The Pace of Progress
As of July 2016, at the midpoint of FP2020, the world’s 69 poorest countries had reached a new milestone: for the first time in history, the number of women and girls using a modern method of contraception topped 300 million.
That 300 million is more than just a statistic: it represents an unprecedented number of women and girls who are now able to take charge of their own health and shape their own lives and families.
The health infrastructure and expertise required to provide family planning services to 300 million individuals is immense, and in itself represents a tremendous accomplishment. It is particularly impressive in light of the fact that it was just 13 years ago, in 2003, that the number of contraceptive users in these countries reached 200 million.
The data in this year’s report highlight the progress the family planning community has made since the 2012 London Summit on Family Planning, as measured by FP2020’s 17 Core Indicators. The data also indicate some of the challenges remaining at global, regional, national, and subnational levels.
Family planning use in many countries is on the rise, and there are entire regions where contraceptive prevalence rates are on an upward swing. In regions where contraceptive use is already high, progress comes in the form of expanding service delivery and improving quality of care:
- In Eastern and Southern Africa, the region that has experienced the fastest growth in modern method use and the steepest decline in unmet need, for the first time more than 30% of women are using a modern method.
- In West Africa, where contraceptive use has been persistently low, several countries have strengthened their family planning programs and are beginning to see contraceptive prevalence rise. The nine West African countries of the Ouagadougou Partnership achieved their collective goal of 1 million additional users between 2011 and 2015, and have now established a more ambitious goal of 2.2 million additional users between 2015 and 2020.
- In several Asian countries, where rates of modern contraceptive use are relatively high and the population of women of reproductive age is very large, health systems already provide services to a huge number of individuals. There are more than 230 million users of modern methods in Asian FP2020 countries, and great effort is required just to sustain this level of service—much less reach the more than 90 million married or in-union women in Asia who still have an unmet need. Many of these countries, however, are taking steps to improve the quality of services and increase the range of methods available, while also aiming to expand services.
Collectively, the efforts of FP2020 countries and partners are having a positive impact on the use of contraception. The figure above shows that compared to 2012, there are now 30.2 million additional users of modern methods—which is 25% higher than the historical trend would predict. Yet this progress, while significant, is still 19.2 million users short of the pace needed to reach our goal of 120 million additional users by 2020.
One way to accelerate progress is by sharpening the focus on country-level goals, challenges, and avenues for improvement. At an aggregate level, annual estimates provide the global community with a transparent means of tracking progress toward the overall FP2020 goal. At a country level, however, the 38 countries that have made FP2020 commitments are monitoring progress toward the goals they have set for themselves. These 38 countries are using FP2020 Core Indicator data, tools such as the S-Curve (see page 17), and other national and subnational data to understand their current trends and guide their actions over the coming years.
Kenya, for example, like many countries in Eastern and Southern Africa, is experiencing a period of rapid growth in its modern contraceptive prevalence rate (mCPR). Recent data indicate that Kenya is on track to achieve its FP2020 goal. But progress has been starkly uneven across the country: rates of use in many counties remain extremely low—as low as 5% mCPR among married women in northeastern counties, as compared to 67% in central counties—and the rate of contraceptive use among the poorest is half that of the rest of the population.3 Family planning partners are coming together in technical working groups to look more closely at this data with an eye toward how to serve these hardest-to-reach populations.
Kenya’s recent devolution, which shifted responsibility for health services from the federal government to 47 newly established counties, presents additional challenges—particularly for the procurement of contraceptives. As a coordination point between donors, government ministries, and service delivery and advocacy partners, the FP2020 platform is facilitating efforts to ensure that the government can procure sufficient contraceptives and that counties can provide high-quality family planning services.
Another example is India, the largest FP2020 country, with more than 130 million contraceptive users. India is currently completing analysis of its National Family Health Survey (NFHS-4), and once available, the full set of national and state-level data will provide an important opportunity to assess progress. But the government is already looking closely at its existing program data and aiming to provide a wider range of short-term and long-acting methods, including injectables, through the public sector. India is also expanding its investment in postpartum family planning and taking action to improve the quality of family planning services. In the coming year, the new NFHS-4 data will enable family planning partners in India to gain a better understanding of the progress to date and shape their programs and investments accordingly.
These are just two examples of how a deeper examination of each country’s data can illuminate the existing situation and point to opportunities for action.
We can also accelerate progress by addressing the persistent challenges that span numerous countries. The analysis of Core Indicators in Chapter 03 highlights a number of key issues:
- Despite gains, there is still great unmet need for contraception. Many countries need to expand and improve the quality of services to satisfy current demand while also working to generate greater demand. The Sustainable Development Goals use demand satisfied with modern methods as a key indicator for family planning, and countries that don’t meet their FP2020 goals will face a steep path to achieve the 75% demand satisfied called for by 2030.
- A diverse mix of contraceptive methods makes it more likely that women will be able to find a method that suits their needs and preferences. FP2020 data on method mix and contraceptive availability suggest that women in many countries do not have access to a full range of short-term, long-acting, and permanent methods.
- Stock-outs remain a pervasive problem with a profound impact on women’s ability to use contraception. Too often the contraceptives that are supposed to be available simply aren’t on the shelves. Particularly worrisome are countries that report a high percentage of facilities with stock-outs of the most commonly used methods.
- Counseling is an important aspect of rightsbased family planning, and women need to be informed of the various contraceptive methods available and the potential for side effects. The data suggest that many countries need to improve counseling to enable more women and girls to exercise informed choice.
- Many women begin using contraceptives and then discontinue, putting themselves at risk of an unintended pregnancy. Contraceptive discontinuation rates are particularly high for short-term methods, including pills and injectables. Across countries with available data, almost 1 in 5 women using pills or injectables will discontinue use for method-related reasons.
Halfway through the FP2020 initiative, we have an opportunity to accelerate progress by focusing on the challenges and opportunities that have already emerged. The evidence base is growing for a wide range of issues and interventions, and the Core Indicators provide important data on the family planning landscape in each country. The resulting insights can help us shape more effective programs, investments, and policies to reach women and girls with the services they need.
3. Kenya Demographic Health Survey 2014. Available from: http://dhsprogram.com/publications/publication-FR3...
- When mCPR is very low, countries tend to see slow annual growth in mCPR. The length of this period varies by country, but to position themselves to enter a period of rapid growth, countries should make sure that barriers to family planning services are not preventing growth.
- Countries will enter into a period of more rapid mCPR growth. The rate of growth and length of this period varies and depends on countries monitoring progress and investing wisely in the appropriate interventions that will maintain progress. Countries that are able to grow at very high rates will transition through this period quickly, increasing the potential benefits of a demographic dividend.
- Finally, when contraceptive prevalence reaches higher levels, growth begins to slow down and eventually plateaus. Programs at this stage need to focus on long-term sustainability, continued improvements in service quality, expanding the range of methods available, and striving to reach underserved groups.
