The Promise of Accessible, Sustainable Family Planning

As we approach World Population Day—which was first observed 22 years ago, on July 11, 1988—many women in the poorest countries, particularly in sub-Saharan Africa, still lack access to modern family planning (FP). As a result, these women suffer high maternal mortality, and their infants die at disproportionately high rates. MSH and its partners are leading a response by developing integrated, community-based FP/HIV services in these countries and repositioning FP as a core activity on the global health agenda.

The results are encouraging: In Malawi, where MSH leads the USAID-funded Community-based Family Planning and HIV & AIDS Services (CFPHS) project, MSH is exceeding its targets in FP/HIV counseling and contraceptive distribution by more than 30 percent, reaching hundreds of thousands of people. And MSH has helped put FP back on Africa’s political map, working with 46 health ministers to develop a policy framework and action plan.

MSH’s ongoing work in health system strengthening includes integrating FP and reproductive health (RH) into primary health care and linking it with HIV & AIDS, tuberculosis, and maternal, newborn, and child health services. MSH collaborates with international agencies such as the United Nations Population Fund and the World Health Organization and public and private partners, including national governments and local organizations, to develop management and leadership for high-quality FP/Reproductive Health (RH) services, strengthen supply management, and train and support service providers.

  • In South Africa, the Integrated Primary Health Care Project managed by MSH reached 15,400 young people with HIV testing, 183,000 with FP information, and more than 56,000 with FP methods in 2008.
  • In Rwanda, the average number of contraceptive users in 285 facilities tripled in 23 of 30 districts, and health center childbirths by trained personnel rose from 21 to 38 per month between January 2006 and March 2008.
  • In Afghanistan, the REACH (Rural Expansion of Afghanistan’s Community-based Healthcare) program helped increase skilled attendance at delivery from 12 to 23 percent and contraceptive use from 16 to 26 percent.
  • In Zimbabwe, the Community-based Distribution and HIV Prevention Program was selected as one of the six most promising evidence-based interventions linking RH and HIV. This model of integrated services is being replicated in Malawi.

Expanding Access to Integrated, Community-Based FP/HIV Services

In Malawi, where a woman can expect to have six children and has a 1 in 18 chance of dying in childbirth, MSH is working to meet the needs of the 84 percent of the population that lives in rural areas and cannot easily access health facilities. In partnership with the Ministry of Health, MSH promotes high-quality services to clients in eight districts by revitalizing a network of community-based distribution agents (CBDAs) trained in FP/HIV integration. The CBDAs—men, women, and youth—provide clients with a range of contraceptive methods, link them to facilities, and offer them information and education through events that bring communities together.

Since the project began in 2007, 600 CBDAs have begun dispensing oral contraceptives and condoms and making referrals for long-term methods. More than 100,000 people have received FP/HIV messages, and 99,000 new and returning contraceptive users have been reached with door-to-door services. And more than 20,000 people were mobilized during Open Days, community events that brought FP/HIV issues to life with traditional dances, songs, and drama.

Demand for FP/RH services will continue to grow in Malawi because the CFPHS program is embedded in local communities. In Balaka District, Mrs. Dalisoni said she wished the project had come early enough to save her the heartache of losing five children. Her daughters are learning from the CBDA about options they will have as adults.

And Mr. Machilikia, a CBDA in Balaka, received praise from his village headmen for what he accomplished in just one month: he conducted three community sensitization campaigns, reaching more than 250 people with FP/HIV messages. The headmen express hope that when people are better able to plan their families, they will be able to focus more on developing their communities.

This is the promise of family planning this World Population Day: providing communities with strong FP/RH services empowers them to improve their quality of life in many ways. With help from MSH and its partners—and leaders like Secretary of State Hillary Rodham Clinton, who has made women’s health a top issue in international development—people are making the connections between FP and saving lives, between FP/RH and community development, and between women’s health and global development. We are challenged with leading the way in implementing and sustaining health programs that offer broad social and environmental advantages.

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