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Access to safe, voluntary family planning is a human right. Family planning is a key factor in reducing poverty. It is central to gender equality and women’s empowerment.

In East and Southern Africa, there has been significant progress in national family planning programmes in the past few decades, but serious challenges remain. Despite a decrease in fertility rates in countries in the region, they remain at a relatively high average of 4.8 children per woman of reproductive age.

Four countries in the region have reached low fertility levels (Mauritius, Seychelles, Botswana and South Africa), at an average of 2.4 children per woman of reproductive age. Fertility has started decreasing in four more countries (Lesotho, Namibia, Swaziland and Zimbabwe), where the average is 3.3 children per woman. Fertility is high in the remaining 15 countries of the region (Angola, Burundi, Democratic Republic of the Congo, Comoros, Ethiopia, Eritrea, Kenya, Madagascar, Malawi, Mozambique, Rwanda, South Sudan, Tanzania, Uganda and Zambia), at an average of 5.2 children per woman.

Unmet need for family planning is also high, at 25 per cent, representing 49 million women who either use traditional family planning methods or no method at all yet wish to avoid pregnancy.

South Africa, Botswana, and Zimbabwe have successful family planning programmes. Other Southern African countries continue to experience extreme difficulties in achieving higher contraceptive prevalence and lower fertility. The reasons include socio-cultural factors, inadequacies in the service delivery systems (including human resource challenges), inadequate national investment in family planning, especially reproductive health commodity security. The high CPRs in Southern Africa may well be attributable to increased condom use as a response to the HIV & AIDS epidemic.

This means, therefore, that millions of people are unable to access family planning products and services. Large disparities also exist within countries due to poverty and barriers relating to age, sex, geographical location and marital status. There are a number of groups, such as adolescents, unmarried people, the urban poor, rural communities and people living with HIV who often face a combination of access barriers and rights violation, leading to high rates of unintended pregnancy; increased risk of HIV and STIs; coerced sterilization, limited choice of contraceptive methods and higher levels of unmet need.

These groups require particular attention to ensure their access to rights-based family planning and other SRH services.

Family planning saves lives

Individuals and couples have the right to decide the number of children they want and to choose the spacing of births. To achieve this, everybody should be able to get and use affordable, quality reproductive health supplies of their choice, whenever they need them. It means that there needs to be secure supplies of reproductive health essentials such as condoms, contraceptives and other medicines and equipment, as well as information and quality counselling.

Access to contraception saves lives, by preventing high-risk pregnancies, especially in women of high parities, and those that would have ended in unsafe abortion, increased contraceptive use has reduced the maternal mortality ratio by about 26 per cent in little more than a decade. About 30 per cent of maternal deaths could be avoided if unmet need for contraception is fulfilled.

Women with unmet need are defined as those who are fertile and sexually active but not using any method of contraception, and who report not wanting any more children or wanting to delay the birth of their next child. Unmet need points to the gap between women’s reproductive intentions and their contraceptive behaviour.

Family planning brings economic benefits

There are clear economic benefits to investing in family planning. For every dollar invested in contraception, the cost of pregnancy-related care is reduced by $1.47. Adolescent pregnancy has a lifetime opportunity cost – this measures the annual income a young mother misses out on over her lifetime. It ranges from 1 per cent of annual gross domestic product in a large country to 30 per cent of annual GDP in a small economy such as Uganda. 

Family planning can also help countries realize a ‘demographic dividend’, a boost in economic productivity that occurs when a growing number of people in the workforce is combined with a drop in the number of dependents.

Helping countries plan for their needs

UNFPA developed the Global Programme on Reproductive Health Commodity Security (GPRHCS) in 2008, following on from the efforts of the Thematic Trust Fund on Reproductive Health Commodity Security (RHCS), launched in 2004. This current fund is a framework for helping countries to plan for their own needs. Through this programme, countries can move towards more predictable, planned and sustainable country-driven approaches to securing essential supplies and ensuring these are used.

With support from GPRHCS, most countries in East and Southern Africa are implementing national strategic plans on RHCS. Additionally, 13 countries are implementing Comprehensive Condom Programming (CCP), which is a means to ensure that people at risk of sexually transmitted infections, including HIV and unintended pregnancies, are motivated to use male and female condoms, have access to quality condoms, get accurate condom information and knowledge, and use condoms correctly and consistently.

UNFPA's response

UNFPA in East and Southern Africa works to increase access to and use of quality family planning services for individuals and couples. The regional programme has strengthened its focus on family planning, including integration within comprehensive reproductive health services linked with maternal health care and HIV prevention. UNFPA focuses on evidence-based advocacy to increase national ownership of family planning programmes and essential reproductive health supplies.

UNFPA supports national partners in developing strategies to improve access to reproductive health and family planning services for marginalized and otherwise under-served populations, including through the Total Market Approach.

There is a need to increase demand for modern contraceptives through advocacy and engaging community-based and civil society organizations. Policies should focus on improving socio-economic conditions for families to have children, while ensuring family planning is always voluntary and never imposed. Non-judgmental and voluntary family planning services are essential particularly for women living with HIV and their partners, thereby decreasing the risk of mother-to-child transmission of HIV.