Want to Talk about Family Planning? Reach Out to Your Local Mayor
“I can’t believe it’s so small!”
I will never forget the reaction of one of the mayors in Rwanda during an advocacy workshop on family planning as we passed around a variety of modern contraceptive methods, inviting participants to open, touch, and feel them. It was his first experience holding an intrauterine device (IUD). He also had never touched a female condom or seen a contraceptive implant.
Our project had designed a series of workshops including hands-on, tactile experiences for mayors of all of the country’s 30 districts. We wanted the mayors to leave with a better understanding not only of the benefits—both health and economic—of family planning, but also of the point of view of the women and men in their communities. This was back in 2007.
What happened next?
After the workshops, and with ongoing advocacy work with parliamentarians, journalists, local community-based organizations, and others, mayors started investing more of their own budgets in high-impact maternal and child health services—including family planning. This, among other initiatives, contributed to Rwanda’s unprecedented increase in the rise of the percentage of women who chose to use modern contraception from 10% in 2005 to more than 40% by 2010.
We also collaborated with the Ministry of Health to train hundreds of health workers in contraceptive technology and counselling to ensure free and informed choice, and helped create secondary health posts in communities to offer modern contraception where it had not been previously available.
Women stood in long lines when they first heard about the availability of contraceptive implants at their local health centers. It turns out that there was a significant latent demand for modern contraception. When family planning services and contraceptives became available at all levels of the health system, women showed up.
What do mayors have to do with family planning?
According to the United Nations, 66% of people around the world will be living in urban areas by 2050—2.5 billion more people than today. Ninety percent of this increase will be in cities in Asia and Africa. Despite increasing urbanization, the poorest and most disadvantaged people living in cities rarely have adequate access to health information and services.
Providing access to a wide variety of contraception choices for the more than 220 million women who currently can’t get the method they would like to use—or have no access at all—would save the lives of hundreds of thousands of women and babies.
Advocating to public officials is essential. Not just at ministries of health and finance but at all levels governments. It’s essential to ensuring continued investments are made at the country level. And mayors are a great place to start.
Empowering civil society members and coalitions to hold their governments accountable for providing family planning also isn’t optional. Since 2011, IntraHealth International has been working throughout West Africa through the Strengthening Civil Society Engagement for Family Planning initiative, helping countries create strong coalitions that are holding their governments more accountable—and empowering youth ambassadors to amplify their voices about family planning and the world they want to create.
Just this past February, mayors from 10 countries in West and Central Africa came together in Dakar, Senegal, for the launch of The Challenge Initiative’s (TCI’s) West African francophone hub, which focuses on urban areas in the French-speaking countries in the region. The mayors spent a day visiting sites—mosques, health centers, and more—in and around Dakar in which IntraHealth has, with support from the Bill & Melinda Gates Foundation, worked to increase access to modern contraception over the past several years. Participants then came together for a two-day workshop to learn more about family planning and TCI, capped by an official launch ceremony.
Let’s get fiscal
TCI focuses on mayors as powerful actors in unlocking resources to support high-impact family planning practices, improving the well-being of the populations they serve and the economic development of the municipalities they govern.
We know that family planning is a “best buy,” and that every dollar spent on family planning results in reductions in child and maternal deaths, returns in savings in other development areas, environmental benefits—and social and economic growth.
At an annual cost of only $25 per woman of reproductive age in the developing world—or $7 per person—family planning produces a return on investment of $150 back on every dollar spent in improved health, productivity, environmental, and social impact, as documented by the Guttmacher Institute.
A group of leading economists associated with the Copenhagen Consensus Center also conducted a cost-benefit analysis in 2014 of the proposed Sustainable Development Goals (SDGs) targets and goals and rated investment in sexual and reproductive health as “phenomenal”—among the top 13 out of 169 SDG targets.
Mayors and other local government officials who understand the broad health and development returns of family planning investments are more likely to become family planning champions.
Yes, an individual IUD might be “so small,” but its potential impact, when multiplied by millions, is huge.
IntraHealth’s advocacy work in Rwanda was part of a William and Flora Hewlett Foundation-supported initiative to help create a more enabling policy environment for family planning at all levels of governments and throughout civil society, supporting the Ministry of Health and the USAID-funded five-year Twubakane Decentralization and Health Program in its family planning work.
Strengthening Civil Society Engagement for Family Planning is an ongoing IntraHealth-led initiative also funded by the Hewlett Foundation and currently being expanded through a grant from the Dutch government.
TCI is a three-year urban reproductive health program funded by the Bill & Melinda Gates Foundation and managed by the Bill & Melinda Gates Institute for Population and Reproductive Health at the Johns Hopkins Bloomberg School of Public Health. TCI was designed to respond to the growing reproductive health needs of those living in urban areas, providing seed funding and advocating for municipalities and their partners to invest in high-impact family planning interventions.