ICPD+15: The Kampala Roadmap to Access
01/23/2010
15 Years after ICPD and on the heels of Kampala, Ward Cates on the roadmap for reproductive health
The common vision of universal access to reproductive health, education and reductions in maternal and child mortality have yet to be realized. ©Wendy Stone/FHI
The International Conference on Population and Development (Cairo 1994) brought together faith leaders, clinicians, researchers, program managers and government officials. They united around a common vision of universal access to reproductive health, education (with a focus on girls and women), and significant reductions in maternal and child mortality. On the 15th anniversary of that conference, Secretary of State Hillary Clinton reaffirmed the United States' dedication to the "Cairo commitments" while recognizing we have not yet reached them.
Besides being one of the Cairo commitments, universal access to family planning is also key to achieving each of the eight Millennium Development Goals. In November 2009 the first International Conference on Family Planning in Kampala, Uganda, reaffirmed this. Secretary Clinton's words today remind us that we must widely disseminate the lessons learned since Cairo and to continue the momentum created in Kampala. As Khama Rogo of the World Bank put it, "We wouldn't consider a child health program without immunization. How can we think about women's health without family planning?"
What did we learn in Kampala and, most importantly, what do we do now? Let's start with what we learned. Three themes framed much of the dialog:
• Family Planning and the MDGs: Rights-based family planning choices - where individuals are empowered with knowledge and supported to determine their own reproductive intentions, free from coercion - are important to achieving all eight Millennium Development Goals.
• Evidence-Based Policies: A comprehensive body of evidence has demonstrated the effectiveness and cost effectiveness of family planning in advancing women's education, child and maternal health, HIV prevention, and environmental sustainability.
• African Ownership: African leaders were urged to aggressively promote family planning at home, because without such ownership, we cannot achieve universal access.
For the opening plenary on the final day of the conference, I presented "10 pearls of wisdom" that I saw emerging from the scientific presentations. I think they may help us answer the question of how we might turn the lessons from Kampala into actions.
1) Promote National Family Planning Policies: Family planning is essential for achieving the Millennium Development Goals. To do this, beginning in 2000, the contraceptive prevalence rate needed to increase an average of 1.5 percent per year in countries with large levels of unmet need. This increase did not occur, and now national family planning policies and programs need to compensate by immediately facilitating access to effective contraception for women who desire it.
2) Increase Contraceptive Demand: Many countries still rely heavily on "short-term" contraceptive methods requiring adherence to daily or coitally-related regimens. These methods are less effective than longer term alternatives, and they require a regular supply of contraceptives. We need to increase use of longer term methods, including implants and IUDs. This is achievable - one 15-country initiative to increase demand and train providers led to 200,000 IUD insertions in one year.
3) Increase Access to the Latest Contraceptive Technologies: Widespread availability of less expensive long-acting methods, such as the Sino-implant and subcutaneous DMPA, is imminent. Additional improvements to current products, including easier-to-use barrier methods and low-cost vaginal rings, will also soon be available. (An added benefit of the ring technology is its potential to provide protection against HIV.)
4) Improve Community Participation in Service Delivery: Communities need to play a stronger role in the design and implementation of family planning programs. Their buy-in is critical to supporting novel contraceptive distribution approaches. Successful service delivery models use multiple strategies to achieve access, including community-based distribution workers, integration with maternal and child health and HIV programs, and effective use of advocacy and media.
5) Improve the Supply Chain: Increased collaboration among multiple funders of family planning is improving delivery of commodities and reducing stock shortages. Systems to assess need and track contraceptive pipelines and creative financing systems are also removing barriers to access.
6) Increase Family Planning and HIV Integration: After years of advocacy, FP/HIV integration is finally reaching a "tipping point" of wide acceptance. The challenge is to demonstrate that the costs of integration are lower than costs of maintaining separate points of care. We saw that this has worked in Uganda, where family planning was shown to be both effective and cost effective in preventing mother-to-child transmission of HIV.
7) Increase Family Planning and Other Integration: Postpartum IUD insertion by trained midwives was successfully integrated into urban clinics in Zambia. And in Tanzania, immunization clinics have effectively provided contraceptive counseling and dissemination. Applying lessons and replicating and scaling up successes, we must simplify health systems and consolidate services.
8) Expand Financing Options: We must increase the resources devoted to family planning. Options for creative financing of programs should be further explored, including public-private partnerships, franchising, and multi-tiered pricing.
9) Engage Men in the Family Planning Dialog: Vasectomy is among the most underutilized contraceptive method. While the term "family planning" may not resonate with men, they have shown openness to the evidence that smaller families may support improved economic stability and better health. Engaging men in family planning needs to be made a priority. As women do not conceive alone, neither should they bear the entire responsibility for family planning.
10) Improve Program Harmonization, Collaboration and Ownership: Fractured programs and incomplete coverage result from a lack of communication and a lack of ownership. Neither is excusable.
The challenge has been made and we know what to do. Now it is time to deliver. Working together with global, national and local leaders, we can and we must expand rights-based reproductive choices to address unmet contraceptive need. The cross-cutting influence of reducing unintended pregnancies will accelerate progress toward our Cairo commitments and achievement of all eight MDGs.
Ward Cates Jr, MD, MPH is president of research at Family Health International.
Thanks for these pearls Ward. It is indeed a new day for family planning and reproductive health, as Secretary of State Hillary Clinton’s comments today reinforce.
— Karen Hardee on 2010-01-08
let us not forget a gender and intercultural perspective and youth empowerment…. especially the latter too are practically invisible in the MDGs, more so, from a youth rights perspective. evidence-based advocacy in this area is critical.
— maria raguz on 2010-01-08
it is the one of the best document, it is because it cover all the ideas we had in the conference. keep it up
— urama bertrand chijioke on 2010-01-09
I could not agree more with Maria Raguz’s comment. Youth are all too often lost in the middle ground between programs that target adults and those that target children. Youth face a unique mix of challenges that demand a tailored evidence-based response, one that empowers them as decision-makers.
— Hannah Burris on 2010-01-15