As the third eldest of nine kids, I can hardly recall my mother not being pregnant during the 1960s and ’70s, when I was growing up in Ohio. Many people assume that’s why I’m so fierce about family planning.
They’re right — but most are mistaken about the reason why.
My parents wanted a big family. Together they decided how many kids to have, and when to have them. Their approach to family planning made a positive impression on me, and certainly had something to do with my passion for reproductive health and rights.
When I left home in 1979 to work in Mali as a Peace Corps volunteer, I was shocked to learn that many pregnant women in the world don’t get to choose how many babies they have, or how closely spaced they are. I met girls living in the Dogon cliff villages who married at age 14 and who would get pregnant a dozen times before the age of 30. More than half of their children died, and many of the mothers did, too. Unlike my mom, they didn’t have the information and supplies to time and space the pregnancies that put their lives at risk.
I wondered why women and girls in Mali’s Sahel region lacked access to lifesaving contraceptives; surely their lives were no less important than those of women in the United States, Canada, and Europe. Even today, only 8 percent of women in Mali use modern contraceptives. Maternal mortality there is deplorable, at 540 per 100,000 live births (it’s just 4 deaths per 100,000 births in Sweden) and complications of pregnancy are the leading killer of women between the ages of 15 and 49.
In 2012, I worked at the Gates Foundation, which partnered with the UK’s Department for International Development, the US Agency for International Development, and the United Nations Population Fund to design and launch the London Summit on Family Planning. There, leaders from around the world committed to expanding access to modern contraceptives for poor and vulnerable populations. This global partnership, called Family Planning 2020 (FP2020), pledged to reach 120 million more women and girls with contraceptive information, services, and supplies by 2020.
With FP2020 more than halfway completed, I still have burning questions, just like I had three decades ago: Why do 225 million women and girls — particularly the poor and vulnerable — still lack access to modern methods of contraception?
With just three years to go, 40 of the 69 countries that pledged to make a difference at the London summit have formally committed to FP2020. Through their efforts, 30.2 million more women and youths are using modern contraception today than in 2012; 82 million unintended pregnancies have been prevented; and 124,000 maternal deaths were averted. In addition, the global community is now tracking, measuring, and publishing data on contraception that, for the first time in history, represents all women, not just those who are married.
Despite this progress, FP2020 is not on track to achieve its goal. Should we change the goal? Walk away? I say neither — we have promises to keep.
What’s needed is to double down on our efforts to bring together governments, donors, media, teachers, nurses, students, and unlike minds to review the data, bottlenecks, and barriers to identify better ways to change the trajectory and bring information about contraception to more women and girls. We need to galvanize critical funding to support the rights of women and girls to decide freely and for themselves whether, when, and how many children they want to have. Access to family planning is one of the most cost-effective investments a country can make in its future.
Global evidence and country data point to the critical importance of reaching women while they are pregnant and soon after they deliver their babies. That’s what my organization, Jhpiego, does. We give pregnant women high-quality counseling and offer them a range of contraceptive options at the time of delivery to make sure they have immediate access to the contraceptive method of their choice to space future births and prevent unintended pregnancies, without discrimination or coercion.
Women living in rural and urban slums often lack access to primary health care services after giving birth. So do most of the 16 million adolescents who give birth each year in low-resource settings. The majority don’t receive information on birth spacing; many soon get pregnant again, putting their own lives and the lives of their newborns at risk.
In most countries, counseling about birth spacing and family planning has never been an integral component of the prenatal care and maternal and newborn health services. But it needs to become an urgent priority. If doctors, nurses, midwives, community health workers, counselors, and others could prioritize the dissemination of birth spacing information, we could reach more than 100 million pregnant women every year with a selection of contraceptive methods, allowing them to plan their futures. Mother’s clubs, faith-based groups, and professional organizations can also play vital roles in getting out the message about birth spacing.
The simple act of better birth spacing and meeting the unmet need for contraception can reduce maternal mortality by 30 percent and child mortality by 20 percent.
We also need to ensure that providers are competent and confident to provide the safe, effective, long-acting methods of contraception that women prefer, namely implants and IUDs. Supplies must be on hand so women can begin using these methods as soon after delivery as they choose. And we need new approaches for tracking and monitoring women so they and their newborns get comprehensive care, including immunizations and counseling on breastfeeding, nutrition, and family planning.
FP2020’s ambitious goals require us to be even more innovative, committed, and persistent as we urgently focus on meeting the unmet need.
The prize, of course, is that all women everywhere would be able to plan their lives and families — just like my mother and I did.
Monica Kerrigan is vice president of innovations at Jhpiego, an international, nonprofit health organization affiliated with Johns Hopkins University. She previously worked at the Bill & Melinda Gates Foundation, the US Agency for International Development, and UNICEF.
