to know what they are entitled to under government policies and programs. To me, it is a dream that programs are implemented with high standards, funding available, and that they allow women and couples to achieve their reproductive goals.
Universal health coverage has become a mantra within the public health world. If health is a right, then there should be mechanisms in place to ensure that people are able to access health services. Yet universal health coverage is a complex idea, involving many initiatives within any given country. I think of it as a patchwork quilt that brings together as many pieces as are needed to ensure that people can obtain the health services they need. One of the big challenges we face is that UHC insurance schemes do not automatically include family planning. It requires evidence, advocacy, and champions to fight the fight to ensure that UHC mechanisms also include universal access to family planning. A second dream is that we see real progress on this front—more action and results, and less talk and theoretical discussions.
And without country ownership, I’m afraid nothing will really move forward. The growing attention to sustainability is linked with country ownership—if countries don’t own the problems, they are not likely to put forward the resources and political commitment to resolve them through the right investments. I see increasing country ownership of family planning programs; policies, initiatives, leadership all reflect the fact that countries are stepping up to own their family planning issues in ways they never have before. This dream is becoming a reality; sadly, there is still insufficient financial commitment to family planning, and too many places still view it as a woman’s issue and not linked to economic growth. However, things do seem to be changing—and that’s part of the changing global family planning landscape.
So, three sweet dreams…and you can guess the nightmare. As numbers of women continue to grow and contraceptive prevalence rates increase, donor funding for family planning is weakening. I understand the need to transition financial responsibility for programs to country stakeholders. But at a time when things are going so well, we need sustained resources to keep things moving forward. And we have a good idea of what works—high-impact practices in family planning are documented and serving as the basis in many aspects of programming. National efforts need continued support to push forward on achieving the goals they have set.
Dreams are important to me—they inspire my actions and help me visualize how I fit into the future. So why not dream of a world with rights-based programs in the context of universal health coverage owned and supported by national governments—that would be a dream come true for women and girls, men and boys around the world! Based on what I’m seeing at this conference, we could well be on our way to making these dreams come true.
Jay Gribble, Deputy Director, FP/RH for Health Policy Plus and Senior Fellow at Palladium, has expertise in policy, research, and communication and more than 25 years of experience in international family planning.