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International Family Planning 2014: Seven Trends to Watch

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What's on the docket for international family planning in 2014? Here are seven issues and trends to watch for.

China's One-Child Policy appears to be headed for a change. An easing of the rules could add 1 million or more births per year in the world's largest nation.

After a sluggish start, the impact of FP2020 commitments should start to kick in. The Jadelle implant access initiative has commenced delivery of product to key countries. Two large monitoring projects (Track20 and PMA 2020) are now in place to track progress. A number of governments have committed resources and political will to further FP2020 goals. What happens in the next 12 months should set the pace for action and show whether or not we will be able to reach 2020 goals on schedule.

Digital technology is fast becoming a way to reach (especially young) people with messages on family planning. In Ethiopia, TemariNet reaches thousands of students with key information while promoting music and online chatting. Youtube ads promote birth spacing and IUDs in Pakistan. In Ghana, Marie Stopes uses Facebook to promote its clinics while the NoYawa program to educate youth on sex uses Twitter. World Health Partners uses telemedicine to provide family planning to rural communities. These new technologies and media are gaining traction around the world and provide new opportunities to reach consumers directly.

National governments from Brazil to the Philippines to Ethiopia are influencing product availability on the ground. Free distribution of contraceptives is flooding the public sector, increasing availability. Some product is leaking to the private sector, but this is not expected to impede private sales dramatically. More importantly, governments continue to erect regulatory barriers which slow or stop the import of improved technologies or products that offer more competitive prices; registration of new pill formulas remains stalled at the Indonesian Ministry of Health, for example, while in India, the entire category of implant contraceptives is still banned by the government.

New contraceptive products offer innovative ways to increase uptake of family planning. A new hormonal IUD is now available with a second model nearing completion. The Sayana Press 3-month injectable contraceptive, which can be self-administered, presents an exciting opportunity to expand use of this method. The Gates Foundation has awarded grants to develop a new condom in the coming year and products like the Origami condom are nearly ready for manufacturing.

Medical abortion drugs remain a game-changer, inexorably altering the reproductive health landscape. In the USA, Planned Parenthood North Carolina reports nearly 50% of its terminations are provided with mifepristone / misoprostol. The trend is echoed in international social marketing organizations, which sold 1.8 million combination packs of the drugs (and another 16 million misoprostol tablets) in 2012. However, research is needed to learn how these medical abortion drugs are being used. In India and Egypt, sales of the drugs appear to exceed the possible number of abortions.

Economic and social trends bode well for increased family planning. Real incomes have risen 30% in Africa and even more in Asia over the last 10 years. Rising incomes bring improvements in education, better healthcare, and falling birthrates. With increasing urbanization and the cultural shifts that accompany it, including delayed marriage and childbearing, we can expect to see a greater demand for family planning.

These are some of the areas where we expect to see exciting developments in 2014. What are your predictions or comments?