02 July 2012

Pregnancy Is a Global Killer; It Doesn't Have to Be

I originally wrote a version of this for the PSI blog.

Pregnancy has the dual ability to bring about joy and sadness. Pregnancy and childbirth are the number one killer for girls aged 15 to 19, claiming an estimated 50,000 lives each year. Additionally, 10 million girls under the age of 18 are married each year. It all adds up to a significant yet easily addressed problem through access to family planning. The challenge is that the family planning needs of 220 women worldwide go unmet.

The positive side is that this big gap, if addressed, can significantly reduce the number of maternal and child deaths around the world. A new report by Save the Children (STC) UK, Every Woman's Right: How family planning saves children's lives, outlines the problem and measures that can be taken to save lives.

The study identifies a few key areas that can ensure girls can live long and healthy lives that ensure their personal safety and the opportunity for their children to thrive. They include: giving birth later, proper birth spacing, improving family planning supply, engaging community-based health workers, education and empowerment.

Wannansa is a twenty-seven year old mother of three children in the Afar region of Ethiopia. “When I was younger there were no contraceptive methods, but now they’re available,” says Wallensa to STC. “I use the contraceptive injection. It’s available in private clinics, and here at this clinic.” When asked what she would tell Ethiopian Prime Minister M“If I had a chance to talk to Prime Minister Meles Zenawi she said, “I’d tell him I would like him to continue what he is doing now with family planning.”
Birth spacing by an interval of 36 months significantly increases the chances that a child will make it to his or her 5th birthday. Despite this knowledge, the majority of births in developing countries occur closer together than the ideal three year spacing. When surveyed, women indicated that their ideal period between births, on average, to be 41.5 months. The reality for them was 32.1 months between births. The desire for more time between births is there. It exceeds the recommended 36 months, yet women are unable to meet their goals.

Part of the problem may be attributed to the lack of family planning services. A previous STC study found that women want to access longer lasting but reversible forms of contraceptives. Though the data is not terribly strong, it appears that the reach of such options fall short in some parts of the world. Supply in some part at fault. The lack of access to health workers is another challenge.

Nearly 1/4 of women in a Population Reference Bureau study said they do not use contraceptives due to concerns about health risks and side effects. STC argues that health workers can make up for this problem by providing counseling services. The WHO estimates that there is a global shortage of health workers by about 3.5 million. Improving supply and increasing the number of frontline health workers can help to reach the some 220 million women who do not have adequate access to family planning services.

"The issue of children having children - and dying because their bodies are too immature to deliver the baby - is a global scandal," said Save the Children’s chief executive Justin Forsyth. "In the developing world, family planning isn’t just a lifestyle choice. Children’s lives depend on it."

The report concludes by examining the financial cost to family planning and the role of gender equity. All is framed within this month's London Summit on Family Planning. Donors, national governments and the private sector will gather to determine how to go forward. The STC report hopes to act as a framework for action and funding.

"Family planning is a vital part of the package of healthcare interventions that have been identified by health experts – eg, The Lancet – as essential for saving the lives of mothers and children and reaching international goals. It is the responsibility of the government to act as the steward of the health sector, regulating the quality of care provided by all healthcare providers, and ensuring universal access to the basic package of services. This depends on the existence of strong legislation and policies, as well as sufficient funding," write the report authors.

The overarching aim is for the provision of universal free coverage of family planning. The report argues that the investment undertaking by various actors can reduce deaths and ensure healthy lives. All then falls under the greater tent of women's empowerment and gender equity. By supporting women through education and legislation, STC believes family planning information can reach more women and increase demand for services.

What remains are questions about the upcoming conference. Buzz is building, but what will actually come from the event. Public announcements point towards money promised, but what will change to meet the needs of women around the world? Given the failure of family planning at Rio+20, to what extent can we expect broad support for this effort?