The Contraception Crisis that Isn’t
The world’s most powerful family planning groups announced a “contraceptive crisis,” calling for more funding and “sounding the alarm over the unmet contraceptive needs of hundreds of millions of people.” A look at their latest report, however, shows the opposite: a glut of contraception in a world where unsatisfied demand has sharply fallen.
The group, which includes Planned Parenthood and the United Nations Population Fund (UNFPA), launched a petition asking the UN Secretary-General to “highlight the centrality of contraceptives to achieving the sustainable development goals.”
The massive family planning community coalesced into a partnership of donors called “FP2020” in 2012 at the London Summit on Family Planning, with the goal of “enabling 120 million additional women and girls to use contraceptives by 2020.” In terms of measurement, “enabling” means “recruiting.” But midway through the initiative, the number of contraceptive adopters is falling short of the target.
FP2020 Executive Director, Beth Schlachter, said that the evidence contained in the initiative’s new midterm report would help with efforts “to reach women and girls with the services they want and need,” but contains little evidence of unsatisfied demand. In fact, the report emphasizes that “contraceptive discontinuation presents a challenge to achieving FP2020 goals.” Among the most commonly reported reasons for discontinuation were the desire to become pregnant or concerns over health risks and side effects.
Apart from voluntary discontinuation, neither FP2020 nor the groups claiming a contraceptive “crisis” argue that funding shortfalls could jeopardize access to family planning by existing users.
The new FP2020 report is significant because UN member states have pledged billions of dollars to meet the UN’s Sustainable Development Goals, including a target of “universal access to reproductive health,” including family planning. The methods used to measure access, however, are often misleading and misunderstood.
The frequently-cited “unmet need” for family planning—estimated at over 225 million women and girls—does not measure access to contraceptives or intent to use them. The Guttmacher Institute estimates that only about 5% of “unmet need” is attributed to lack of access by the women themselves. Beneath the human rights language, the main limitation in reaching the FP2020 target is a market nearing a saturation point.
Country-level survey data indicate that where women are not using contraceptives, lack of access is rarely the reason. Even the pro-contraception Population Council acknowledges that awareness of artificial family planning methods is nearly universal.
If the success of the Sustainable Development Goals is said to rely on inducing millions of women to use contraception, even over their objections, it could raise concerns about coercion within family planning programs, which has been well-documented in the past.
Efforts by family planning groups to ensure continued funding may also result in the siphoning of resources away from maternal and child health programs. The FP2020 report contains data showing “the consequences of use or non-use of modern contraception for women’s health and well-being.”
The report claims that contraceptive use over the last year in focus countries prevented 124,000 maternal deaths. But non-users of contraceptives, including women who desired to have children, are still giving birth in dangerous conditions: the very fact that the risk of maternal death is high in many FP2020 target countries enables the claim that so many deaths were averted.
