Family planning: the essential link to achieving all eight Millennium Development Goals

Commentary

Family planning: the essential link to achieving all eight Millennium

Development Goals

Willard Cates Jr.

⁎

Family Health International, Durham, NC 27713, USA

Received 21 December 2009; accepted 5 January 2010

The International Conference on Family Planning, held in

Kampala, Uganda, from November 15–18, 2009, drew over

1300 family planning researchers, program managers and

health ministry officials from across the globe. This

conference marked the reinvigoration of a global commit-

ment to family planning.

Why such renewed empha sis on family planning after 15

years of relative quiet? P erhaps it is because as 2015

approaches, we realize we are not on target to achieve the

Millennium Development Goals (MDGs) [1]. Perhaps we

have also finally understood that family planning may indeed

be one of the most cost-effective development investments [2].

Here is my opinion on why family planning is crucial to

achieving the MDGs:

• End poverty and hunger — Family planning generates

wealth. For example, the per capita Gross National

Product is correlated with the prevalence of modern

contraceptive methods [3]. Moreover, family planning

also reduces the aggregate demand for increasing

scarce food products. In 1997, 775 million people were

categorized as undernourished, and the world grain

stocks were 108 days. By 2017, an estimated 1.2

billion people will be undernourished, and the world

grain stocks are projected to run out [4].

• Universal educat ion — Family planning prolongs

education. Unintended pregnancy is a major obstacle

to school attendance, since many youth drop out of

school once pregnancies occur. Les s than half of all

African girls complete primary school [5]. And by age

18, nearly half of women 18 years of age or younger in

such countries a s Malawi and Bangladesh have

children or are currently pregnant [5].

• Gender equality — Family planning empowers

women. Unplanned pregnancies interrupt work and

career plans. In Egypt, women who use contracep-

tion are more likely to be employed than nonusers

[3]. In Brazil and Indonesia, use of long-acting or

permanent contraceptive methods was associated

with a greater likelihood of working for pay [3].

The recent book by Nicholas Kristof and Sheryl

WuDunn, Half the Sky [6], documents that empo-

wering women, including their ability to achieve

desired family size, is the most important driver of

modern development efforts.

• Child health — Family planning saves infant lives.

Spacing planne d births and limiting unintended births

increases child survival [7]. Currently, 1.2 million

infant deaths are averted globally each year by

preventing unintended pre gnancies [8]. Another

640,000 newborn deaths would be prevented if we

could meet unmet con traceptive needs.

• Maternal health — Family planning improves mater-

nal health. Unintended pregnancy affects a woman's

health in several ways: if she seeks to terminate that

pregnancy, the risks of unsafe abortion are among the

main causes of maternal death in young women [9].If

she wishes to continue the pregnancy, in low-resource

settings without safe delivery services, the risks of

maternal mortality are high. By preventing unintended

pregnancy, wider family planning access reduces the

risk of abortion or childbearing.

• Combat HIV/AIDS — Family planning prevents HIV

[10]. Contraception is the best kept secret in HIV

prevention. Women with HIV who have unintended

pregnancies run the risk of transmitting the virus to

their child. Preventing pregnancies among HIV-

positive women who do not wish to become pregnant

reduces HIV-positive births and the number of

Contraception 81 (2010) 460 – 461

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children needing HIV treatment, care and support

[11,12]. Three times as many infants are spared HIV

infection by current contraceptive use compared to

providing antiretrovira l treatment to mothers during

pregnancy, birth and breastfeeding [13].

• Environmental sustainability – Family planning pro-

tects the environment [14]. Environmental degradation

is fueled by (1) per capita consumption, (2) the

technology used to produce what is consumed and (3)

population growth. Preventing unintended pregnancy is

the factor in popula tion growth most amenable to

intervention. Many women want fewer children, and

217 million have unmet needs for contraception [8].

Moreover, family planning is environmen tally cost-

efficient. Family planning is five times cheaper than

conventional green technologies for reducing CO

climate change [13].

• Global partnerships – Family planning promotes

global partnerships. Four decades of global invest-

ment in family planning programs has contributed to

strong collaboration among international agencies,

governmental ministries, multinational organizations

and local community groups. The current move

towards strengthening health services has been

founded on linkages between family planning and

HIV services [15].

Beyond the MDGs, family planning has a direct influence

on improving lives worldwide in two other ways:

• Enhanced national security – Family planning stabi-

lizes society. Expert groups have concluded that high

birth rates in many areas of the world have produced a

steadily increasing population of young men without

any reasonable expectation of suitable or steady

employment [16]. The “youth bulge” undermin es

national transition to liberal democracies [17]. These

become a source for social turbulence.

• Optimize financial resources – Family planning saves

dollars. Preventing unintended pregnancy is less

expensive than treating maternal/infant complications

of pregnan cy. In Zambia, for every $1 invested in family

planning, $4 are saved in other development areas [18].

A crescen do is building to support the essential role of, and

the necessary resources for, family planning as a foundation

for addressing global health and development [19]. While

family planning will not solve all our problems, it is,

however, a highly effective cross-cutting development

imperative that can help us reach the MDGs. Achieving

universal access to family planning is within our grasp, but

we need to increase investment in contraceptive technology

research, develop more evidenced-based policies, engage the

public and private sectors, and expand the local commitment

to family planning worldwide.

Acknowledgment

I appreciate the editorial suggestions of Hannah Burris to

this manuscript.

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