It Takes a Village: Getting Family Planning Where It’s Needed

Sandra Krause

This unprecedented effort to fund family planning worldwide could be a major milestone in global health, development and women’s rights. But we need to make sure this new funding and political commitment is followed by swift action—and change felt on the ground.

See all our coverage of the 2012 Global Family Planning Summit here.

July 11th was definitely momentous, but I don’t think the hundreds of thousands of women and girls that are displaced by conflict living in South Sudan’s villages heard the news. The Bill and Melinda Gates Foundation, the British government and other donors committed $2.6 billion dollars to give a projected 120 million women in the world’s poorest countries access to lifesaving contraception. This unprecedented effort could be a major milestone in global health, development and women’s rights. But we need to make sure this new funding and political commitment is followed by swift action—and change felt on the ground.

In the humanitarian settings where we work, we have found that few aid agencies and governments focus on family planning—even though it is a critical public health intervention that saves lives and has impact far beyond health. In the immediate aftermath of a disaster, men and women fleeing their homes are not likely to be thinking about their contraceptives as a first priority, and neither is it a main concern of humanitarian aid agencies responding to these crises. Yet, experience has shown us that even in the earliest days and weeks of a humanitarian emergency, women and girls want to use contraception.

Providing family planning information and services should be a top concern from the very onset of a crisis. Many countries have protracted humanitarian situations; the average length of displacement for people living in refugee camps is now 18 years. Not having family planning services available can have far-reaching and long-term effects: keeping young girls out of school, increasing the chances they will marry early, and raising rates of maternal and infant deaths.

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There have been some significant improvements in reproductive health care in crisis situations. The humanitarian community, governments and others are working to ensure that a set of basic measures are taken during humanitarian crises to meet women’s and girls’ reproductive health concerns. Yet, family planning often falls by the way side.

In a five-country study we conducted in 2011, we found that use of contraception is generally lower in refugee camps than in surrounding areas.  And awareness is low as well.

In recent years, several developing countries, like Bangladesh—which has successfully implemented a community-based approach—have seen improvements in family planning uptake. Now we need to make sure these programs and models are adapted and implemented in humanitarian settings on a wide scale—in the camps, villages, and urban areas where displaced persons live. Without this concerted effort, women and girls in regions hit by humanitarian crises will remain vulnerable to unplanned pregnancies and risk dying from complications.

Simple measures and methods that could protect them—like the pill or injectable contraceptives—are often neglected during crises. We have been working to develop educational materials that help local health providers and peer educators to explain the benefits of family planning and where and how to seek services. This outreach to communities is needed to really save lives and to ensure women and girls are informed and able to make choices about their futures.  

Community members are often best positioned and able to respond to the needs of their peers. We have seen this in South Sudan, where the Women’s Refugee Commission worked with the American Refugee Committee and local partners on an initiative to assess whether training community members and peer educators to provide information on family planning—and to provide methods like the pill and condoms—is a feasible approach.  Our project focused on the town of Malakal, which experiences heavy rain for half the year, decimating the few roads that exist. Needless to say, transportation is limited and health clinics are scarce. Prolonged conflict in the region further restricts access to whatever health care there is available.

We wanted to see if community workers making home visits and informing their peers about contraception, holding health education sessions in villages and doing radio shows would be effective. This approach did show potential: communities were open and enthusiastic about family planning. Adolescent girls, especially, were motivated to learn about and use contraception so they could stay in school and delay pregnancy.

Initiatives like these put family planning in the hands of those who would not be reached otherwise and are absolutely essential to improving reproductive health in the poorest parts of the world. Empowering communities, local leaders and health workers should be the next step in our global efforts. Without involving communities and engaging them from the start our plans will remain just that, no matter how good the intentions.

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