Politics in action: the case for family planning
Assimwe Rehema has lived in rural Uganda around Bwindi Impenetrable National Park all her life. When she was a child, the fertility rate in her community was 7.10 births per woman. Many families had difficulty affording school fees for all their children or providing medicine when a family member fell ill.
Today, however, life for many women in Bwindi is changing. Contraceptive use has risen from 20 percent to 60 percent in the past ten years. This success can be partially attributed to the partnership between Conservation Through Public Health (CTPH) and FHI360 to train Village Health Teams (VHTs) to deliver Depo Provera, an injectable contraceptive that prevents pregnancy for three months.
Rehema was part of one of the first VHTs trained by CTPH and FHI360. She continues to work today as a member of a Village Health and Conservation Team (VHCT) — an expansion of VHTs pioneered by CTPH — to provide primary healthcare and educate her community on the importance of conservation.
There is a direct connection between family planning and conservation efforts in Uganda. Population pressure, exacerbated by poverty in communities around Bwindi Impenetrable National Park, often leads to illegal poaching and use of park resources for fuel and food. Soloshot, a new technology developed by the global health nonprofit PATH, is transforming the way the contraceptive Depo Provera reaches women.
The SoloShot syringe automatically disables after one injection and cannot be reused, making it safe and feasible for VHCTs to administer Depo Provera. SoloShot is a simple tool, but it is also symbolic of the much larger forces that shape global health today. It began with a problem — how to reduce unsafe injections. Through a public-private partnership, multiple collaborators including PATH, the World Health Organization, US Agency for International Development (USAID), and the American medical technology giant Becton Dickinson, made this technology a reality.
Once the technology was developed, partners had to ensure that SoloShot was affordable and accessible to the people who needed it the most, such as those living in rural communities in Uganda. This required advocating for U.S. Congress to fund family planning programs and leveraging USAID’s desire to increase injectable contraceptives in developing countries. It also required advocating for the Ugandan government to pass a law that enables VHCTs to deliver injectable contraceptives in their communities, which can significantly reduce the time women spend traveling to health centers to receive the injection.
The research and development (R&D) of new and improved health technologies is critical for improving wellbeing in low- and middle-income countries. The process is not black and white — why would a company invest in making a technology where they will see very little profit? To overcome this lack of profit incentives, non-profit organizations share the financial burden with private-sector partners and the U.S. government. The U.S. government has historically been the largest funder of this work, in part because organizations and individuals advocate for U.S. investment in global health R&D. Without these investments, along with an environment that encourages innovation through funding and partnerships, SoloShot may have never come to fruition.
Advocacy campaigns resulted in SoloShot being produced on a massive scale, not only for injectable contraceptives but also for vaccination campaigns. With funding from USAID, FHI360 partnered with CTPH to train VHCTs to provide injectable contraceptives. Today, women are better able to access modern family planning methods, including long-term contraceptives. Instead of traveling hours to the nearest health center, they can receive the injections they need in their own communities.
Thanks to investments in global health R&D, there have been more advancements in simple technology to deliver contraceptives. Recently, PATH has rolled out programs to introduce Sayana Press — an injectable contraceptive that can be easily administered by VHCTs or by a woman herself. The initial pilot programs have been successful, and very soon, the same VHCTs who learned how to administer SoloShot could be teaching women in their communities how to use Sayana Press.
Now, more than ever, we need to advocate for effective, evidence-based policies that empower families to choose whether and when to have children.
This is the real, tangible impact of advocating for policies and funding for global health programs. Despite working in advocacy and policy for nearly three years in Washington D.C., I only really understood the impact of the policy process when I met with VHCTs. The process can be confusing and convoluted, but its implementation means that today, VHCT member Francis can provide family planning directly to women in Mukono parish in southwestern Uganda. What’s more, he is dispelling many of the myths about contraceptives (not least of which is that they cause infertility) among men in his community.
Now, more than ever, we need to advocate for effective, evidence-based policies that empower families to choose whether and when to have children.
Amy Roll is a 2016–2017 Global Health Corps fellow at Conservation Through Public Health in Uganda. She previously worked on the Policy and Advocacy Team at PATH.
