Former Program Director
PRB recently announced its public commitment to a global family planning (FP) movement—the FP2030 partnership. We stand strongly committed to a future in which every woman and girl can make an informed decision about whether and when to have a child. And we know that our work over the next eight years can advance sound policymaking and evidence-based programming in ways that will improve the quality and equity of the care women and girls around the world receive when they seek contraceptive services.
Collaborating with colleagues and partners to draft over the last few months has given me a unique opportunity to reflect on my own experiences and commitment to ensuring access to contraceptives for all as a critical component of women’s rights and bodily autonomy. I want to share three personal reflections on seeing myself in a global movement through PRB’s work.
I had just finished work on my master’s degree when I first learned about the launch of FP2020. The London Summit’s rallying cry to increase access to contraceptive information and services captured my attention.
As a young woman rapidly exiting my 20s circa 2012 when FP2020 launched, access to and use of modern methods of contraception had already made a big difference in my life. I am a white woman living in a high-income country with access to considerable privileges, yet the concept of unmet need for family planning was also personally familiar to me at that time. Shoddy student health insurance plans limited the methods that I could afford. I frequently spoke with friends or acquaintances who weren’t consistently using a modern method of contraception even though they didn’t want to get pregnant for reasons ranging from infrequent sex to fear of side effects, illustrating the complexity of unmet need. And, of course, I had switched methods more times than I cared to remember—depending on health care access at different times of my young life, my partners’ preferences, side effects… so many reasons.
These experiences stopping or switching contraceptive methods are common. PRB’s growing body of work on contraceptive use dynamics uses data to illustrate the complexity of contraceptive use as a critical aspect of women’s health. Our work identifies important patterns in method starting, stopping, and switching across geographies and women’s reproductive lifespans that are influencing policy decisions that better respond to women’s preferences. For example, our original analyses have shown that in low- and middle-income countries, contraceptive discontinuation accounts for 35% of unintended pregnancies and occurs at higher rates among youth ages 15 to 24.
Technical analysis, like our contraceptive use dynamics work, is central to PRB’s FP2030 commitment. Technical and policy analyses provide policymakers with the information they need to make informed decisions. Such analyses can also help individuals better understand their own experiences so they can demand equitable access to higher quality of health care for themselves and their communities. Over the next eight years, PRB will deepen understanding of family planning data, including national, subnational, and regional variations and trends, and shed light on complex family planning topics such as the dynamics of contraceptive use, comparability of family planning policy environments, and the interactions between fertility and development outcomes such as educational attainment and labor productivity.
I’ve been lucky enough to speak to people from all over the world and different walks of life about their sexual and reproductive health. The most meaningful conversations have been fluid and far-ranging, recognizing the many layered factors that shape the experiences of individuals, communities, and nations worldwide. The deep meaning in these conversations derives from the fact that none of us lead single-issue lives, and our sexual and reproductive health exists within relationships, social and cultural contexts, and systems.
The best of PRB’s policy advocacy and communications work is contextualized within these complex social and political systems. For example, PRB and Organization of African Youth Kenya (OAY Kenya) produced a package of materials directly responding to recent events and contextualized within the Kenyan political environment to highlight the need for the Ministry of Health and county leaders to prioritize youth family planning needs during public health emergencies such as the COVID-19 pandemic.
PRB’s FP2030 commitment describes how we will provide tailored, flexible support to partners undertaking family planning policy advocacy initiatives and those raising the visibility of critical issues through effective strategic communications. Our national and subnational civil society partners are experts on the complex social and political environments within which they work, and we commit to equitable, transparent, and mutually beneficial partnerships that advance locally defined goals and priorities. Through these context-specific initiatives, we commit to working at the intersections—connecting and galvanizing family planning policy communities and building bridges across geographies and between sectors We also commit to learning from our partners—and from our mistakes—to increase our effectiveness and equitable impact.
Not everyone understands the connection between the desire to chart the path of one’s own life and global efforts to expand access to voluntary, rights-based family planning as a direct one. Yet, at its core, family planning is about self-determination. It’s about choosing whether, when, and how many children to have; the freedom to act on that choice; and the ability to act free of discrimination, coercion, and violence. Given its heavy focus on ensuring access to services, the global family planning community sometimes loses sight of preventing and ending reproductive coercion. Early in my career, I counselled women whose partners sought to control their reproductive outcomes and health as part of a pattern of exerting power and control. Reproductive control is frighteningly common and can take many different shapes. Reproductive justice is its antidote.
The FP2030 partnership upholds person-centered and rights-based approaches, and PRB affirms that rights, equity, and inclusion must be central to everything we do. PRB acknowledges that multiple and often intersecting systems of power grant privilege and access unequally, and these systems influence all sections of our work, including our family planning work.
PRB leverages data and analysis to illuminate dimensions and drivers of inequality and summarizes evidence to define policy changes and investments needed to ensure inclusivity. For example, The Future of Family Planning in Africa examines the relationship between family planning, fertility trends, and socioeconomic inequality both between and within countries in sub-Saharan Africa. Recognizing the discrimination and barriers that women and young people with disabilities face when trying to exercise their rights, PRB developed a multimedia presentation that describes the necessary policy changes and investments needed for women and young persons with disabilities to fully realize their sexual and reproductive health and rights and be protected from gender-based violence.
As part of our FP2030 commitment to equitable partnerships and inclusive programming, PRB will continue to use data and evidence in ways that advance reproductive justice by illuminating inequity, promoting inclusivity, and elevating the voices and diverse experiences of those most affected by reproductive control and injustice.
What comes naturally to many of us at PRB is a tendency to place emphasis on data and evidence over personal stories, and yet we all carry deep commitments to health and equity. Working on PRB’s FP2030 commitment with colleagues and partners has reminded me that direct and indirect connections exist between our lived experiences and the available evidence and—whether we reflect on it daily or not—it’s clear to see that the global family planning movement is personal.