Effective use of birth control alone could eliminate the 47,000 maternal deaths caused each year by unsafe abortions, and thereby reduce worldwide maternal mortality rates by 13 percent, according to a series of new research papers published in the Lancet.
In fact, use of birth control could save the lives of 104,000 women and infants each year overall. Every one percent rise in contraceptive use could mean avoiding 4.3 maternal deaths for each 100,000 live births each year.
“Vaccination prevents childhood mortality, contraception prevents maternal mortality,” said Saifuddin Ahmed, lead author of a study on contraception and averting maternal deaths.
“The substantial effect of contraception on health is often overlooked by medical specialists,” commented John Cleland, lead author of a paper on contraception and health in the Lancet series.
Unmet demands
The demand for birth control is especially large and unmet in sub-Saharan African countries. According to the new research, more than 25 percent of married women in sub-Saharan Africa had unmet birth control needs in 2009, a figure twice as high as the global average.
“One in four women in sub-Saharan Africa would wish to delay the next pregnancy or stop childbearing altogether, but they’re not using any method of family planning,” added Alex Ezeh, lead author of a study on population trends and policy options.
Between 6,000 and 8,000 women in each country were asked whether family planning options were available to them, and ideally how many children they would plan to have, Ezeh told theGrio. Results were that women in sub-Saharan Africa would have planned for at least one fewer child than the current average of five children they have now.
Planning families
Launched in advance of the London Summit on Family Planning, the Lancet examines how family planning policies affect maternal deaths globally, as well as wider issues of population trends, climate change, economic development and human rights.
In addition to contraception and birth control — namely, condoms, pills, injectable and barrier devices — family planning services include providing information, counseling and access to safe abortions and post-abortion care.
Research evidence about the public health benefits of birth control and family planning services is receiving growing recognition and shaping global health policy. Yet, making marginalized women’s voices and choices central to provision of family planning services remains a challenging, but key aspiration of the summit.
“If this is to work, then we need to have women as central to this… central to the decision making,” urged Theo Sowa of the African Women’s Development Fund. “Women have to be the core. We have to hold ourselves accountable to the women of the world in this initiative.”
The London summit does show that political support for family planning programs is more forthcoming than ever from governments around the world. Robust research about the benefits has led governments, public health advocates and pharmaceutical giants to endorse family planning as a vital public health tool.
“Every 6 minutes a woman will die in childbirth. How many minutes do we want to wait?” asks UK Prime Minister David Cameron, “I say we don’t wait at all.”
Summit commitments
Global leaders united in setting a goal to ensure access to contraception for 120 million women in the world’s poorest countries by 2020.
African government heads of state, including Malawian President Joyce Banda, Rwandan President Paul Kigame, Tanzanian President Jakaya Kikwete and Ugandan President Yoweri Musevini, all affirmed their commitment to expand access to family planning services and contraception for their citizens to reach this goal.
Pledges were made from U.K. and Norwegian governments, as well as from the Bill and Melinda Gates Foundation, that funding for family planning in developing countries will be doubled to meet the goal. Commitments were also made by Bloomberg and pharmaceutical companies Merck and Pfizer.
The financial target to secure $2.3 billion at the summit was exceeded with pledges of nearly $2.6 billion to date; more pledges will be needed to meet the $4.3 billion estimated cost of the 2020 goal.
But the anticipated benefits of providing comprehensive family planning services will not be seen immediately. Over the last 5 years, Rwanda has increased family planning and birth control access for women by 30 percent to over 50 percent. But, clear and robust evidence of reduced maternal mortality is unlikely for at least another 5 years.
“You can’t measure change in a very short period of time” said Ezeh. “[But] I believe that over the next 5 to 8 years we will be able to see the impact of increased access on reductions in maternal mortality [in Rwanda].”
Controversy to consensus
“The reason [birth control and family planning] hasn’t been on the global health agenda is because of the controversy on either side of the issue. So we have kept it off for well over 30 years,” reflected Melinda Gates of the Bill and Melinda Gates Foundation. “We haven’t served 200 million women that are saying they want access to contraception because of the controversy.”
In order to make the initiative work, Gates added, we’re finding the consensus, and making clear what we can achieve by offering contraceptives to women. Access for 120 million women could mean 15 million fewer abortions over the next 8 years and provide welcome news to both sides of the abortion debate.
Despite the controversy, consensus around family planning issues in the U.S. is a reality according to Suzanne Ehlers of Washington D.C.-based Population Action International.
“Ninety-one percent of Americans think women should have access to contraception…. Conservative critics of contraception overplayed their hand,” said Ehlers referring to political incidences that occurred earlier this year.
“[They] misjudged the American public’s passion and appetite around an issue which is supporting again women’s wellbeing, independence and empowerment.”
Of both the United States and the global picture on family planning, Ehlers stated “there’s no controversy here, there’s so much consensus on this issue.”