I Choose to Celebrate
To be honest, I’m never quite sure if World Population Day is meant to be a day of commemoration or of celebration. Many will take the day to reflect on the losses that we have experienced in the past year and the many areas where humanity can improve. This year especially, with the COVID-19 pandemic continuing, there are plenty of things to commemorate — the ongoing loss of life, the lack of access to vaccinations around the world, the impact of climate change that we see in droughts and rains that exacerbate the economic hardships brought on by the pandemic. Plenty of issues contribute to the world being a tough place to live and the need for humanity to work together.
On the other hand, there are also positive forces making the world a better place. Scientists have developed numerous COVID-19 vaccines at an unprecedented speed — increasingly, those vaccinations are finding their way into more and more countries, helping millions of people avoid future infections. International collaboration is improving the lives of countless people through better agriculture, health, and technology. And from the perspective of family planning and reproductive health, we see tremendous reasons to celebrate: more women are using modern contraception than ever before, youth have stepped into the spotlight and are contributing to the global dialogue, and universal health coverage and the inclusion of family planning is gaining traction. Are the world’s problems solved yet? No. Are we seeing progress? Yes! And in that “yes,” I find a reason to celebrate World Population Day 2021.
More women are using modern contraception. According to the latest data available from FP2020, more than 320 million women are using modern contraception in its 69 priority countries — an increase of almost 3 percent from the year before. Related trends confirm that the unmet need for family planning has gone down and the demand for family planning, satisfied with modern contraception, has increased. So why should you care about these positive trends? Because they mean that more women can have the number of children they want and are able to exercise autonomy over a vital aspect of their lives. I’m optimistic that these trends will continue to improve because efforts like Health Policy Plus are working behind the scenes to make these advances happen. We have worked in Madagascar to support a new family planning law that abolished the colonial requirements of spousal consent and no access to contraception for unmarried women that persisted since the 1920s. We are working in Bangladesh and Nepal to support the implementation of policies to better engage men in family planning. And we are exploring blended financing opportunities to mobilize additional funding from donors and private investors to support family planning programs.
The burgeoning role of youth. Regardless of which definition of youth you consider, the number of young people around the world is staggering. It reminds me that if global efforts like the Sustainable Development Goals are to be achieved, youth need access to quality education to prepare for responsible employment; quality health services to avoid unintended pregnancies, HIV, and sexually transmitted infections; and “soft skills” to help them effectively navigate their environment, relate well with others, and achieve their goals. Global rates of teenage pregnancy are decreasing, but often it is the most vulnerable young women who become pregnant because of a poor understanding of reproduction and poor access to contraception. So, what do I see as the good news? That my colleagues are working with young people in West Africa, Malawi, and Guatemala to strengthen their leadership and communication capacity to address issues like youth-friendly health services, unintended pregnancy, and maintaining access to essential services like family planning during the COVID-19 pandemic. I continue to be impressed with the seriousness and knowledge that young people who are involved in national and global family planning initiatives demonstrate. With a seat at the table comes the responsibility to represent and deliver to the people they represent — and I see that happening skilfully.
Universal health coverage that includes family planning. Universal health coverage remains an elusive concept to many of us — myself included. I think of it as a patchwork quilt of national, state, or community-level health insurance programs that assure all people have access to basic healthcare — especially preventive care. It’s an important concept because each year, 100 million people are driven into poverty because of out-of-pocket health expenditures. Yet in many countries, the nascent efforts at universal health coverage exclude family planning. One reason for family planning’s exclusion is that some see family planning as a well-funded donor priority, not necessarily a national budget imperative. Given the health benefits of family planning to women and children through birth spacing, it is surprising that there is any question about including family planning. However, of USAID’s 24 family planning priority countries, only 14 operate some form of government-sponsored health insurance, and of those 14, only six government-sponsored health insurance schemes include family planning in their benefits package. Even among those six, the benefit may not be fully implemented.
So how do we improve this situation and ensure that family planning is covered by more insurance programs? Work supported by Health Policy Plus in Kenya and Nigeria provide guidance to help make this happen. Kenya’s Mama Linda program provides antenatal and delivery care, as well as family planning, to all women free of charge. Nigeria’s state-level health insurance schemes also include a selection of family planning methods as a means to improve access to contraceptives through its national universal health care initiative. The combination of evidence to make the case for family planning’s inclusion, advocacy to win over decisionmakers, and persistence among champions all contribute to the policy changes that were required for these programs to happen.
There are plenty of things that could be better on World Population Day 2021, but I try to stay optimistic and focus on the progress and accomplishments that we are observing. Whether you see the glass half full or half empty, at least we have a glass to fill. Identifying the challenges that we face is an important first step to improving a situation. The combination of data and our subjective experiences help us uncover areas that need improvement. The progress we see in the uptake of modern contraception, youth engagement in family planning issues, and the expansion of universal health coverage to include family planning result from working together to make the case and find consensus among diverse stakeholders. As we look down the road to World Population Day 2022, I’m optimistic that we will continue to see progress. In the meantime, let’s focus on where we are going and find reasons to celebrate the small victories every day!
