(February 2017) One year after the Zika global health emergency, World Health Organization (WHO) director-general, Margaret Chan, urged sustained attention to two important weaknesses in global health preparedness revealed by the Zika crisis—insufficient national mosquito control programs and poor access to family planning services.1

Zika was declared a global public health emergency in 2016 because the situation met several criteria:

  • The suspected link between Zika infection and a sharp rise in cases of microcephaly.
  • The ability of the virus to spread rapidly especially through widespread international travel.
  • The number of people potentially at risk because their daily environment was host to the Aedes mosquito species that carried the virus—half the global population.

Many women in affected areas were warned by their governments to delay or postpone pregnancy. Yet significant shares of women who were at risk did not have access to family planning services that would allow these women to avoid getting pregnant.

The United Nations Sustainable Development Goals (SDGs) for 2030 call for universal access to family planning. Progress is monitored through an indicator that measures the demand for family planning satisfied by modern methods. Targets for this indicator set the bar at 75 percent. In other words, a country should aim to reach 75 percent of women of reproductive age who want to avoid or delay pregnancy with modern methods of contraception. This measure, together with an indicator that measures unmet need for family planning, gives a good snapshot of whether a country’s family planning programs are healthy and strong. As Chan mentioned, shortfalls in this measure indicate weaknesses in global health preparedness.

Women Cannot Postpone Pregnancy Without Access to Family Planning

The table below shows the number of women of reproductive age in the countries and territories that have reported active Zika virus transmission according to the U. S. Centers for Disease Control and Prevention, and each country’s status on two indicators—unmet need and demand for family planning satisfied by modern contraceptives. In one-quarter of these Zika countries, demand satisfied is less than 75 percent.


TABLE
More Than One-Quarter of Zika Countries Do Not Reach Benchmark

All Countries and Territories With Active Zika Virus Transmission

# of Women of Childbearing Age

Unmet Need (%)

Demand Satisfied  (%)

Antigua and Barbuda

26,000

13.8

81.9

Argentina

10,804,000

9

----

The Bahamas

106,000

11.9

84.8

Barbados

68,000

16.0

74.3

Belize

99,000

17.8

75.8

Bolivia

2,748,000

18.0

50.4

Brazil

56,749,000

7.7

86.8

Colombia

13,203,000

8.2

83.0

Puerto Rico, US territory

927,000

6.0

81.5

Costa Rica

1,278,000

6.2

89.1

Cuba

2,755,000

8.7

89.4

Dominican Republic

2,739,000

10.7

83.1

Ecuador

4,227,000

9.1

75.1

El Salvador

1,744,000

11.9

77.9

Grenada

28,000

13.5

82.4

Guadeloupe

111,000

16.2

68.2

Guatemala

4,281,000

17.3

64.1

Guyana

193,000

26.5

60.9

Haiti

2,854,000

32.9

47.5

Honduras

2,212,000

10.6

76.5

Jamaica

753,000

9.7

83.1

Martinique

91,000

15.2

71.0

Mexico

34,528,000

10.5

81.0

Nicaragua

1,688,000

7.2

87.0

Panama

1,023,000

15.6

75.0

Paraguay

1,735,000

6.4

81.4

Peru

8,310,000

9.0

89.2

Saint Lucia

50,000

16.1

78.4

Saint Vincent and the Grenadines

28,000

12.7

79.4

Suriname

138,000

19.4

71.1

Trinidad and Tobago

353,000

19.0

63.4

United States

73,394,000

7.1

91.2

U.S. Virgin Islands

22,000

10.8

78.2

Venezuela

8,225,000

12.0

77.8

Note: Countries and territories with no data for the indicators were not included in the table.
Sources: Centers for Disease Control and Prevention, “All Countries & Territories with Active Zika Virus Transmission,” accessed at www.cdc.gov/zika/geo/active-countries.html, on Feb. 23, 2017; and United Nations (UN) Population Division, World Contraceptive Use (New York: UN, 2015).


Investments in Family Planning Critical for Women’s Health

The Zika emergency may have passed, but the family planning emergency has not. According to Family Planning 2020 (FP2020), an initiative to increase the share of women using modern contraceptives by an additional 120 million by 2020, the trajectory to meet global goals in family planning access was off course at the mid-point.2 Some countries are on track, but the global efforts have yielded almost 20 million fewer users than was hoped.

Haiti and Bolivia are two of the countries with reported Zika cases that are also focus countries for FP2020. Many countries in Latin America have done well providing family planning services to women of reproductive age, but these two countries fall far short of the 75 percent goal for meeting women’s family planning demand, at 47.5 percent and 50 percent respectively. Moreover, both of these countries are poor performers on measures of unmet need.

Global research suggests that meeting 90 percent of women’s unmet need for contraception could prevent 22 percent of maternal deaths, 22 percent of stillbirths, and 8 percent of child deaths around the world.3 In Bolivia, where two thirds of the country is covered by the Amazon rainforest that is host to the Aedes mosquito species, almost 20 percent of women had unmet need for family planning in 2015. Sustained attention to countries like Bolivia and Haiti are critical.

But sustained attention can only come with more commitment from country governments and the donor community. FP2020 is focused on country-level goals and challenges and has developed new tools that galvanize the data for better-honed strategies. Family planning advocates must secure the promises made by the world’s biggest donors, particularly now when that promise is threatened.


Heidi Worley is editorial director at PRB. Kristin Bietsch is a former research associate at PRB.

Notes

1. Margaret Chan, World Health Organization (WHO), “Zika: We Must Be Ready for the Long Haul,” Feb. 1, 2017.
2. Family Planning (FP) 2020, FP2020 Momentum at the Midpoint: 2015-2016 (Washington, DC: FP2020, 2016).
3. R.E. Black et al., “Reproductive, Maternal, Newborn, and Child Health: Key Messages From Disease Control Priorities 3rd Edition,” Lancet 388 (2016) 2811–24.