Family planning: A look at the past, the present and the future

Photo Credit: Jessica Scranton/FHI 360

In 1971, the world was a different place demographically. Our planet was mostly agrarian, family sizes were large and birth control was unavailable. That year, FHI 360’s heritage organization, the International Fertility Research Program, was created to perform clinical trials of emerging contraceptive technologies, such as oral hormonal contraception and intrauterine devices (IUDs). These studies helped jump-start global family planning programs, creating health services for women where none had previously existed.

1994: Setting a new agenda

Fast forward to 1994, the year of the International Conference on Population and Development (ICPD). This pivotal global event caused a seismic shift in family planning, from concern about population growth to a commitment to reproductive rights and justice. Women’s empowerment took center stage. Issues related to sexually transmitted infections, especially HIV, were folded into the sexual and reproductive health agenda.

The ICPD also strengthened voluntary family planning as a fundamental human right. This enabled women and couples to determine the timing and spacing of their pregnancies. With control over their fertility, women improved both their personal health and their career aspirations. Family size preferences decreased, and the demand for more effective, longer-acting contraception increased.

Family planning drives development

Today, the shift from larger to smaller families represents one of the most important transformations in developing regions. This shift was made possible in large part by the increased availability of modern contraception. Demographers have traditionally defined “modern” as any method other than “traditional” (for example, natural family planning and withdrawal). During the past two decades, evidence has demonstrated the contributions that family planning can make to global health and development, including progress toward the Millennium Development Goals. The use of contraceptive methods in developing regions rose from negligible levels 50 years ago to an estimated 57 percent of married women ages 15–49 in 2014 (Guttmacher Institute). Contraceptive services — whether delivered through public-sector family planning programs; nongovernmental organizations; or private-sector clinics, pharmacies and drug shops — have enabled millions of women and couples everywhere to choose the number and timing of their children.

Despite the progress, hundreds of millions of women across the globe say they want to avoid a pregnancy but lack access to effective contraceptives. Modern contraceptive use varies widely around the world, from 88 percent of married women in East Asia to only 19 percent in sub-Saharan Africa (Guttmacher Institute). In some of the poorest countries, the quality of services remains poor while the desire for smaller families is increasing. In addition, increasing levels of sexual activity among young, unmarried women — related to a rising age at marriage in developing countries — points to a growing need for contraceptives.

FHI 360: Cutting-edge leadership in family planning

Within FHI 360, our approach to family planning evolved well ahead of the curve. In the 1980s, we foresaw how the field of sexual and reproductive health would expand in new directions. We incorporated research on new barrier contraceptive methods into our portfolio as the HIV epidemic grew.

In the 1980s and 1990s, we were the first organization to evaluate the available spermicides/microbicides (nonoxynol-9) for their effectiveness against HIV and other sexually transmitted infections. By the 2000s, we were advocating for the integration of HIV and family planning services and studying the most efficient and effective ways to link them.

And in the 2010s, we’ve embraced getting the truly “modern”—and more effective— contraception (World Health Organization [WHO] Tier 1 methods, such as implants and IUDs) into WHO registries, country tenders and health services stockpiles so women can more easily access them. We also are leading initiatives on community-based family planning, especially injectables. Working with colleagues in Tanzania and Senegal, FHI 360 pioneered and continues to support the development and implementation of costed implementation plans for national family planning programs, a tool that is becoming a central component of Family Planning 2020 (FP2020).

Through these actions over the past 40 years, FHI 360 has transformed from an organization focused on family planning research into one at the forefront of developing solutions that lead to more effective policies, programs and technologies in the area of sexual and reproductive health.

Looking ahead

We continue to look for new ways to more effectively confront critical health and development issues. We have expanded our reproductive, maternal, newborn and child health domains to prepare for the post-2015 development agenda. We have added nutrition, sanitation, education, environment and economic development to our organizational capabilities. We have returned to our contraceptive technology roots to develop, evaluate and introduce innovative mid- to long-acting contraceptives, including implants and longer-acting injectables.

We have identified several futuristic ideas for possible development, including:

• Promoting the possible synergies between family planning and menstrual hygiene management, including amenorrhea as a noncontraceptive benefit of certain family planning methods
• Increasing the political will for family planning by promoting the demographic dividend and family planning as a tool for economic growth
• Studying the acceptability of using unmanned aerial devices for commodity delivery in hard-to-reach locations

While FHI 360’s approach to family planning has undergone a dynamic evolution since 1971, we are excited about what lies ahead. FHI 360’s future contributions to new contraceptive technologies and more efficient family planning services will help support the recognized right to voluntary family planning. This longstanding goal is now more important to global development than ever.