Family Planning and Reproductive Health
USAID's family planning and reproductive health (FP/RH) program is a true development success story. FP/RH activities have increased access to, and use of, quality reproductive health care, including voluntary family planning. These activities have allowed couples to plan the size of their families and the spacing of their children, and have reduced unintended pregnancy and the incidence of abortion. USAID's FP/RH investments have improved the health of individuals and families in developing countries, and have contributed to lasting social and economic development, the growth of civil society and good governance, and environmental sustainability. Despite the success achieved thus far, major challenges remain.
Program Emphasis
Increasing access on a sustainable basis to high quality voluntary family planning information and services in the countries where USAID works is the ultimate goal of USAID's FP/RH program. With an eye toward sustainability and eventual graduation from USAID support, the FP/RH program invests in field-driven and evidence-based activities that improve access to modern contraceptive methods, improve the health and survival of mothers and children through better birthspacing, reduce abortion, and achieve environmentally and economically sustainable rates of population growth. FP/RH activities include family planning service delivery at the community level, contraceptive research (including natural family planning), family planning and HIV/AIDS integration, population and environment programs, securing contraceptive supplies, health communications and policy, health provider training, program monitoring and evaluation activities, and commodity logistics management.
Program Successes
Over the past 40 years, USAID family planning programs have had a significant impact at the global level including a decrease in the average number of children per family in all developing countries (excluding China) from more than six in the 1960s to slightly more than three in 2005. At the country level, for example, virtually all women in Bangladesh are currently aware of modern family planning methods, and approximately half of married women of reproductive age use modern contraceptives, up from 8% thirty years ago when USAID initiated support to the national family planning program.
Family planning successes in USAID-supported countries over the last 15 years, as seen in Table 1, include reduced fertility, increased use of modern contraceptives, and improvement in demand for family planning met by modern contraceptive use. Additionally, achievements in maternal and child health include improvements in child spacing and declines in births to young mothers.
The graduation of 12 countries from USAID FP/RH assistance over the past two decades is further indication of FP/RH program success.
Table 1. Family Planning and Reproductive Health Indicators
USAID Countries 1990-2005 (Projected)
Results
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Indicator Name | 1990 | 1995 | 2000 | 2005 |
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Total Fertility Rate (TFR) | 5.2 | 4.7 | 4.3 | 3.9 |
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Modern Contraceptive Prevalence Rate | 19.5 | 25.7 | 31.9 | 37.7 |
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Percent of Demand Satisfied with Modern Contraceptive Methods | 31.3 | 38.3 | 45.8 | 52.9 |
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Percent of Births Spaced Three or More Years Apart | 36.3 | 40.2 | 44.6 | 49.1 |
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Percent of First Births to Mothers Under Age 18 | 26.5 | 25.8 | 24.3 | 22.9
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Countries receiving >=$1m in CSH or 'other health funding' in FY03 and FY04 and having data from at least two Demographic and Health Surveys (DHS) or Reproductive Health Surveys (RHS). Data from 31 to 39 USAID countries with available trend data.
Unweighted average extrapolations of all countries meeting the above criteria by indicator and year.
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Challenges Ahead
Many challenges for continued success lie ahead for couples around the globe and the professionals who provide them with services. For example, the unmet demand for family planning remains large in developing countries, particularly in Africa. Poor child and maternal health and deaths continue as a result of early and closely-spaced childbearing. As a result of projected increases in population size (including the largest generation of young people ever) and demand for contraception in developing countries, the number of contraceptive users is estimated to increase by 200 million between 2000 and 2015. Meeting this growing demand will require significant investment in securing contraceptive supplies.
Reducing disparities in access to family planning services between socioeconomic groups and improving services to the hard-to-reach segments of the population continue to be major challenges. Facilitating private sector partnerships between low-cost producers and markets in the developing world is important for meeting the needs of family planning users. However, promoting these partnerships, which is important for sustainability, can be slow to develop and mature in some countries. Continued research investment is necessary to further identify, develop, test, and deploy new and improved modern contraceptive technologies and natural family planning methods, to meet the needs of all couples. Scaling up proven FP/RH program approaches and integrating with related services, such as HIV/AIDS, also holds potential for strengthening health services.
Strategic Allocation of Family Planning Resources
In accordance with USAID's Policy Framework for Bilateral Foreign Aid, USAID is meeting remaining challenges by taking additional actions to strategically allocate funding among developing countries based on considerations of need, measured by such factors as population density, fertility rates, and unmet demand for family planning services. This multi-year strategic budgeting process includes incremental shifts in funding to high-need countries over time. Using 2002 as a baseline, 14 high-need countries received an additional $75 million in 2005. High-need countries are mostly found in Africa and South Asia and include: Congo, Ethiopia, Kenya, Nigeria, Rwanda, Tanzania, Afghanistan, and Pakistan. Other high-need countries outside these regions include Yemen and Haiti.
Simultaneously, USAID is testing a rational process for ending family planning assistance to countries that have reached low fertility rates and achieved high family planning use in addition to other indicators of sustainability. The process for graduation from assistance, including the allocation of necessary additional technical assistance resources in some cases, will ensure a responsible, feasible, and sustainable plan for program phase out, while assuring that the underserved have continued access to services.
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