Access to Family Planning is a Global Public Health Emergency

Victor and Therese, married for 30 years, share a powerful, tender bond. He is thin, wiry and has a bum eye. She is younger than I, which is incredible to consider. Her hair is tinged with orange from malnutrition.  She has enormous cheekbones and sweet, soft eyes, especially when her husband is looking at her, which he does often. They live in a tiny, stifling home in Kinshasa, DRC. There are but 2 pieces of furniture, a collapsed sofa, and a non working refrigerator, which they use as a cupboard. The family’s 2 toothbrushes hang from the ceiling near their only decoration, a plastic pine cone. Their change of clothes neatly hang on wire stretching across the tiny room where they sleep on the floor. Their 6 children, the great loves of their life apart from one another, get to sleep on  the ragged pieces of dirty foam. The family eats once a day, and sometimes not at all. Their water supply is not safe, so the family often experiences episode of diarrheal disease. You don’t want to hear about the sanitation used by the family and neighborhood.

Victor and Theresa did not wish to have so many children, whose very survival they could not take the most basic measures to ensure. However, not only did they have 6, Theresa has had 3 additional pregnancies, which ravaged her health.

Unregulated fertility is a catastrophe in DRC and a global public health crisis. In DRC, 600,000 babies a year are born for no other reason than to suffer and die. My husband and I despondently call these precious infants “the born to dies,” of whom there are 8 million annually world wide. The deaths take an incalculable toll on the lives that remain in emotional trauma, illness, loss of social and economic capital, and productivity.

Women, and in many cases their partners, do not want it to be this way. In DRC, 20% of men and woman approached in 2007 do not wish to have more children, and another 25% of women want to delay childbearing or space births by at least 2 years. 92% of all women have never had counseling, and only 6% actually use a modern method. In developing countries worldwide, the numbers stagger: 200 million women do not have access to family planning; in 2007, there were 80 million unintended pregnancies worldwide.

But consider this outrageous number, applicable in DRC alone: Under the tutelage of Professor Ken Hill, Harvard School of Public Health, based on Demographic Household Survey data, I have calculated that by 2050, amongst only women who currently wish to use modern family planning but cannot, there will be be 80 million unintended pregnancies.

Lack of access to medically accurate, modern family planning is a global public health emergency. PSI is addressing this emergency, striving through grassroots programs, behavior and communication change outreaches, and social marketing to make modern family planning methods available to women and their partners. Research confirms that having fewer children is linked to higher educational attainment for women, greater income generating ability, and, critically, improved health amongst her other children. Hence, a woman being able to regulate her fertility involves not just the number of children she has, but the timing and spacing of those children, who benefit enormously from their mother’s better health, time, attention, and a greater share of scarce resources.

In my work around the world with PSI and our many partners, I have seen irrefutable evidence that disempowered reproductive health cross cuts every major health, economic, environmental, and social challenge we face. Thus, empowering reproductive health is low hanging fruit; in helping women and their families prevent unintended pregnancies and space births, we access a powerful matrix through which we can help improve outcomes in every area of human endeavor. 

Empowering reproductive health is acknowledged as essential for achieving the MDG’s. Unless we make urgent progress to reach the 200 million Therese’s, the dream of ending poverty in our time will not be realized.

The good news is PSI and its partners demonstrate that grass roots access to science-based, modern family planning is achievable, by scaling up awareness and capacity. In 2008, PSI helped avert 3.1 million unintended pregnancies, with funding from USAID, Gates, and others. Those are women and families who can now concentrate their scarce resources and human capital on improving the quality of their lives, take better care of their children, and perhaps even break out of the nightmare extreme poverty, and make real the dream of plenty and peace.