No one left behind: has the pursuit of FP2020’s 120 million additional users goal left some women behind?

Article by Shiza Farid, Jason Bremner (Senior Director, Data & Performance Management at FP2030), and Emma Anderson

In 2012 at the London Summit on Family Planning, key family planning partners came together to reinvigorate the family planning movement and accelerate progress toward universal access to family planning. The summit led to the creation of the Family Planning 2020 partnership (FP2020) with the aim of improving access to voluntary family planning information and services and enable 120 million additional women to use modern contraceptives in 69 focus countries by 2020. Many in the family planning community welcomed the new commitments of aid from donors, new commitments by country governments, and the push to bolster family planning as a development priority; however, there were also concerns about the focus on numbers of contraceptive users and a global goal1,2. Advocates pointed toward family planning’s past experiences of coercion and targets, warning that the FP2020 goal could lead to a focus on numbers and prioritization of easier to reach populations.

Background: An important question is whether the FP2020’s “120 million additional users” goal exacerbated inequities and led to a prioritization of populations within countries where substantial gains towards the goal could be made. We examine FP2020 country data and policies for signs of inequity in gains in modern contraceptive prevalence (MCP) and in the focus of family planning programs and policies.

Methods: We selected 11 countries (Bangladesh, Burundi, Ethiopia, Haiti, Malawi, Mali, Nepal, Pakistan, Senegal, Sierra Leone, Uganda, and Zimbabwe) to conduct a bivariate analysis. We evaluated if MCP growth had been equitable by assessing MCP between two surveys stratified by residence, levels of education, age groups, marital status, and wealth.

Results: In most countries, MCP increased among rural women and in seven African countries these gains were significant. In six countries, MCP gains were significant both among women with no education and in the lowest wealth group. MCP gains among young women aged 15-19 and 20-24 were seen in four African countries: Malawi, Senegal, Sierra Leone, and Uganda.

Conclusions: Our findings suggest that between two surveys since 2010 many countries saw MCP gains across different dimensions of equity and do not suggest a focus on expanded coverage at the expense of equity. As the family planning community begins to look ahead to the next partnership, this analysis can help inform the emerging FP2030 framework, which includes equity as a guiding principle.