The Road Ahead: Discussing the Future of Family Planning at the FP2020 Reference Group Meeting

By Dr. Natalia Kanem, Executive Director of UNFPA, and Dr. Chris Elias, President of the Global Development Program for the Bill & Melinda Gates Foundation

Prior to the Reference Group meeting, FP2020 hosted a reception for the DC-based family planning community to meet Reference Group members.

The Family Planning 2020 (FP2020) Reference Group provides leadership and counsel to the global family planning partnership created in 2012 to fulfill the London Summit promise made by world leaders: that by 2020, our collective efforts will enable an additional 120 million women and girls in the world’s lowest income countries to use voluntary modern contraception. For two days this April, we convened in Washington, DC, to talk about the future of this partnership we’ve built together.

We’re 25 members strong, representing diverse backgrounds and perspectives from governments, donors, civil society organizations, multi-lateral institutions, young people, and the private sector.

This particular meeting had special significance, because it was our first opportunity to hear feedback from the broader family planning community captured through the post-2020 global consultation, including results from the recent survey circulated among our partners about the future vision for this movement. Our agenda also included planning for the impending results of the ECHO trial (Evidence for Contraceptive Options and HIV Outcomes), and championing the incorporation of family planning within the growing Universal Health Coverage (UHC) movement and benefits packages.

This agenda was ambitious, and primarily focused on the future. A discussion about the ECHO trial results — scheduled to be released in mid-July — made it clear that preparation will be vital. The United Nations Population Fund (UNFPA) and the World Health Organization (WHO) are working closely with governments and civil society at a country-level to ensure ECHO coordination mechanisms are established. FP2020 and AVAC are co-leading a civil society engagement strategy across the family planning (FP) and HIV communities to raise awareness about the trial and provide communications and links to advocacy tools in support of trial preparation efforts. Many partners are contributing — working together to make sure the trial results are understood through a lens of informed choice, and that actions taken in light of the results support women’s access to a range of HIV prevention, treatment, and contraceptive options.

Perhaps the most memorable portion of the ECHO discussion were presentations by two African sexual, reproductive health and rights (SRHR) advocates, Yvette Raphael from APHA South Africa and Jhpiego’s Angela Mutunga from Kenya. They reminded us the risks women face in their sexual and reproductive lives are deeply personal. Yvette rightly pointed out that, “No woman just has HIV. Or just needs family planning. There is just one woman with many needs.”

Looking beyond the ECHO trial, we are fast approaching the original end date of the FP2020 partnership: December 2020. A discussion on data prompted a key question: knowing what we know now, was the 120 million additional users of family planning by 2020 goal unrealistic? This sparked a lively discussion. We believe this specific and ambitious goal was the reason we bent the curve and accelerated progress for family planning. While we won’t reach our goal by 2020, progress is 30 percent above the historic trendline, which is a remarkable achievement. Further, many countries are on track to achieve the goals they set for themselves in their ambitious FP2020 commitments. Our overarching goal compelled us to collaborate — to form a strong, diverse partnership. It garnered resources and interest and moved us to be more inclusive of other sectors beyond health. Our vision to achieve the 2030 goal of universal access to family planning should be no less ambitious, and we will use all that we have learned from FP2020’s data to assist countries to set specific milestones and measures of progress on that path.

A similar discussion took place around how to integrate family planning into the UHC and primary health care frameworks. WHO’s Ian Askew reminded us that family planning has an advantage because it’s embedded within two of the Sustainable Development Goals, unlike other global health issues. As we all know, there are life-threatening consequences if family planning is not included in UHC schemes; there is no development without girls and women. And we must elevate the economic benefit argument so that family planning is included in the list of interventions driven by real value.

The second day of the Reference Group meeting was devoted to the post-2020 consultation discussion. It was led by consultants from Deloitte and based on the responses of more than 1,000 stakeholders. We learned the top identified vision themes included sustainable access, equitable access, and normalization of family planning. Integration of family planning into primary health care and UHC frameworks also came out as a top priority. Other major themes that emerged included supporting country implementation, youth engagement, establishing country commitments, accountability mechanisms, effective advocacy, and a focus on rights and empowerment.

We look forward to sharing a more complete analysis of the global consultation and the vision for next steps with the community during a special session on post-2020 at Women Deliver that will be hosted by FP2020.

During a session led by youth reference group members, Manasa Priya Vasudeven of YP Foundation India and Andrew Mbencho Millan, MD, of Youth Health International Cameroon, we heard many of the ideas young people have about their greater inclusion in the current partnership and recommendations to improve the partnership beyond 2020. Young people are interested in seeing and shaping national commitments that are transparent and grounded in evidence, and they are passionate about holding their governments accountable for these commitments. They reminded us of the necessity to build the next generation of family planning leaders to ensure sustainability of the partnership. Additionally, they argued the value of an adolescent responsive health system that promotes coordination and facilitates access to key information and services instead of the current system which is fragmented, piecemeal and siloed. Further, they pointed out that the term “family planning” does not resonate with unmarried sexually active adolescents, who are using contraception and not planning their families, and suggested that programming for youth be driven by language and content that appeals to their reality. Andrew and Manasa were also joined by Professor Robert Blum from Johns Hopkins University who presented preliminary and compelling findings from the Global Early Adolescent Study. Professor Blum urged the group, as they begin to think beyond 2020, to consider the importance of 10–14 year olds as their experiences and vulnerabilities at home and in the community (both positive and negative) are critical antecedents to the ability of older adolescents to adopt heathy practices and behaviors. It is increasingly evident that FP2020 should identify ways to assess other outcomes beyond birth rates, to incorporate additional measurement of these essential antecedents to poor SRH outcomes, such as rates of early marriage, school enrollment and completion, and personal safety, and to quantify and qualify meaningful youth engagement.

Chilufya Hampongo, Yvette Raphael, Dr. Natalia Kanem, and Ninabina Davie at the Washington, DC reception celebrating the launch of the UNFPA SWOP Report 2019.

Clearly, there is much to do as we head toward one finish line, and a new starting point. This Reference Group raised as many questions as it answered, pushing us to create a new vision for the partnership that is more inclusive, more strategic, with more accountability mechanisms, among other priorities. We will continue to be thoughtful. And we will not lose sight of those global moments that are on the horizon that demand a coordinated response from all of us.

So what comes next? We’ll share the outcome of the global consultation with you all in June, and based on your response, we’ll craft a vision for the future of FP2020 to be launched during the ICPD25 Summit in Nairobi in November. That vision will guide our partnership through any transition in 2020, as we launch a revitalized partnership toward 2030 later next year. We continue to believe that transparency of the work of the Reference Group is integral to its success, and we are happy to share with you details of the work we are doing.

FP2020 Reference Group members, Washington DC