Unmet family planning needs Bad for economy and health

Bobby Ramakant *

An illustration to be used by women whose menstrual cycles are usually between 26 and 32 days in length
The Standard Days Method works for women who always have menstrual cycles between 26 and 32 days in length. Avoiding sexual intercourse on the days labeled 'fertile' results in a pregnancy rate of 5% per year.
Pix - wikipedia/Vargklo

222 million women in developing countries, who want to use modern contraception methods, are not able to have access to them. Meeting women's family planning needs would prevent 54 million unplanned pregnancies, 79,000 maternal deaths and 1.1 million infant deaths. There are other savings too, for every USD 1 spent on family planning saves countries USD 4 in areas such as education, healthcare, water and sanitation, said delegates at Women Deliver 2013.

Contraception plays an important role in women’s health. In India, family planning focusses on permanent methods such as female sterilization (tubectomy), male sterilization (vasectomy) or contraceptive pills, IUDs, condoms, among others; and old evidence-based methods such as SDM get much smaller mention. We have to expand the basket of choices for women and men to prevent unintended pregnancies and sexually transmitted infections (STIs) if possible. Each method has a unique clientele as no one method fits all at all the times. Women and men have their unique needs at different points of their lives and we need to expand the range of options they may choose from.

Unmet need of contraception in India is 21.3% and contraceptive prevalence rate (CPR) is 54%. Female sterilization was practiced by 34% people but male sterilization practice was limited to only 1%, pills 4%, IUD 2%, condom: 5-6% and other traditional methods 7%. Condom use in India is hovering around 5% over the past decade and failing to increase despite it being an effective multipurpose prevention option for STIs and unintended pregnancies.

"It is important to include natural methods that are scientifically tested into the method mix because they can overcome many common barriers to family planning adoption such as fear of side effects and impact on fertility, unwillingness to use a hormonal contraceptive, or religious restrictions. Our experience shows that offering methods such as the Standard Days Method (SDM) opens a doorway for those who are closed to the idea of family planning" said Priya Jha, Country Representative, Institute for Reproductive Health (IRH) India.

Priya added: "Being a knowledge based method, the SDM can be offered in innovative ways so as to bypass various barriers to accessibility. From our work in India, we know that the SDM can be offered is multiple ways: through the public health delivery system, by involving social marketing and private sector agencies, and via mobile phones, internet, and even with paper CycleBeads."

Results of an efficacy study published in 2002, showed SDM to be more than 95 percent effective with correct use and 88 percent effective with typical use, well within range of other user-dependent methods. SDM is used in over 30 countries. Men support their female partners, women understand their bodies and their fertility better, and couple communication improves with SDM use. Studies have shown that use of SDM has brought in couples who had never used family planning methods before. So may be one of the ways to increase utilization of methods to prevent STIs and unintended pregnancies might be to reduce side effects of new under-development technologies and promote evidence-based methods without any side effects as part of the expanded range of prevention options.

"In all these years, we have learnt that making family planning more accessible would not go very far until we involve men into the efforts. The great thing about a method like the SDM is that it gets men to begin thinking about things like fertility, reproductive health, and their role in planning the size of their family. Now men, too, are being included into the family planning dialogue" said Priya Jha.

Many prevention options to protect against STIs and unintended pregnancies need cooperation of both male and female partners. Since gender based inequalities and discrimination severely jeopardizes access to prevention options for STIs and unintended pregnancies, sensitizing male partners become all the more critical. It also increases couple communication on issues related to family planning and STIs.

It is also critical to recognize the need to increase investment to scale up and strengthen broader sexual and reproductive health and rights (SRHR) particularly in low- and middle- income countries. Delegates at Women Deliver 2013 said to Citizen News Service - CNS that if we doubled our investment in family planning, the benefits to girls and women would be: reduced unintended pregnancies by 68%; averted new born deaths by 35% and reduced unsafe abortions by 70%. It makes economic sense as well as a strong public health and social justice sense to support SRHR.