The key themes of the London Summit on Family Planning July 11, co-sponsored by the U.K. Government and the Bill and Melinda Gates Foundation, align well with the policies of the last two Republican Presidents -- George H.W. and George W. Bush. Preventing unplanned pregnancies saves the lives of mothers and children and allows women and their husbands to decide on the size of the family that they can love, clothe, feed, educate and nurture to create a better life for their children than they had. Those are solid American ideals.
Despite progress in the past few years, approximately 290,000 women die each year while giving life (1). Almost a quarter of those would be averted if unplanned pregnancies were prevented. When mom dies, children are up to 10 times more likely to die -- mothers ensure that children are fed, go to school, go to the doctor when they need to and take their medicines when they are sick. It should be embarrassing and a wake-up call to us men that there is no change in the rate of childhood death when the dad dies.
Many gains would come from spacing births, which allow young women in low- and middle-income countries to regain their strength and to provide for their children. The nutritional status of a pregnant woman is important to her own health, but also to providing nutritious breast milk to an infant -- a key determinant in survival. A recent report concluded that a staggering 25 percent of deaths in children under five would be prevented if births were spaced three years or more (2). That is more deaths than would be averted by eradicating malaria or preventing HIV transmission from mothers to newborns.
The data on the life-saving potential of birth spacing matches with what many women in Africa say they want. An analysis of surveys conducted in Sub-Saharan Africa show that nearly 40 percent of women of reproductive age want to space births by two years or more. Not surprisingly, younger women want to have more children, but as they get older the majority want to space at longer intervals (3). The good news is that there are both natural and pharmaceutical interventions that allow women to space births to promote healthy families. There are also families who have decided that they already have the right size for a loving, healthy life together.
There is broad agreement that birth spacing saves lives. However, some organizations and individuals accept natural methods to space or avoid pregnancy but do not accept the use of pharmaceutical products for theological reasons. Respecting that viewpoint is necessary to find common ground and prevent the most unintended pregnancies. While there might be a difference on methods, there is agreement on the need to save lives and lift up families. And many of the organizations that do not accept the use of drugs to prevent unplanned pregnancies are among the most progressive advocates for social justice including universal access to health, education and food, alleviation of poverty and an end to gender violence - views also rooted in their faith.
Advances in technology now allow for implantable devices with slow-release formulations of drugs that prevent pregnancy, are easily removable and can last for up to four years. In Ethiopia, community health workers have been trained to insert them. These products are cost-effective to health systems because they require a one-time implantation rather than injections every three months (the most common method used in many low-income countries). But they also save women and their families the four-times a year trip to a health facility to receive the injection, which steals a day from the farm or workplace and travel costs which can total $70 dollars a year. For a billion people living on less than a dollar a day, that's a lot of money. Finally, stockouts of the quarterly injections are common -- as are missed visits due to the household costs. Both problems can be overcome with longer-acting products.
The bad news is that 200 million women who want access to interventions to prevent unintended pregnancies do not have it (4). It is the goal of the London meeting to ensure that by 2020, 120 million will get it.
There is a dark side to unintended pregnancies. Tragically, there are women who have no role in deciding to have a child and become pregnant through sexual assault and abuse. And it should not be a surprise that unplanned pregnancies, whether through sexual violence or because the family size grows beyond what is manageable, the demand for abortion increases. It makes sense that women and parents who plan for a pregnancy are not likely to seek abortion. Data backs up common sense -- it is estimated that more than two-thirds of abortions would be averted if programs to prevent unplanned pregnancies were available to all women who want them (5).
Providing women and their families with the access to an array of effective, evidence-based programs allows them to select the approach that meets their needs and belief systems is the best strategy to ensure programs are used and the most lives are saved and families are lifted up.
Working together with a shared vision to save the lives of women and children, to prevent as many abortions as possible, we can create a world of healthy, happy families. The London Summit could be an important step to achieve that vision.
(1) WHO, Trends in Maternal Mortality, 1990 to 2010: WHO, UNICEF, UNFPA and The World Bank Estimates, Geneva
(2) Rutstein SO, "Further evidence of the effects of preceding birth intervals on neonatal, infant, and under-five-years mortality and nutritional status in developing countries: evidence from the demographic and health surveys," DHS Working Papers, No. 41, Calverton, MD, USA: Macro International, 2008.
(3) Demographic Health Surveys from each country in Sub-Saharan Africa
Amb. Mark Dybul, Distinguished Scholar, The O'Neill Institute for National and Global Health Law, Georgetown University and Inaugural Global Health Fellow, The George W. Bush Institute. He was the US Global AIDS Coordinator from 2006-2009.
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