Family planning and the post-2015 development agenda.

Family planning improves the health and overall well-being of women and families around the world. In 2010, a summary of the evidence showed family planning’s connection to all eight Millennium Development Goals.1 A multitude of stakeholders have since advocated for family planning to be prioritized within the next global development agenda. These calls have come not only from the reproductive health community but also from heads of state and key decision-makers in developing countries, global policy-makers, major funders and groups representing and serving women around the world.2–5 Simultaneously, the international community has shifted its focus towards a post-2015 development agenda that widens the lens from primarily micro-level social development to include macro-level economic, sustainability and governmental objectives. As the development framework becomes broader, the extensive ripple effect of family planning’s benefits remains clear. Evidence made available since the published summary in 20101 continues to confirm that family planning has an impact on global goals that will remain after 2015 – e.g. poverty reduction, gender equity, and improvements in education, health and environmental conservation.6–8 It is also clear that access to family planning has a beneficial impact on several of the newly proposed global development objectives. For example, with regard to sustainable livelihoods and job growth, family planning programmes can reduce unwanted fertility in resource-poor settings. This, in turn, allows women greater opportunities to participate in paid employment and to increase their productivity and earnings.2 Furthermore, when women are employed or have more control over household incomes, they tend to spend more than men do on food, health, clothing and education for their children and this expenditure can generate improvements in household nutrition, health and education.9 Family planning can also help catalyse accelerated macro-economic growth. It does this via the period created when a country’s young dependent population is smaller than the productive, working-age population. Known as the demographic dividend, this scenario helped produce the “East Asian Miracle”, when between the late 1960s and early 1990s some countries in east Asia experienced rapid economic growth. In just one generation, these countries achieved impressive advances in overall standards of living and development which were, in part, the result of accelerated investments in voluntary family planning programmes. National and local social tensions may also be reduced by family planning, leading to more peaceful and stable societies. Leaders in foreign policy have repeatedly acknowledged the influence of fertility rates and population growth on the security and stability of fragile states.10 Indeed, countries with the most rapid population growth are typically the poorest and most volatile countries – i.e. countries that offer the fewest opportunities for their large youth populations. The stress that rapid population growth places on a country’s economic, environmental and social resources can serve as a trigger for social unrest or political upheaval. Family planning programmes help reduce that stress. Investment in family planning is a best buy for development. The United Nations11 has estimated that, for “every dollar spent in family planning, between two and six dollars can be saved in interventions aimed at achieving other development goals”. Yet persistent delays in the strengthening of family planning programmes are inhibiting important potential demographic dividends and development gains – particularly in Africa. To capitalize on the window of opportunity presented by the post-2015 development deliberations and to ensure that the promising momentum behind movements like FP20203 reach their full potential, four things must happen. First, broader political buy-in and support are essential. Awareness must be raised – among decision-makers and development planners at the highest level – on the potential impact of family planning on social, environmental and economic goals. Second, we must invest in new research on contraceptive technology and service delivery. Third, we need to commit to the scale-up of existing – and under-used – evidence-based practices for effective family planning policies and programmes. Fourth, we need to move beyond the status quo for improving programmes and embrace innovative entry points for the delivery of family planning. Models for integrating family planning into microfinance, agricultural and environmental projects have already proven to be feasible, acceptable and effective.12 By ensuring that universal access to family planning is included in the post-2015 development agenda, we can accelerate progress and fulfil our promises to the next generation.