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In the world there are 1.9 billion women of reproductive age (between 15 and 49 years old), of whom 842 million use contraceptive methods and 270 million want to control their fertility with modern and reliable methods, but cannot.
The Association for Family Planning 2020 (FP2020) works with governments, the private sector, donors and civil society with one goal: to contribute to meeting this unmet demand.
A right.
Beth Schlachter has served as its director since it was created in 2012, a position she will soon leave after completing her mission.
"It is not about forcing women to use contraceptives, but that they are available to them and they can use them if they choose."
In eight years, 60 million more have started using them in the 69 countries of the Global South where FP2020 works.
"It is a lot, but it is not enough," he acknowledges.
It is, in fact, half of the goal they set then: 120 million additional users.
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And this was before the pandemic.
Family planning services were interrupted in 68% of the countries, and 9% reported that the stoppage was complete, as revealed in a follow-up survey by the World Health Organization in August 2020. “Now, the COVID-related interruptions can lead to an additional 15 million unintended pregnancies, ”remarks Anita Zaidi, head of the gender division at the Bill and Melinda Gates Foundation.
In the Asian and sub-Saharan African countries where FP2020 operates alone, 320 million women claim to use modern contraceptive methods - pills, injections, implants, condoms, IUDs - according to their recently released annual progress report, with data through July 2020. The effort to maintain this advance cannot wane, warn its promoters, while the female population of reproductive age continues to increase.
According to his calculations at a rate of 15 million a year in all the territories in which he works.
“Women want to control their reproductive life, but with the right methods, with all the information to choose what works best for them according to their biology, their relationships, their life… And it is a complicated task to make them available to everyone everywhere ”Schlachter says in a video call.
Ensuring supply is one of the main problems that FP2020 has encountered.
“Much work has been done on it, even before our association, so that there is also access to a variety of contraceptives, short and long term.
But not all health systems have the capacity or qualified personnel to implement some of these methods.
Some do not even have a legal framework that allows it, ”he continues.
For this reason, one of the legs of its work consists of political advocacy and technical support so that governments acquire commitments in this area and can fulfill them.
Girls sometimes use contraception when they are not married, but when bonding, there is a rule that they have to prove they are fertile and have very young children
Beth Schlachter, Director FP2020
The other great challenge is "to break down the social and religious beliefs and norms", in Schlachter's words, that prevent women from exercising their right to say how many children to have and when.
“These resistances have to be tackled one by one.
It is very important to prevent unwanted early pregnancies and also child marriage.
Girls sometimes use contraceptives when they are not married, but when they bond, there is a rule that they have to show that they are fertile and have very young children ”, explains the expert.
Just guaranteeing the supply is not enough.
Without information and awareness work, he says, there will be no long-term progress.
"You can achieve a breakthrough and take these methods to all parts of the world and that women do not use them because they do not know them, because they are not allowed in their relationships or in their societies."
In practice, these awareness-raising projects are translated into talks under a tree, in neighborhood meetings, in explanatory brochures with drawings, in boxes with wooden penises with which to learn how to correctly put condoms or plastic vaginas in which to observe where an IUD is inserted.
This informative work is carried out by so-called defenders or activists, also community health agents trained for the case, and even expert nurses who advise, resolve doubts and dispense contraceptives in remote areas.
Uganda is one of the countries supported by FP2020.
The total rates of fertility, maternal mortality and teenage pregnancies there are still among the highest in the world, they warn from the entity.
The African country pledged in 2012 to ensure that all Ugandan women can choose when and how many children to have.
“The Government of Uganda is striving to expand its reach and delivery of services and method mix, including long-acting, reversible and permanent methods,” describes its file on file with FP2020.
In 2016, Uganda was one of four countries in which 300,000 doses of the injectable contraceptive Sayana Press (supplied at low cost by Pfizer, with support from the Gates Foundation) were distributed.
FP2020 marks it as a milestone among the family planning measures implemented in the country.
To do this, a group of community health agents were deployed, usually women trained in sexual and reproductive health, who community by community, explained the different methods to small groups, including the new injection.
Some false beliefs about contraceptives in rural and traditional areas of developing countries are that they nullify libido or cause infertility
In one of those talks, which Planeta Futuro attended as part of a group of media invited to witness one of these activities live, the users who came both to obtain information and the contraceptives themselves asked if taking them will reduce their libido and showed their fear of side effects.
Certain myths such as that causing sterility circulated around the place.
Once corroborated with the experts that only vasectomies and tubal ligation have permanent effects, and that even these methods would not prevent relationships, some women came to ask for the injection.
An option that they preferred, as they expressed it, because it was more durable (three months) than other options such as pills - which avoided having to travel to a clinic every month to collect them - and invisible to the eyes of their husbands in case of not having your permission to control your fertility.
Uganda's ultimate goal was to reduce the proportion of women who are not meeting their need for contraceptives to 10% and increase the prevalence rate of their use to 50% by 2020. It has not been successful.
In both cases there have been advances, but they have stayed halfway, with 30% in both indicators.
However, the greatest progress in this area among the countries studied by FP2020 has been achieved by Africans.
Despite the fact that most of the funding for family planning is concentrated in five Asians, says Schlachter.
According to their data, 13 countries have doubled the number of women using modern contraceptives, 14 have added more than a million new users, and 17 have achieved Sustainable Development Goal 3.7 of guaranteeing universal access (availability) to health services sexual and reproductive health, including family planning, information and education, and the integration of reproductive health into national strategies and programs by 2030.
However, the eagerness to highlight the positive, as an encouragement to continue the battle, is soon muted by reality. “This is a tough and constant battle.
Progress is achieved step by step, but there is a lot of resistance, setbacks, and now an economic crisis… ”, alerts Schlachter.
Covid-19 has emerged as a real threat to women's rights, especially sexual and reproductive rights.
A UNFPA report warned in April 2020 that some measures to combat COVID-19, such as confinement and the closure of clinics due to lack of material and personnel, would leave 47 million women without access to contraception in just the six first months.
In the absence of corroborating these data, for which various initiatives have already been promoted, organizations testify to the problem.
In addition to the lack of supplies, social and religious norms, and the difficulties that the pandemic has added to make family planning services accessible, we must add a final obstacle: scarce funding.
“There is very little funding for contraceptive-related programs in Africa.
That has to change.
But if you look at the economic situation in these countries, which has worsened with the covid, as well as that of consumers, neither one nor the other have the resources for these products, ”explains Schlachter.
In this sense, the expert recalls that the United States Agency for Development Cooperation (ASAID) and UNFPA provide 70% of the articles for Africa.
“What it reveals to us is that the governments of the continent do not have to pay for them themselves or they decide not to prioritize them because they know that donors will do it.
There must be a change and that leaders value women's rights, their reproductive autonomy and invest in it.
This transformation is very difficult to achieve ”, he says.
"Expanding access to contraceptives and family planning programs is one of the most cost-effective ways to break the cycle of poverty," Zaidi defends by email.
“More girls stay in school, women have more freedom to work outside the home, earn an income and contribute to the economy.
Fewer die from unsafe abortions or pregnancy-related complications.
More children survive childhood and communities benefit, as parents can dedicate more resources to the health and education of their children, preparing them for a more productive future, ”he lists.
In the opinion of the Gates Foundation specialist, "gender inequality is not a problem that we can ignore, especially in a pandemic."
She is optimistic that change is possible and hopes to spark concrete commitments at the Generation Equality Forum, organized by France and Mexico, together with UN Women, which will bring together governments, the private sector and civil society partners to engage with ambitious and specific actions to promote gender equality.
"It will be the most important call on gender equality in a quarter of a century," he remarks.
So far, the United States has not waited for the appointment to take a small step forward: President Joe Biden repealed the so-called Gag Rule (the gag rule), which prevents foreign organizations that receive US aid from using their own money to provide information about abortion or termination of pregnancy.
What ends up affecting the programs of the organizations that promote the sexual and reproductive health of women in developing countries, so dependent on American aid.
FP2020, which was born with an expiration date as its name suggests, reinvents itself in 2021 to continue its still necessary task.
The entity that Schlachter has run from Whasington will be established on four continents, with centers piloted by local staff.
“They don't need us to tell them what to do, they know it very well,” he concludes.
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