The contraceptive revolution: focused efforts are still needed

March 2013,Online Library;Impressive reductions of up to 29% in maternal deaths may be expected from satisfying unmet need for contraception, as shown in a recent analysis covering 172 countries (Ahmed et al. 2012). Despite the cost-effectiveness of family planning (Prata et al. 2010), investments remain low (Osotimehin 2012), a concern declared under Goal 5 on the UN Millennium Development Goals website, ‘Inadequate funding for family planning is a major failure in fulfilling commitments to improving women’s reproductive health.’ Alongside investment and political commitment, clear indicators for the coverage and quality of family planning services are required to design and implement strategies to improve family planning. However, the evidence used in planning and monitoring of family planning is often suboptimal and poses a serious problem for effective, efficient responses to scale up these services.

The 2012 London Summit on Family Planning signalled renewed interest in this important intervention by the global community. Large investments were pledged and ambitious targets of access to contraception for 120 million women and girls by 2020 were set. This has also prompted the Alliance for Reproductive, Maternal and Newborn Health to work with WHO and development partners to facilitate a prioritisation of the family planning research agenda. With a view to informing these discussions, we were commissioned by the Australian Agency for International Development (AusAID) to identify the key knowledge gaps for evidence-based planning and budgeting for family planning.

As part of a multicountry initiative working with policy makers to effect a more rational use of resources for reproductive, maternal, newborn and child health (Jimenez-Soto et al. 2012), we collated the data necessary to inform local decision-making on scaling up family planning services. Our work highlighted major evidence gaps that have the potential to undermine efforts to plan and invest in family planning and interfere with monitoring progress. The seven leading knowledge gaps identified are outlined in this short paper and provide an essential ‘front-line’ perspective to inform research priorities for effective scaling-up of family planning. We draw on examples from our study sites in four countries: two districts and two cities in Indonesia, two provinces and one city in the Philippines, three clusters of districts in Nepal, two districts in the Indian state of Orissa and two districts in the state of Uttar Pradesh. We believe that this view from the front line provides a much-needed link between global agendas and the realities of implementation at a local level.

 

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