Stan Bernstein

Family planning: the unfinished agenda

Promotion of family planning in countries with high birth rates has the potential to reduce poverty and hunger and avert 32% of all maternal deaths and nearly 10% of childhood deaths. It would also contribute substantially to womens empowerment, achievement of universal primary schooling, and long-term environmental sustainability. In the past 40 years, family-planning programmes have played a major part in raising the prevalence of contraceptive practice from less than 10% to 60% and reducing fertility in developing countries from six to about three births per woman. However, in half the 75 larger low-income and lower-middle income countries (mainly in Africa), contraceptive practice remains low and fertility, population growth, and unmet need for family planning are high. The cross-cutting contribution to the achievement of the Millennium Development Goals makes greater investment in family planning in these countries compelling. Despite the size of this unfinished agenda, international funding and promotion of family planning has waned in the past decade. A revitalisation of the agenda is urgently needed. Historically, the USA has taken the lead but other governments or agencies are now needed as champions. Based on the sizeable experience of past decades, the key features of effective programmes are clearly established. Most governments of poor countries already have appropriate population and family-planning policies but are receiving too little international encouragement and funding to implement them with vigour. What is currently missing is political willingness to incorporate family planning into the development arena.

ICPD Goals: Essential to the Millennium Development Goals

The year 2005 is a pivotal year for ensuring that sexual and reproductive health are fully addressed in the implementation and monitoring of the Millennium Development Goals (MDGs). When the MDGs were developed following the Millennium Summit in 2000 no goal was included on sexual and reproductive health for reasons that are now history. Matters that have an impact on or are components of sexual and reproductive health were included – maternal and child health HIV/AIDS gender equality and education – but sexual and reproductive health were left out. This year however there are real opportunities to redress the imbalance and to ensure that sexual and reproductive health are there for the rest of the time earmarked for the implementation of the MDGs i.e. in the ten years to 2015. Targets and indicators were set shortly after the MDGs were agreed. As far as maternal health was concerned the target set was the reduction of maternal mortality by two-thirds and for HIV/AIDS of halting and beginning to reverse the spread of HIV/AIDS both by 2015. Whole other areas are not included however especially access to contraceptive services. There is an increasing trend among donor governments to tie development aid to the MDGs and to use monitoring of implementation of the MDGs for this purpose. Hence implementation of the Programme of Action of the International Conference on Population and Development 1994 would be more easily achieved if targets for achieving sexual and reproductive health were fully integrated into the MDG process. (excerpt)

Progress towards the Millennium Development Goals: a long trek for reproductive health.

With only six years remaining to achieve the Millennium Development Goals in 2015, issues pertaining to universal access to reproductive health deserve more emphasis as part of current efforts in international health. The maternal health goal is the Millennium Development Goal with the most disappointing progress. Whereas much has been achieved globally for the utilization of family planning services, there are some geographical areas and subpopulations where progress is lacking. Health systems should be strengthened whilst addressing disparities. The rights and gender aspects of reproductive health have been fully documented, but equitable access and economic aspects should be considered in policy formulation and program implementation. Advocacy is needed for key players to leverage support, whereas efforts for accelerating progress should be sustainable in the long term.

Sexual and Reproductive Health at 2015 and Beyond: A Global Perspective

The International Conference on Population and Development and Millennium Development Goals propelled reproductive health into priorities for international development through declarations, statements, and frameworks. However, key indicators demonstrate that progress in both service provision and clinical outcomes has not been optimal, especially for certain disadvantaged groups. With the Sustainable Development Goals, efforts over the next two decades will focus on access to and quality of health services. Advocacy for mobilizing resources will be complemented by accountability, especially monitoring and evaluation, for utilization of these resources during the life cycle. Stakeholders should emphasize national commitments, with broad partnerships, to ensure long-term sustainability.

The Role of Reproductive Health for Attainment of the Millennium Development Goals

Universal access to reproductive health services is a major aim of current efforts towards attaining the Millennium Development Goals, and reproductive rights and poverty reduction are crosscutting issues for this current focus of international development. Political statements should be complemented by financial commitments for mobilizing resources and the formulation of country-owned action plans. Upscaling services will necessitate strengthening health systems, integrating care, and building capacities. Policy makers, service providers, and stakeholders have responsibilities and duties to ensure that frameworks are available for the adequate provision of services. The implementation of multiple international development strategies currently constitutes a priority for reaching the targets by 2015.

Evidence and reality must trump Trump’s ideology: an international perspective

In his editorial in this journal’s April 2017 issue, Grossman anticipated that President Donald Trump would have to make changes from his ambitious electoral promises when making decisions in office.1 Whereas the domestic economy, security and health were top priority issues for the USA presidential election, the themes of a political campaign are quite different from the precise positions required during policy formulation, especially when world events intrude on the “America first” transactional perspectives that seek to “make America great again”. With both health and security knowing no geographical boundaries, a domestic agenda has global repercussions. Reacting to the anticipated international “population bomb” of the 1960s, the USA promoted family planning (FP), which was subsequently recognised as an integral part of maternal and child health, an essential element of primary healthcare as defined by the World Health Organization (WHO) in 1978. Considering …