PRB

The March 2022 edition of PRB’s Youth Family Planning Policy Scorecard evaluates the favorability of 28 current national policy and program environments for youth access to sexual and reproductive health services. The Scorecard allows users to quickly assess the extent to which a country’s policy environment enables and supports youth access to and use of family planning through the promotion of evidence-based practices. Users can explore the digital interface and self-select countries to compile their own Scorecard!

Globally, 25 percent of the world’s population—1.8 billion—are youth (ages 10 to 24). This large and diverse group will shape demographic, economic, social, and political futures and should be the focus of investments to help them and their countries achieve their potential. The highest proportion of young people today—89 percent—live in developing countries. In some sub-Saharan African countries, where fertility remains high, we can expect growing cohorts of children and youth, unless fertility needs can be met.

Addressing the sexual and reproductive health of this large youth population is critical to support their universal right to health—including access to contraception—and to contribute to efforts to expand education, provide meaningful employment, and reduce poverty. This brief, funded by USAID under the PACE (Policy, Advocacy, and Communication Enhanced) project, discusses the advantages and challenges of providing LARCs—specifically contraceptive implants and intrauterine devices (IUDs)—to youth, and provides case studies from Ethiopia and Madagascar. It also outlines actions for policymakers and donors to make youth access to LARCs a reality.

Remote rural communities in developing countries typically face the related challenges of extreme poverty, poor health, and environmental degradation. And population growth often exacerbates these challenges. In communities that face environmental challenges along with high fertility and high maternal and child mortality, health programs that include family planing can have great benefits for the health and well-being of women and families, with positive influences on the local environment. Meeting the reproductive health needs of women and ensuring environmental sustainability by connecting family planning with environment programs has proven to be a “win-win” strategy. Yet this connection has often been seen as controversial or irrelevant to environmental policymaking.

While more developed countries have low populations, they have much higher per capita consumption and resource dependence. However, developing countries, with their faster rates of population growth, are contributing a growing share of CO2 emissions, due to rapid deforestation which releases large amounts of carbon dioxide into the atmosphere. The United Nations Development Programme’s 2011 Human Development Report pointed out that developing countries face a double burden of being more vulnerable to wider environmental challenges such as climate change but also having to cope with immediate environmental problems such as resource depletion and poor water quality.

This is where family planning comes in. Expanding family planning is a response to an existing need, and it gives women autonomy and equity. A study analyzing data from 2008 found that unintended pregnancy accounts for up to 41 percent of all births worldwide.¹ According to UNFPA, it is “the factor in population growth most amenable to program and policy interventions.” In addition, over 200 million women worldwide have an unmet need for family planning. Researchers estimate that the demand for contraception will grow by 40 percent over the next 15 years.² The context of family planning has shifted from population control decades ago to individual rights. And the impetus for programs is coming from local communities and developing countries.

Two programs in rural communities in sub-Saharan Africa show how conservation and environmental initiatives can help extend the right to reproductive health care to women and communities that are remote and well beyond the range of existing health care systems. These programs show the overlapping benefits attained when responding to the needs of local communities, improving environmental sustainability, and ensuring women and families’ health.

Improving Access to Family Planning in Democratic Republic of Congo

The World Wildlife Fund, through partnerships with local nongovernmental organizations and the Ministry of Health in the Democratic Republic of Congo, is working to improve access to family planning in rural areas with existing conservation programs to give women more autonomy to limit their births and improve maternal and under-5 mortality.

Focusing on Salonga National Park in central Democratic Republic of Congo, the projects began with women reporting no access to family planning services. After decades of civil war, the women were completely beyond the reach of government and other aid organizations. The closest health center to either give birth or access other health services is up to 30 kilometers away and has few personnel, very limited equipment, and often no medicines. Because of this challenge, the programs focus on training community-based health workers who distribute contraceptives and provide guidance and counseling in rural villages. Public awareness campaigns, based on face-to-face dialogue, focuses on the benefits of family planning on women’s health and income and how these benefits extend to children, families, and the entire community. Women with access to family planning services will know how to space births, have the time to recover from childbirth, and have the strength to work in their own businesses or in agriculture, leading to more income.

Working with local communities to help women gain access to family planning influences the local environment. Since mainly women collect wood and work in the fields, their health affects conservation activities. In these programs, local women participate in land management training and learn about family planning. As a result, women are healthier to participate in conservation activities, decreasing the population pressure on the environment. Through working with the local community to respond to their needs and ensuring access to reproductive health, new opportunities have opened up to work more closely together on conservation as well.

Meeting Unmet Need and Ensuring Sustainable Fishing in Rural Madagascar

Madagascar is an environmental treasure in the Indian Ocean off the coast of Eastern Africa. The island is home to 5 percent of global biodiversity and 80 percent of its flora and fauna are found nowhere else in the world. Yet it also ranks as a “least developed country,” with GDP per capita at US$438. Its population of 21 million is one of the fastest-growing in the world and is projected to reach 29 million by 2025. Maternal mortality is extremely high, with 469 deaths per 100,000 births, and only 29 percent of married women are using modern contraception.

But these national-level figures mask disparities. In Andavadoaka, a coastal area in the remote southwestern part of the island that depends on fishing, fertility rates are higher than the national average. Women average six to seven children each, and there is little access to reproductive health care or education; the closest facility that provides reproductive health care is 50 kilometers away through a desert. High fertility and unmet need for family planning is stressing the environment. Growing demands for resources are outstripping supply. In one area, the number of fishermen has almost tripled from 535 to 1,510 in 20 years. And in 2011, 60 percent of the fish caught were juveniles, a trend that points to unsustainable fishing practices.

Blue Ventures, a UK-based marine conservation organization dedicated to conservation, education, and sustainable development in tropical coastal communities, started a marine conservation program in the area to support sustainable resource use. The Velondriake program, “to live with the sea,” covers an area of 640 square kilometers and is the first and largest locally managed marine area in the western Indian Ocean.

In 2007, Blue Ventures opened the first regional family planning clinic and by 2011, 40 villages were covered by multiple sites. The clinics focus on “reaching the hardly reached” through involving the local community in peer-led education campaigns, group discussions, educational films, and community events such as theater, sports, and cultural activities. As a result, contraceptive prevalence has risen from under 10 percent in January 2007 to almost 35 percent by January 2011, and the fertility rate has fallen by about one-third since the start of the project.

To learn more about these joint family planning and environmental health programs, watch an interview with Bob Engelman of Worldwatch Institute on how family planning can benefit the environment; and an interview with Vik Mohan of Blue Ventures on how remote fishing communities benefited from both family planning and conservation programs in Madagascar.

Eric Zuehlke is web communications manager at the Population Reference Bureau.

References

1. Susheela Singh et al., “Unintended Pregnancy: Worldwide Levels, Trends, and Outcomes,” Studies in Family Planning 41, no. 4 (2010): 241-50.
2. UNFPA, “Family Planning and the Environment: Stabilizing Population Would Help Sustain the Planet,” accessed at www.unfpa.org/rh/planning/mediakit/docs/new_docs/sheet3-english.pdf, on Jan. 3, 2012.