Finding the nexus between Family Planning and Universal Health Coverage

By Adebiyi Adesina, Director of Health Financing and Systems Strengthening, PAI and Cate Nyambura, Partnerships Consultant, FP2030

The International Conference on Family Planning – the premiere venue for family planning advocates, researchers, and policy makers to come together – just concluded, and experts discussed the latest trends in rights-based family planning, new research and data, and particularly the nexus between family planning and universal health coverage (UHC). Now, it has never been more urgent to take action to achieve UHC – especially as the target date for the Sustainable Development Goals is only seven years away.

UHC is a measure of the world’s commitment to ensuring good health and well-being for all (SDG 3). It characterizes an ideal where all people have access to the health services they need, when and where they need them, without financial hardship or other barriers. This includes — but is not limited to — access to sexual and reproductive health and rights (SRHR) and family planning, which are not only human rights but catalysts for economic development. Specifically, access to family planning provides individuals with the choice and agency to freely decide if or when to become parents, as well as the number and timing of their children. This right is enshrined in various global, regional and national laws, policies, and instruments, which obligate governments to respect, protect, and fulfil this right.

According to the World Health Organization (WHO), prior to the COVID-19 pandemic, at least half of the world’s population could not access essential health services, including family planning. Meanwhile, 800 million people spent at least 10 percent of their household budget on health care expenses, and half a billion people were pushed further into extreme poverty by out-of-pocket health spending. These gaps are especially pronounced in low- and middle-income countries, where an estimated 23 million adolescent girls and young women were not able to meet their needs for contraception before the pandemic due to structural barriers such as negative service provider attitudes, lack of access to health information, and discriminatory laws rooted in gender inequality. Despite the resilience of health systems and people in general, pandemic conditions exacerbated pre-existing social inequities in access to and use of family planning services. The pandemic exposed serious inequities and gaps in emergency preparedness: women and girls suffered more disproportionately from the economic blowback and serious health consequences of the pandemic. Notably, the long-term impacts of the pandemic on the global and national economies may have future impacts on family planning financing.

Family planning plays a critical role in achieving UHC globally and ensuring everyone worldwide can access lifesaving healthcare. Healthcare will not be universal without access to family planning. As countries develop various policies and design programs to ensure all citizens have access to health as a human right, the history and lessons from family planning are invaluable. The family planning community has recognized, and in some cases successfully addressed, the structural barriers that continue to plague health systems.  Achieving UHC presupposes the inclusion of family planning with effective financial protection from hardship, ensuring family planning services are available, accessible and affordable for everyone.

The inclusion of family planning services in a country’s UHC policy also presents one of the biggest returns on investment in attaining sustainable UHC. According to UNFPA, every dollar invested in family planning generates $8.40 in economic gains However, we have not yet cracked the formula that ensures we ‘leave no one behind’. We will not do so by mere slogans but ensuring our limited and finite health resources at national level and as a global health community reach the last mile.

We are at a turning point. Given the quickly-closing timeline for achieving the Sustainable Development Goals, and the impact that the COVID-19 pandemic has had on gender equality and family planning supply chains, now is the time for us — as individuals, movements, advocates and nations — to recommit to our collective goals to achieve good health and well-being and gender equality for all.