Contraception – Population Matters-USA

What if every woman in the world had access to her choice of safe, effective contraception? So far, this is a dream, but two programs are helping this dream come true.

In the past, only members of the rich elite had access to family planning (at least among English-speakers). Francis Place in England (1823) and Margaret Sanger in the USA (1916) brought Family planning to disadvantaged people. Sanger is accused of having racist or classist motivation, but Place, a revolutionary thinker, was a commoner. He learned how the rich controlled their fertility and spread that knowledge through a series of pamphlets. Both of these pioneers realized that limiting a couple’s fertility would be likely to improve their well-being.

The London Summit on Family Planning in 2012 was organized to continue Place’s work, on an international scale. People gathered in London from 120 countries and included doctors, social scientists and financial donors who came up with an international program, Family Planning 2020 (FP2020). In those few years between 2012 and 2020 they hoped to provide 120 million women (and men) with contraceptive information and supplies.

One of UN2020’s initial concerns was that it not coerce people to use contraception, as happened in China and India. Social scientists drew up rules to try to avoid any semblance of coercion—all motivation had to be strictly voluntary. Thus, there would be no undue incentives nor any quotas. These steps would help ensure that all adaptors of contraception did so without pressure. In the organization’s own words, it “…is a global movement that supports the rights of women and girls to decide—freely and for themselves—whether, when, and how many children they want to have.” It is amazing that FP2020 functioned in some very patriarchal societies in Asia and Africa.

The governments of more than 30 of the world’s richer countries pledged money to support FP2020. Major funding included the US Agency for International Development, the Gates Foundation and the United Nations Population Fund. Although FP2020 worked in some of the least wealthy countries in the world, each of the 69 countries where they provided care also had to provide some funding.

The Covid 19 pandemic started just as FP2020 was ending. Despite the risk of spreading the virus, the program found ways to deliver high quality reproductive health care. The program was able to continue its outreach using strict precautions.

How successful was FP2020? The program fell short of its ambitions goal. The final tally is that it increased the number of modern contraception users by 46 million. Nevertheless, this is a pretty amazing feat! An impressive way of measuring the program’s success is that it doubled the number of users in 13 African countries. The use of modern contraception in these poor countries is estimated to have prevented millions of unsafe abortions and over a hundred thousand maternal deaths. What intervention could be more humane?

Because populations were growing rapidly where FP2020 worked, the need for family planning increased faster than FP2020 could reach potential users. It is estimated that the number of women of reproductive age grew by 15 million each year! That is the challenge for the program that succeeded FP2020, unsurprisingly labeled “FP2030”. The successor has more local direction and less management from donor countries, and has expanded to 82 countries. Funding is its biggest problem, unfortunately, especially since some funders have reneged on promised donations. FP2030 is directing its focus on adolescent pregnancy. If a woman is empowered by modern family planning when she is young, it is likely that she’ll be a lifelong user.

There is a success story here. The teen pregnancy rate is already dropping globally, thanks to programs such as FP2020 and FP2030.

The really bad news is that we have elected a misogynistic felon with a narcissistic personality disorder. Even worse news is that people have fallen for Trump’s lies.

There’s some good news, despite lots of disappointments. In my state, Colorado, almost 2/3rds of voters chose to amend our constitution to guarantee the right to safe abortion care. In addition, the state will start paying for abortions for women who are state and local government employees, and for those on Medicaid.

The state to our north, Wyoming, had abortion laws preventing almost all abortions. In November, a Wyoming judge ruled that the laws were against that state’s constitution. She wrote: “The abortion statutes suspend a woman’s right to make her own health care decisions during the entire term of a pregnancy and are not reasonable or necessary to protect the health and general welfare of the people.” Although the state will probably appeal this decision, for now women can obtain safe, legal abortion care in Wyoming.

Public health scientists have identified several causes why young children don’t flourish. Children may not do well if pregnancies are too close together. We also know that if a mother really, really doesn’t want to carry a pregnancy, but is forced to give birth, that the child may not fare well. Do children who result from unintended pregnancies also suffer?

“Yes” is the sad answer. Researchers looked at Demographic and Health Surveys from developing countries. Surveyed mothers rated their births as being desired, mistimed or unwanted. The endpoint of the research was infant mortality—the death of the child before age one year of age. What they found is that children whose pregnancies were described as unwanted or mistimed were more likely to die. This finding held for 41 of the 60 countries studied. Moreover, the effect was stronger in poorer, less educated places.

Unfortunately, there are over 120 million unintended pregnancies globally each year. These findings are the bad news. The good news is that now there is proof that contraception decreases infant mortality in impoverished areas.

Unfortunately, there is concerning news about two of the Long-Acting Reversible Contraceptive (LARC) methods. DepoProvera, has been associated with an increased risk of users developing meningiomas. These are benign tumors of the membranes covering the brain. Meningiomas are more common in women, and have been found to have receptors that respond to female hormones. However, the risk of developing a meningioma is very, very small, and it is still very small for users of Depo.

There are four IUDs containing a hormone. In addition to providing excellent contraception, they make periods less painful and lighter. Fortunately, they don’t seem to increase the risk of meningioma, but the latest information is that they may increase the risk of breast cancer.

It will take more studies to confirm (or refute) these concerns about LARCs causing tumors. In the meantime, it is the right of women to know of these possibilities. However, the risks of morbidity or mortality from pregnancy exceed by far the likelihood of a problem caused by any contraceptive method, if used properly. For women who desire long-term reversible birth control, the ParagardÒ IUD is a hormone-free LARC. It can provide excellent protection for 10 years—or possibly even longer.

Since the Dobbs decision, many states have made it very difficult to access safe abortion care. Furthermore, unintended pregnancies cause problems if the mother is forced to carry to term. Taken together, these facts make it all the more important to increase the availability of contraception.