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Who will pay for accessible contraceptives in developing countries?

May 19, 2010

This post is part of a series leading up to the Women Deliver conference (www.womendeliver.org), a global meeting on maternal and reproductive health and the advancement of women and girls.

Reproductive health, therefore, implies that people are able to have a responsible, satisfying and safe sex life and that they have the capability to reproduce and the freedom to decide if, when and how often to do so.- World Health Organization

Photo via Marie Stopes International

Like most universities, mine is always touting ways to remind students of the free pills and condoms available whether in the sexual health office or the open-all-night help cabin. The local pharmacies are giving them away for free (in addition to selling them) as long as you can show that you’re a student. Heck, you can even pick up condoms in any pub around here for cheaper than anything. But as with the majority of perks that come with living in the Western world, it’s easy to take for granted the things that occasionally seem over-the-top, that are absolutely life-breaking elsewhere.

About 215 million women need effective contraceptive methods but can’t access it. Every year, about 536, 000 girls and women die from pregnancy related causes. Every year, about 20 million unsafe abortions take place. Though there are many organizations that exist for the sole purpose of distributing these contraceptives, it is not as straightforward as one would hope to ensure that this goal is met. One of the recurring problems is that contraceptives are delivered to the country’s capital city—not the developing parts that really need them. In fact, the Women Deliver conference is gathering voices in hopes of addressing issues like these.

Who should be held responsible? Who is responsible? Is it the government’s fault that the campaign to make contraceptives available for all is so ineffectively organized that they don’t even make the delivery target? Maybe, but if we blamed the government for everything and left it at that, we could guess just how much would get done. And attitudes like this don’t help the situation much either.

Now, consider this story: a couple of weeks ago, the Canadian government announced that it would not fund abortions even though it had made maternal and children’s health its centerpiece issue at the G-8 summit. Though some Canadians applauded the government’s decision—on the grounds that they didn’t want to be spending more of their taxes on foreign affairs—many others were perplexed by the seemingly contradictory decision. Canada’s opposition to abortion spending puts them at odds with Britain, the United States, and other G-8 leaders. In response (though Canadian foreign minister Lawrence Cannon claims she was merely expressing a personal view), Secretary of State Hilary Clinton stated that,

There’s a direct connection between a woman’s ability to plan her family, space her pregnancies and give birth safely and her ability to get an education, work outside the home, support her family and participate fully in the life of her community.

You cannot have maternal health without reproductive health and reproductive health includes contraception and family planning and access to legal, safe abortions. – Secretary of State Hilary Clinton

Granted, this is a big step forward considering the Bush administration conservatives, in yet another anachronistic jacket, wouldn’t even use the term “reproductive health services”. It is disappointing that Canada taking this somewhat conciliatory approach and is putting a limit on where they are directing their funding because Clinton’s right. If they aren’t looking at abortion (and unsafe abortions lead to about 68,000 deaths) then they aren’t looking at the full problem. This seems to sum up a lot of the issues surrounding the reproductive health effort. As I’ll illustrate in more detail further on, some donors are not thinking things through.

In Uganda, the executive director of Reproductive Health says they are turning away from short-term family planning methods to long-term planning methods but again, accessibility is still a big problem.

We need to promote commodity security for reproductive health supplies like family planning and increase uptake of long-term methods like Intrauterine Devices, implants and permanent methods which have been long ignored. – Elly Mugumya

He argues that Uganda’s maternal death rate (435 deaths for every 100, 000 births) would significantly drop if the government increased financial support for reproductive health. Again, if is the key word here. According to WHO (who sets the bar for the budget, that’s supposed to be allocated to health, at 15%), Uganda’s budget allocation is set at less than 10%. But the inability to secure proper funding isn’t Mugumya’s only concern. Much like organizations such as Marie Stopes International and the Reproductive Health Supplies Coalition, he believes that the system is in desperate need of an overhaul. Currently, whenever there’s an emergency, the immediate practice is in response to stock-outs but according to Mugumya, ‘replenishing contraceptives’ shouldn’t even be in their vocabulary. He fights for a system that is sustainable and won’t ever run into issues like depletion of supplies.

Organizations like MSI organize mobile clinics, rural outreach teams, and hold peer education programmes. In Afghanistan, they were able to work closely with government officials to make sure their services reached as many people as possible (435,000). What governments can learn from them is that they aren’t just throwing money and supplies at an area and hoping for the best; they apply strenuous research to monitor the quality and effect of their effort.

There is nothing explained to us, it’s just go through, what method do you want and if it’s an injection they will inject you. The nurses always look busy and we are afraid to ask questions. – Young woman, South Africa, Reproductive Health Journal study

In a study done by the Reproductive Health Journal, the authors discussed the reasons for restrictions on young women’s contraceptive choices across developing countries (limited knowledge, access, worries about fertility, and the low status of women). So maybe ‘who will pay for accessible contraceptives?’ isn’t the question we should be asking. As with almost anything in life, money means very little unless you know how to spend it. With that said, Marie Stopes International, Reproductive Health Supplies Coalition and many others are answering the more appropriate question of ‘how will we pay?’ by ensuring that WHO’s declaration of the right to reproductive health is upheld.

Facts and statistics gathered from WHO, UNFA, and Marie Stopes International.

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