World Population Awareness

How to Attain Population Sustainability


Before, we didn't know how to control pregnancy, we didn't have the education, and people in the area were having nine or ten children. We have 18 families and no one has more than three children. The health of the children and mothers has improved, and so has the spacing of babies. Everyone understands the importance of family planning now. Vincente Jarrin and Maria Juana Jarrin Malca, Husband and Wife Family Planning Promoters in Pasquazo Zambrano, Ecuador doclink

   Carl Haub - Population Reference Bureau

It took the US 200 years to go from 7 babies per family to two. "Bangladesh has done that in 20. Iran has more than halved its fertility rate in a decade." doclink


Before, we didn't know how to control pregnancy, we didn't have the education, and people in the area were having nine or ten children. We have 18 families and no one has more than three children. The health of the children and mothers has improved, and so has the spacing of babies. Everyone understands the importance of family planning now. Vincente Jarrin and Maria Juana Jarrin Malca, Husband and Wife Family Planning Promoters in Pasquazo Zambrano, Ecuador doclink

The Two Parts of Sustainability Are Consumption and Population


The world could possibly reduce consumption down to a very basic level, but if population keeps growing, eventually that will not be enough. Even today many are living on a sub-sustainable level, due in part to an uneven distribution of resources, but also because, in many regions, population has outgrown essential resources for that region.

When people feel threatened by a hand-to-mouth existence, they are more likely to look towards less-than democratic ways to reduce population, especially if they have the foresight to realize that population growth is like a run-away train, very difficult to slow and stop.

However, more and more evidence is showing that the methods that work the best towards reducing population growth, are the methods established by the principles of the Cairo Conference in 1994 (United Nations International Conference on Population and Development (ICPD) September 1994, Cairo, Egypt), which include: a. Empowering women and girls in the economic, political, and social arenas; b. Removing gender disparities in education; c. Integrating family planning with related efforts to improve maternal and child health; and d. Removal of 'target' family sizes. doclink

Population Progress

   October 6, 2004, Boston Globe

A United Nations report says poverty perpetuates and is exacerbated by poor maternal health, gender discrimination, and lack of access to birth control. This holistic view has helped slow the increase in world population. The average family has declined from six children in 1960 to around three today. The world's population is expected to grow by 39% over the next 45 years and births in the 50 poorest nations are estimated to rise by 228%. Education and improved health for women and access to contraception are vital. Smaller families are healthier families and improve the prospects of each generation. 201 million couples do not have access to contraception and if they could practice family planning, 22 million abortions, 142,000 pregnancy-related deaths, and 1.4 million infant deaths each year could be prevented. Since 1994 more women have access to education and other rights, and more early-marriage traditions are being opposed. Most countries have laws prohibiting violence against women, female genital mutilation, and other violations of human rights. doclink

End to Population Growth: Why Family Planning is Key to a Sustainable Future

   April 13, 2011, The Solutions Journal

by Robert Engelman ... We are far from a world in which all births result from intended pregnancies. Surveys show that approximately 40% of pregnancies are unintended in developing countries, and 47% in developed ones.

Over 20% of births worldwide result from pregnancies women did not wish to occur.

It is estimated that 215 million women in developing countries are sexually active, but don't want to become pregnant; in other words, they have an unmet need for family planning. For various reasons they are not using contraception.

If all births resulted from women actively intending to conceive, fertility would immediately fall slightly below the replacement level; world population would peak within a few decades and subsequently decline.

It is not expensive to help all women to be in fully control of the timing and frequency of their childbearing. The key obstacles are religious, cultural, and political opposition to contraception or the possibility of population decline.

More research and a public better educated about sexuality and reproduction could engender a global social movement that would make possible a world of intended pregnancies and births. doclink

The Best Way to Attain Population Sustainability

   Amy Coen, PAI, Vanity Fair LTE

What could we, should we actually do about human population growth? Can population trends be altered? If so, can they be altered without violating core human values about the worth of all human beings and the freedom of all to make decisions about their own childbearing? Does the idea of altering population trends lead inevitably to "population control," to walls erected to keep out immigrants, and to coercive policies on childbearing that punish poor women for environment problems that may be the fault of wealthy people living far away?

At the United Nations International Conference on Population and Development in Cairo in 1994, some 180 nations agreed with economist Amartya Sen that coercion has no place in any population program, whether it be a one-child policy, sterilization, forced marriage, forced childbearing, or forced sex. The Chinese, to their credit, are turning away from coercion and toward the approach that the United Nations Population Fund is the United Nations Population Fund is demonstrating, and groups such as Population Action International are advocating worldwide. This more democratic and comprehensive approach champions women's education and access to information and to reproductive-health to reproductive-health care. That care ideally includes not only contraceptives but also pre-natal and post-natal care, professional birth attendants, nutritional and child-care counseling, as well as H.I.V./AIDS prevention. doclink

Meeting the Cairo Challenge

   Family Care International

Policies based on population control are moving towards more people- oriented, reproductive health approaches. Although it takes time for policy and legal changes to benefit women and men at the community and household levels, such changes are a critical first step. Policies and laws are needed to hold health services courts, schools, and other institutions, as well as communities and families, accountable. As such, the policy and legal changes made since 1994 based on human rights, equity, and meeting people's needs--are central to fullfiling the Cairo Mandate. doclink

Empower Women for the Health of the Planet

   June 8, 2015, New York Times   By: Carmen Barroso

We cannot deny that environmental and reproductive justice are intertwined, or that reproductive justice has influence on the quality of life of women and families and on the sustainable health of the entire planet.

Providing family planning for those who want it could result in up to 29% of needed reductions in carbon emissions, scientists say. Voluntary family planning would also help our planet be more sustainable. However 225 million women lack access to modern methods of contraception.

Empowering women and promoting their right to choose what is best for them and their families is also one of the most effective pathways to reduce unintended pregnancies and improve maternal and child health. Providing access to [and information about] contraception would reduce the number of unwanted pregnancies by 70%, according to the Guttmacher Institute.

A woman who is able to decide if and when to have children and how many, tends to go further in school, is empowered as a decision-maker in her household and is more adaptable and resilient during times of hardship. She is more likely to invest money back into her family, her family is more likely to prosper and her community and our planet thrive because of it.

Investments in these sexual and reproductive health services have been slow in coming from the international community, even though the cost would be low. For example, in Latin America and the Caribbean only $31 per year would provide a woman with these needed services.

Upholding the human rights of women is essential in balancing both fears of so-called overpopulation and underpopulation. doclink

Population + Solutions

   April 1, 2015, Global Population Speakout (GPSO)

Note: this is a teaser only. Please click on the link in the headline to read the entire set of articles.

There is good news -- in the 21st century, solutions to the population challenge are many. They are progressive. They strengthen human rights and improve human health. They are things we should be doing anyway. And they contribute toward solving some of today's most pressing social and environmental challenges.

Improving the Stats of Women and Girls

How well a society treats its women is one of the strongest indicators of the success and health of that society. Discrimination against women and girls occurs in many forms - through gender-based violence, economic discrimination, reproductive health inequities, and harmful traditional practices ....

Primary and Secondary Education

Education is not only an obvious human right - but it is also an important demographic variable, influencing global population growth trajectories. There is a strong correlation between fertility decline, education, and socioeconomic development. Girls' secondary education is especially important because, among other things, ....

Family Planning Information and Services

Family planning, one of the greatest public health achievements in human history, allows individuals and couples to anticipate and attain their desired number of children and the spacing and timing of their births. It protects the health of the mother and the outcome of .....

Population, Health and Environment Programs

Population, Health, and Environment (PHE) programs offer an integrated approach to solving human development and conservation challenges through improving access to health services - including family planning and reproductive health - while also helping people improve livelihoods, manage natural resources, and conserve the critical ...


Entertainment-education (EE) is any form of communication that is designed to entertain and educate audiences simultaneously. Entertainment-education has existed for thousands of years in the form of parables and fables that promote social change. Modern forms of entertainment-education include television productions, radio soap-operas, and ....

Public Discourse, Campaigning, & Activism

"Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it's the only thing that ever has." So said Margaret Mead, a leading feminist whom Time magazine once named "Mother of the World." When it comes to the issue .... doclink

10 Reasons Why Investing in Women and Girls is So Vital

   July 9, 2014, Global Citizen   By: Leticia Pfeffer

70% of the 1 billion poorest people are female. These women are disproportionately affected by discrimination, violence, and exploitation. Too many are deprived the opportunity to an education and to basic health care services.

The great news is that investing in girls and women makes economic sense. If the world educated, empowered, and kept all girls and women healthy, we would lessen extreme poverty and build healthier, wealthier, and more educated communities.

1. Studies show that women reinvest up to 90% of their incomes back into their families, compared to just 30-40% by men. Mothers provide better nutrition and health care and spend more on their children. Investing in women and girls creates long-term social and economic benefits for all individuals, their communities, and the world as a whole.

2. 31 million girls in the world don't have the opportunity to pursue an education. Every day, they are taken out of school and forced to work or marry. One out of five girls in the developing world doesn't even complete the sixth grade.

Educated girls and women are healthier, have the skills to make choices over their own future and can lift themselves, their communities and their countries out of poverty. Even one more year in school makes a difference. A girl's income will increase by up to 25% every year she stays in school. If India enrolled 1% more girls in secondary school, the country's GDP would rise by $5.5 billion.

3. 222 million women today lack access to family planning services, information and contraception. If we doubled investment in family planning, we could reduce unintended pregnancies by 68%; avert newborn deaths by 35%; reduce unsafe abortions by 70%.

For every dollar spent on family planning, governments can save up to 6 dollars on health, housing, water and other public services. Family planning enables millions of girls to stay in school, saves lives and has the capacity to lift entire communities out of poverty.

4. Each year, an estimated 16 million girls aged 15-19 give birth. Only 35% of unmarried girls and women in developing countries use a modern method of contraception -- so most teen pregnancies are unplanned. Girls who become pregnant are forced to leave school and are prone to high health risks, such as HIV, obstetric fistula, and complications during pregnancy. The number one cause of death for girls is childbirth.

By delaying teen pregnancies, girls are able to stay in school, invest in their futures and have healthier children when they are ready. If all young girls completed primary school, we could save 900,000 of their children each year. And if those girls got a secondary education, we could save three million lives.

5. In a given year, approximately 300,000 women die from complications related to pregnancy and childbirth. Maternal mortality is much higher in poor communities and rural areas. 99% of all maternal deaths occur in developing countries.

When women have access to health services and information by skilled health professionals during pregnancy and childbirth, this can make the difference between life and death -- for the lives of women and their newborn babies.

6. 14 million girls are married before the age of 18 every year. In the developing world, poverty and traditional gender roles magnify this problem. 1 in 7 girls is married before age 15, and some child brides are married as young as 9 years old.

When girls have the opportunity to complete their education through secondary school, they are up to six times less likely to be married as children than girls with little or no education. Educated girls are also less likely to have unintended pregnancies as teenagers.

7. Women work two-thirds of the world's working hours, produce half of the world's food, but earn only 10% of the world's income and own less than one percent of the world's property. On average, women earn half of what men earn.

In order to achieve gender equality, women and men must have equal employment opportunities and receive equal pay.

8. Women are a central part of the solution to ending hunger and poverty. Yet, female farmers face numerous constraints: they own less land, cultivate smaller plots of land, and have a harder time accessing credit.

If we want to reduce poverty and end hunger, we must give women access to the resources they need for agricultural production and participation. This could: Increase farm yields by 20-30%; increase agricultural output by 4%; and reduce the number of hungry people in the world by 150 million

9. 1 in 3 women and girls worldwide, one billion, will experience violence such as torture, rape, sexual trafficking, honor killings, beatings during pregnancy and domestic violence in their lifetime.

Violence is a major cause of poverty. It prevents women from pursuing an education, working, or earning the income they need to lift their families out of poverty.

10. 100 to 140 million girls and women around the world have undergone genital mutilation -- including 6.5 million in Western countries. This practice continues to be concentrated in Africa, where 90 million African women and girls have been victims. It is mostly carried out on young girls under 15, often with the consent of mothers, in conditions that lead to lifelong pain, infection and premature death. doclink

Articles From the Last Day of ICFP 2013 Conference in Addis Ababa

   November 20, 2013, Degrees Live

This is a series of articles and videos from the November 2013 International Conference on Family Planning , including:

Girls' Globe Reports Live from ICFP: Coverage Archive -

CFP 2013 Reflections: Maternal & Child Health, Family Planning... and NTDs

Video: The Importance of Women Leaders in Family Planning - Ellen Starbird, USAID

Connected Health Workers Key to Improved Healthcare

Day Two of the ICFP and the Energy around Youth is Electric

Latin America's Contraception Crisis

Inspired by youth involvement: Kate Gilmore, UNFPA

ICFPLive Crowdblog: Wednesday Plenary - Achieving Equity through Women in Leadership

Family planning leads to health, education and income

Video: The Importance of Involving Youth in Family Planning - Isaiah Olowabi

The Challenge Ahead: Initiating a Demographic Dividend doclink

We Must Always Monitor Population Growth. Always

   October 8, 2013, World Outline

Ravi Prasad disputes the June 2013 "medium-variant projections" (MVP) of the Population Division of the United Nations' Department of Economic and Social Affairs. The UN offers these figures to the media as their most likely population forecast. Companies and governments often use the country-specific MVP breakdowns in planning. For example, where should a water purification company build plants to meet expected demand in thirty years, or what allocation of public funds should be set aside for pension provision given the size of the population in 2040. These projections should be based on realistic estimates of population growth and size. Ravi fears that, especially for certain developing nations, the MVP projections underestimate what will occur.

The MVPs project that world population will reach 9.6 billion by 2050 and 10.9 billion by 2100. These estimates assume that global fertility rates will plummet and converge to a rate of 1.85, with most nations reaching that level by 2050 and the rest by 2100. The UN Population Division derives these figures by basing the pace of future fertility decline on the historical experience of countries that underwent major fertility rate reductions after 1950. The MVP actually shows what is possible if poor nations achieve reductions in childbearing resembling those of more advanced nations. To achieve the MVPs rates, nations would need to produce about 20 billion fewer people by 2100 than current rates would produce.

Most future population growth will occur in the least developed countries (LDCs). Between 2013 and 2100, the population of 35 mostly LDC countries is expected to triple or more. Among them, the populations of Burundi, Malawi, Mali, Niger, Nigeria, Somalia, Uganda, United Republic of Tanzania and Zambia are projected to increase by at least five-fold by 2100. Of the 3.7 billion additional people anticipated, 2 billion will originate from LDCs - highlighting their above-average fertility rates. To meet the MVPs, the largest falls in fertility must occur in these regions. For example, in Mali, fertility must fall from 6.86 to 2.24 between now and 2100. The UN Population Division acknowledges these challenges, and admits the rates rely on "expected actions" being taken. They define "expected action" as LDCs improving family planning and widening access to contraception. Yet these LDCs differ fundamentally from advanced nations and do not follow conventional historical experience. Professor Paul Collier's "The Bottom Billion" (which won the 2009 Estoril Global Issues Distinguished Book Prize), explains why these countries are 'trapped' and have not had the economic growth that permits them to follow in the footsteps of other nations.

One of the best known statistical relationships is that rich nations have lower birthrates than poor nations. For example, a country like Ethiopia, where the total fertility rate is 6.12 children per woman, is fifty-one times poorer than the United States, where the total fertility rate is 2.05. People offer a variety of explanations. For example, female empowerment helps reduce family size. Richer countries empower women through advanced legal systems (e.g. freedom of divorce), political systems (e.g. votes for women), social systems (e.g. contraception, childcare and education readily available) and economic systems (e.g. more employment opportunities for women). Another explanation argues that better healthcare in richer countries results in higher child survival rates, which lessens the need for having more children. Also, since retirees in richer countries can survive on their retirement incomes, they depend less on their children to support them in later life. Finally, since lower population growth means more capital per worker, workers can exploit productivity gains and drive economic growth.

All of these theories have merit, so if a nation is both rich and has a low population growth rate, the two advantages reinforce each other, and unless the cycle is broken, if a country is poor and has a high population growth rate, the two disadvantages reinforce each other. Breaking that cycle is difficult. Deep-rooted cycles prevent economic growth in LDCs, ranging from endemic diseases to endless conflicts. Yet, both growth and lower fertility rates require breaking those cycles. The UN Population Division assumes fertility will fall due to expected improvements in family planning, widening access to contraception, and educating about the dangers of unprotected sex. But these alone will not cut fertility rates. The UN must acknowledge the causal link between economic growth and fertility rates. It bases MVP forecasts on historical experience, but it fails to note that the historical experience the UN refers to, in nations where fertility rates fell since the 1950s, also saw an acceleration of economic growth rates.

The UN sees a lack of family planning usage, and explains it by a lack of supply. Yet, lack of usage is not necessarily indicative of lack of supply. Many LDC parents choose or feel forced to have more children either to support themselves on retirement or to counteract high child mortality (e.g. 20.9% in Chad) Also, in a war-torn country where sons die in conflict, people have more kids to offset their losses. Simply throwing condoms at LDCs to bring their fertility rates down has minimal impact where people choose to have large families. The driver for declines in LDC fertility rates is economic growth. doclink

Art says: Bangladesh demonstrates that birthrates can be lowered before a nation achieves economic success.

Karen Gaia says: I agree with Art. And also condoms are not 'thrown' at LDCs. Women must be empowered to have control over their own decisions and their bodies. Methods of birth control must be effective, accessible, available, and accompanied with advice from health care workers in integrated services. Often entire communities are involved in integrating conservation, health services, and family planning. The author assumes these things are not being done, but more and more is being done each year. Still .... funding is lacking for these programs.

Crowded Planet

A conversation with Alan Weisman
   September 2013, Orion Magazine

Human population has grown in the last hundred years 'at a rate rarely seen outside of a petri dish'. Alan Weisman wrote the World Without Us and, recently Countdown: Our Last, Best Hope for a Future on Earth? He spent two years traveling to twenty nations to investigate what the the world's recent population explosion means for our species as well as those we share the planet with.

Weisman was recently interviewed by Orion managing editor Andrew D. Blechman. His book addresses whether we'll be able to continue as a species, given all the things that we have been doing to our home.

The explosion began at the time of the Industrial Revolution when there were suddenly jobs in the cities rather than on farms. But they were crammed into tight quarters, and diseases ran rampant, so doctors learned about dealing with diseases. Suddenly, people were living longer, and fewer infants were dying.

Before that women would have seven or eight kids, but only two survived, on average. Two surviving is replacement rate where people have essentially replaced themselves, and population remains stable.

Then in 1930, when we were at 2 billion, we discovered how to pull nitrogen out of the air artificially and we were able to double the food supply. Today we've grown to 7 billion. 40- 50% of us would not be alive without artificial nitrogen fertilizer.

If you overfeed city pigeons, they have more babies and the population starts maxing out, whereas if you don't overfeed them, the population keeps itself in check. Too much food expands a population beyond its resource base, and then it crashes. And this is "not going to be very pretty."

"Some argue that population is in fact self-correcting, and that the correction is already underway."

Is there an answer to the question "How many people can fit on the planet before we set in motion changes that will threaten the future of life as we know it"? "We're all part of a big experiment to see how many of us can live on this planet without doing something to it that is going to destabilize it so much that our own future is in jeopardy," Weisman said.

"Should we take the responsibility to try to manage population decline gracefully, and possibly speed it up? We can do it humanely if we decide to manage it rather than let nature take its course."

It is not just the large number of people, it is also the amount that we consume that matters. The more consumers there are, consuming too much, the more consumption.

Paul Ehrlich said that there's no condom for consumption. "By the time we change human nature enough so that people consume a lot less, I think the earth will be trashed in the meantime."

"There's also no question that the most overpopulated country on earth is actually the United States, because we consume at such a ferocious rate. We may not be as numerous as China or as India, but our total impact is huge."

When Weisman was in the African country Niger, which has the highest fertilty rate in the world, people would talk about all the trees that had been cut down for firewood. This changed their climate so that there's less rain now. They also graze many more animals, creating more changes. "They're now in chronic drought. In every village, hundreds of children had died".

Eventually people in Niger and other countries will realize - if they haven't already - that "they don't have the luxury of continuing life as they used to live it, where men had multiple wives and wives had many children". By educating people, especially women, "they start to put these things together". "Education is the best contraceptive of all" because educated women adopt a family-planning mentality.

When you educate women, and give them rights equal to "anybody else's on this planet", they usually "choose to have fewer children, because they have another way to contribute to society that would be difficult if they had seven kids to care for".

Whereever you have educated women, society is more livable. "All we have to do is offer fair, equal opportunity to half the human race, the female half".

Weisman says people can adjust to smaller families, even one-child families. When in China he found out that, while these single children missed having siblings, but they said, "On the other hand, our cousins have become our siblings. Sometimes our best friends have. We've reinvented the family."

Of China's one-child policy he said "while a draconian edict may have worked in one place, it's not going to work everywhere".

We need to make contraception "very attractive to people, and let them manage their own population"". "There are a couple of Muslim nations that" ... " have brought their populations down to replacement levels without draconian controls from above, without any edicts". Iran got down to replacement rate a year faster than China, and it was completely voluntary. The ayatollah Khamenei, "issued a fatwa saying there was nothing in the Qur'an against having an operation if you felt that you had enough children that you could take care of. Everything from condoms through pills, injections, tubal ligations, vasectomies, IUDs-everything was free, and everything was available in the farthest reaches of the country". The only thing that was obligatory was premarital counseling. "They would talk about things to get you prepared for getting married, including what it costs to have a child, to raise a child, to educate a child".

Of catholicism, he said the Catholic Church is unique in its adamant opposition to birth control except for the rhythm method. The Vatican is populated by "just one-thousand people, virtually all of them men. They're making these rules that many Catholics outside its walls are paying no attention to. Italy and Spain, for example, have two of the lowest birth rates on the planet".

In Niger an iman showed him in the Qur'an where "Muhammad says that each child is entitled to two years of mother's milk," which was interpreted as an admonition to carefully space births. Another imam says that children are a gift from God and you can't turn down gifts from God, so he's even against birth spacing.

While many Evangelical churches have been an anti-abortion, even anti-contraception, one Evangelical leader "absolutely supports contraception and campaigns hard for it".

Every four to 4.5 days, there's a million more of us on the planet. That doesn't sound sustainable.

In Uganda, in order to preserve the wildlife, as well as the tourist-related income for the people who live in these areas, wildlife ecologists are trying to convince residents to have fewer children. In the Philippines, ecologists are convincing people to have fewer children to prevent them from running out of fish.

One the other hand, in the European democracies, their birthrates are so low that they've resorted to paying their citizens to have children. But we've always had room to expand. Now China has knocked down more and more forests, until they lost all their flood control.

"For an economy to keep growing, you have to have growing populations, because you need more laborers to produce more products, and then you need more consumers for those products".

We need to redefine prosperity in a way that doesn't involve perpetual growth.

The president of Uganda, who's convinced that his country's economic future is dependent on massive population growth is sorely mistaken. Look at Singapore with a very low birthrate and the highest per capita incomes of any country on earth.

On aging: there will be a generation or so of a bubble where they're going to have more older people, and then, as that generation dies off, the number of older people and younger people are going to balance out again. If we redirected our funds to "taking care of a generation of older people until our population evened out, we'd be a much better society".

How much the population grows rests on whether women on average have a half child more or a half child less. The projection of nearly 10 billion by 2050 assumes that all the family planning programs we have in place will remain in place. And that's dependent on a few donor countries, such as the United States. If the "last presidential election gone differently, the United States may well have withdrawn a great deal of its support for family planning programs all over the world".

If family planning loses funding, "a half a child more per fertile woman means that by the end of the century we're going to increase to 16 billion people. A half a child less per woman means that we're going to be back down to 6 billion really quickly".

"Nearly a quarter of a billion women who might use contraception don't have access to it. However, it would only take about $8-9 billion a year to ensure that everybody did". That's not a lot of money. doclink

Karen Gaia says: Singapore, South Korea, Macau, and Hong Kong all have lower fertility rates than China, yet they had no policy on number of children.

On education and family planning, health is also a very important factor. If a woman does not have a health care worker she can trust, she will not have enough to go on to help her to decide to start using contraception. Health care is usually combined with birth spacing for a very compelling reason to use contraception.

On aging: more emphasis should be put on our children's and grandchildren's future, and their education, health, well-being. They are the ones who will have to get through the bad times and they need to be well-equipped.

End of this section pg 1 ... Go to page 2

United Nations International Conference on Population and Development in Cairo, 1994

The Cairo Program of Action


Acknowledges the complex personal and social contexts within which decisions about childbearing are made. It separates the problem of unwanted fertility, which can be addressed by access to family planning services, from other causes of population growth, including the desire for large families. Calls for other social investments -- such as the education of girls and the reduction of infant mortality -- to help make small families the norm.

  • Endorses a reproductive health approach to family planning.
  • Recognizes the central role of gender relations, with a link between high fertility and the low status of women, and offers strategies to empower women through access to education, resources and opportunity.
  • Addresses the harmful effects of northern consumption patterns, drawing the connection between consumption, population growth and environmentaldegradation.
  • Strikes a historic compromise on abortion. While declaring that "in no case should abortion be promoted as a method of family planning," the document asks governments to address unsafe abortion as a major public health concern. It also asks governments to ensure that abortion services are safe when they are not against the law, to provide reliable and compassionate counseling for all women who have unwanted pregnancies and to provide humane care for all women who suffer the consequences of unsafe abortion.
  • Stands on solid ethical ground. Coercion of all is rejected. The means it proposes to slow population growth are all desirable ends in themselves. It offers strategies to narrow the gaps between rich and poor, and between men and women.
  • doclink

    The United Nations Population Conference


    It took 40 years to build consensus.

    1954 - The Club of Rome

    1960 - USAID family planning services in the developing countries increases contraceptive prevalence from 14% in 1965 to 57% today. "Population control" sometimes used.

    1974 - Bucharest UN World Population Conference. Industrial countries wanted to control population growth, while developing nations said that "development is the best contraceptive."

    1984 - Mexico City U.N. Conference on Population becamed emeshed in U.S. debates over abortion and contraception.

    1994 - Cairo International Conference on Population and Development (ICPD)- characterized by an extraordinary degree of international cooperation and consensus, by improving health, education, and access to opportunity doclink

    World's Population Projected to Grow From 7.3 Billion in 2015 to 8.4 Billion in 2030

       April 9, 2015, Population Media Center   By: Joe Bish

    The United Nation's Commission on Population and Development held its 48th annual session in early April at the UN Headquarters in New York City. Here are extracts of statements made during the session having to do with population.

    UN Secretary-General's message to the Commission on Population and Development (see ):

    "You meet as the international community strives this year to forge a set of sustainable goals and a meaningful new universal climate agreement. These twin priorities will be influenced by the profound demographic shifts taking place in our world, especially those related to youth, the elderly, urbanization and migration."

    "Our world now has the largest generation of young people in history. Countries experiencing a 'youth bulge' can reap a demographic dividend by optimizing conditions for youth to thrive. This requires enhancing education for both girls and boys, ensuring access to sexual and reproductive health care, and creating more decent jobs."

    "Workforces are shrinking and populations are greying."

    "Already more than half of the world's population lives in cities, and that proportion will grow over the next 15 years, adding urgency to efforts to optimize the benefits of urbanization and overcome its challenges."

    "Far too many migrants suffer from exploitation, discrimination and xenophobia. Addressing these violations of their rights will empower migrants to increase their contributions to development in both countries of origin and destination."

    "The 1994 International Conference on Population and Development Programme of Action as well as the 2014 operational review underscored the centrality of the rights and worth of every individual. We must be guided by this vision as we aim to help people meet their needs while protecting the environment for generations to come."

    Additional Reporting on Commission on Population and Development, Forty-eighth Session


    Babatunde Osotimehin, Executive Director, United Nations Population Fund (UNFPA), said that, as a post-2015 development agenda was designed, the Commission on Population and Development, by integrating population issues into sustainable development, could turn its timeless principles and commitments into reality. Investments in the rights and well-being of adolescents and youth, now and throughout their lives, would unleash a demographic dividend of inclusive, sustainable economic growth in many countries. Young people, especially adolescent girls, must be empowered to make informed decisions to have control over their bodies and to stay healthy.

    It was also important to reach young people early in life to foster positive life-long health behaviour. Investing in the health, education and employment of young people today was the best investment to improve the lives of older persons tomorrow. ... It was imperative to integrate population issues into development, as there could be no sustainable development without people, he said, stressing that "we cannot afford to wait, the time is now".

    John Wilmoth, Director, Population Division, Department of Economic and Social Affairs, said that, in Cairo, in 1994, the world had acknowledged the importance of the population dimension, but had also cautioned against efforts to manipulate aggregate trends, out of concern that such policies risked violating individual human rights.

    Continued rapid population growth would make it more difficult for some countries to improve health, provide adequate housing, achieve universal education, and provide adequate job opportunities over the next 15 years.

    The lesson of Cairo was that the collective concerns about current or future population trends should never become a justification for violating the fundamental rights and freedoms of individuals. Population trends mattered for all three pillars of sustainable development..

    Barney Cohen, Assistant Director, Population Division, Department of Economic and Social Affairs, introducing the report of the Secretary-General entitled "Integrating Population Issues into Sustainable Development, Including in the Post-2015 Development Agenda", said the world's population was projected to grow from 7.3 billion in 2015 to 8.4 billion in 2030, roughly equivalent to adding approximately 73 million people every year. By 2030, the global economy would need to support a population that was approximately 15% larger than it was today. In addition, while countries will experience different rates of growth, globally, 2 billion babies would be born over the next 15 years. If the world was to achieve the new sustainable development goals and leave no one behind, then every one of those new-born children, as well as their mothers, should have access to high-quality health services throughout all phases of life. In addition, all children should be able to attend school, and no child should have to grow up malnourished or live in extreme poverty.

    Over the next 15 years, he continued, the world would also need to prepare for the 1.9 billion young people who would turn 15, which was a 7% increase globally over the previous 15-year period. Underscoring that young people could be an important vehicle for economic development and social change, he said there must be greater investment in secondary and tertiary education, youth-friendly health services, and opportunities for young people in the labor market.

    He said that population projections also suggested that the number of women of reproductive age would increase globally by 9%, and in Africa, by 45% over the next 15 years. Thus, it was important to advance gender equality, ensure that women had a voice in the political process and were given the knowledge and tools to decide on the number and timing of their children. doclink

    Assessing Progress for Populations Worldwide

       April 3, 2014, United Nations

    Almost on the 20-year anniversary of the largest intergovernmental conference on population and development ever held -- the International Conference on Population and Development (ICPD) in Cairo in 1994, the meeting of the 47th session of the Commission on Population and Development will be held.

    In advance of that meeting, John Wilmoth, Director of UN DESA's Population Division, spoke about how the heart of what the Cairo conference was all about individuals and their rights and needs, and addressing those issues first and foremost.

    Cairo helped galvanize action that brought major improvements in the well-being of people around the world. In 2013 over 90% of governments provided either direct or indirect support for family planning programs. Life expectancy has increased from 65 years in the period 1990-1995 to 70 years in the period 2010-2015.

    At the upcoming April session, representatives and experts from a large number of UN Member States and NGOs will meet in New York to assess the status of implementation of the Programme of Action, adopted by 179 governments in 1994.

    Wilmoth said there was more to be done: continuing to improve life expectancy, reduce fertility, enhance access to education, and achieve gender equality.

    The world's population is expected to reach 8.1 billion in 2025 and 9.6 billion in 2050. In 1994 the world's population was growing at 1.5% a year, compared to only 1.2% in recent years.

    The combined population of the 49 least developed countries is projected to double by 2050. In contrast, in more than 40 other countries - many of them in Eastern Europe, East, South-East and Western Asia, other parts of Europe and Latin America and the Caribbean - the size of the population is expected to decline in the coming decades.

    Despite these advances, most countries will not achieve the ICPD Programme of Action target for life expectancy of 75 years (70 years for the countries with the highest mortality levels) by the target date of 2015. Worldwide, women live 4.5 years longer than men, a gap that has remained virtually unchanged since 1994. Similarly, the world as a whole will miss the Conference target of a 75% reduction in maternal mortality.

    The international community is increasingly recognizing the contribution of migration to global development. In 2013, the number of international migrants worldwide reached 232 million, up from 154 million in 1990. There are more people living outside their country of birth than ever before, and it is expected that the numbers will increase further.

    Lower fertility combined with higher life expectancy results in population ageing. Aging combined with rapid urbanization "creates challenges in terms of meeting the needs of the older population and also in managing the relationship between the generations as the working-age population inevitably has to provide a certain amount of financial and other forms of support for the older population," he said.

    The Commission will also be an important preparatory event for the special session of the General Assembly, which will take place on 22 September 2014 to commemorate the 20th anniversary of the Cairo conference. doclink

    Voluntary Family Planning Programs That Respect, Protect, and Fulfill Human Rights

       September 12, 2013, Futures Group

    Key points:

    In the orward to the 2012 State of World Population report, "By Choice, Not by Chance", Babatunde Osotimehin, UNFPA reaffirmed the right of the individual to freely and responsibly decide how many children to have and when to have thme has been the guiding principle in sexual and reproductive health, including family planning.

    The foundation for voluntary and human rights-based family planning can be traced to the 1968 International Conference on Human Rights, which included in its proclamation that "parents have a basic human right to decide freely and responsibly the number and spacing of their children." This right was reaffirmend at three subsequent international population conferences in Bucharest in 1974, Mexico in 1984, and Cairo in 1994.

    The landmark International Conference on Population and Development, which took place in Cairo in 1994, affirmed that ...reproductive rights rest on the recognition of the basic right of all couples and individuals to decide freely and responsible the number, spacing and timing of their children, and to have the information and means to do so; and the right to attain the highest standards of sexual and reproductive health. It also includes their right to make decisions concerning reproduction free of descrimination, coercion and violence, as expressed in human rights documents (UNFPA, 1994, Programme of Action para. 7.3)

    Amidst the positive response to FP2020 (London Family Planning Summit in July 2012), including a civil society declaration signed by more than 1,000 organizations worldwide, some civil society organizations expressed concerns that the numeric goal of reaching 120 million new users of contraception by 2020 could signal a retreat from the human rights centered approach that underscored the 1994 ICPD. Concern was also raised that the FP Summit goal could also lead to a focus on services for urban groups who may already have access to services, at the expense of marginalized women, men, and young people are are more costly to reach but who may face more financial, social, or other barriers preventing them from accessing such services.

    A focus on reaching more women with contraceptives will not negate the the broader reproductive health and rights focus of ICPD. instead, it will draw attention and resources to family planning, a key component of reproductive health that has received insufficient attention and resources for nearly two decades.

    The need for renewed attention to family planning has been highlighted, resources have been pledged, and political will is high, offering what Kingdon (1984) identified as a window of opportunity for transformational change. Taking advantage of this opportunity will require bringing together diverse stakeholders -- representing family planning, reproductive health, human rights, and public health to harness relevant approaches to programming and create the conditions for achieving the FP202 goal (120 million new voluntary family planning users) in ways that guarantee choice and respect, protect, an fulfill human rights.

    Few attempts have been made to link voluntarism and human rights into a comprehensive operational framework to guide family planning policies and programs.

    This conceptual framework was reviewed by more than 150 people from 25 countries through a series of in-person and web-based consultations and the World Health Organization (WHO) consulting on rights-based family planning held in April 2013. Ultimately, it is hoped that this effort and the resulting framework can contribute to the implementation of the FP2020 program.

    As rights violations related to reproductive health have tended to focus on some egregious cases - such as forced abortion in China, forced sterilizations in India, Peru, and more recently among HIV-positive women -- more subtle forms of rights violations have been missed. Some programs or providers pressure or coerce clients into using family planning methods they do not want, while others create barriers that prevent individuals from obtaining and using methods they desire.

    Programs that offer a limited choice of methods cannot really be said to offer a full choice.

    The principle of volunteerism has been integrated into all U.S. government assistance for family planning since 1968. USAID notes that its assistance is guided by the principles of voluntarism and informed choice:

    * People have the opportunity to choose voluntarily whether to use family planning or a specific family planning method.

    * Individuals have access to information on a wide variety of family planning choices, including the benefits and health risks of particular methods.

    * Clients are offered, either directly or through referral, a broad range of methods and services.

    * The voluntary and informed consent of any clients choosing sterilization is verified by a written consent document signed by the client.

    Follow the link in the headline to see the entire, very long paper. doclink

    UN to Hold Special Session in 2014 on Population

       February 21, 2013, Associated Press

    The UN General Assembly has decided to hold a special session on Sept. 22, 2014, on the anniversary of the 1994 Cairo population conference - when some 180 nations adopted a plan that focused on birth control, economic development and giving women more power over their lives - to assess implementation the 20 year-old plan to slow the global population explosion.

    The world's population has grown since the 1994 conference, from 5.7 billion to about 7 billion. The U.N.'s top population official, Babatunde Osotimehin recently said the world will add a billion people within a decade, further straining the planet's resources.

    Kenya's deputy U.N. ambassador Koki Muli said there will be no final document from the 2014 session, a move that will avoid contentious negotiations on issues such as reproductive rights for women, sex education, abortion and family planning.

    The Cairo conference changed the U.N. Population Fund's focus from numerical targets to promoting choices for individual women and men, and supporting economic development and education for girls. Underlying the shift was research showing that educated women have smaller families.

    At the heart of the 1994 action plan is a demand for equality of women through education, access to modern birth control, and the right to choose if and when to become pregnant. It also recognized that abortion is practiced around the world and should be treated as a major public health issue and indicated that affordable and acceptable family planning is central to achieving safe motherhood. doclink

    Task Force to Kick Start Cairo Population Goals

       October 12, 2012, IPS Inter Press Service   By: Becky Bergdahl

    In 1994 in Cairo, Egypt, the International Conference on Population and Development (ICPD) instituted a Programme of Action which is the guiding document for the United Nations Population Fund, UNFPA.

    Recently, at the Ford Foundation in New York, a new 26-member high-level task force assembled to galvanise support behind the goals of the International Conference on Population and Development (ICPD).

    Gita Sen is a professor of public policy at the Indian Institute of Management in Bangalore, and has worked on population policies for 35 years. She is a member of the new task force, and attended the conference in Cairo in 1994.

    "I would not say that the goals have not been fulfilled, but that they have only been partially fulfilled," she said. "One thing that has definitely happened in those 18 years is that there is a language of sexual and reproductive rights, which was never there before." "This language has scared some people in governments, some very religious people, some social conservatives," she said.

    "They think that if women are empowered, if young people get autonomy and choice, they are going to lose out in terms of their ability to control them. Which is probably true, to some extent. But in the end it is for a better life for everybody."

    Sen said "The spread of evangelical conservatism in Africa is funded heavily from" the U.S. ..."It is funded by very rich people who are pouring their millions into very poor countries, in order to ensure that they turn their agenda away from sexual and reproductive rights, against gender equality. And with that much money pouring in it is hardly surprising that we have faced so much trouble as we do."

    Yet Sen maintains a positive attitude. "We are going to win this one. You can not keep young people and women back forever. This is not the dark ages," she concluded.

    200 million women worldwide still lack access to effective contraception, resulting in 80 million unintended pregnancies each year, with 40 million ending in unsafe abortions, many with life-threatening consequences. 800 women who carry out their pregnancies, wanted or unwanted, die every day in childbirth - 99% of them in developing countries.

    Ishita Chaudhry, a member of the new task force and the leader of the youth organisation TYPF in India, highlighted the importance of banning child marriage in order to achieve the ICPD goals.

    Child brides, girls married before their 18th birthday, run especially high risks of unwanted pregnancy and also of abuse. And there are currently over 60 million child brides worldwide.

    One in seven women experience domestic or sexual violence in their lifetime. Up to one in four women experience abuse during pregnancy.

    "Women's sexual and reproductive rights are at the heart of sustainable development," said Tarja Halonen, a former president of Finland and co-chair of the new high-level task force.

    "Pregnancy should be one of the happiest times in our life... Girls pay the price of taboos and double standards," she said. doclink

    Karen Gaia says: "179 nations at the 1994 Conference in Cairo endorsed the right to decide freely and responsibly the number and spacing of one's children, and the right to a satisfying and safe sex life."

    Policymakers Recommit to Unfinished Agenda of Landmark International Consensus on Population and Development Adopted at 1994 Cairo Conference as 20-Year Marker Fast Approaches

       May 29, 2012,

    In late May in Istanbul some 400 delegates, including more than 200 parliamentarians, discussed a course of action over the coming years to implement the ICPD Programme of Action by 2014 and beyond. They also considered ways to influence any new development framework to follow the Millennium Development Goals (MDGs) in 2015.

    Congresswomen Carolyn Maloney and Jan Schakowsky from Chicago represented the United States at the parliamentarian conference.

    "ICPD is about human beings, respect, rights, and what we can do to ensure that every individual can make his or her own decisions," said Dr. Babatunde Osotimehin, Executive Director of UNFPA, the United Nations Population Fund.

    Delegates committed themselves to its unfinished Cairo agenda plan by unanimously adopting the Istanbul Declaration of Commitment. In it, and under the theme, Keeping Promises - Measuring Results, they determined to advocate for increased national and external funding for the entire implementation of the ICPD agenda in order to achieve access to sexual and reproductive health, including family planning. They committed to strive to "attain at least 10 per cent of national development budgets and development assistance budgets for population and reproductive health programmes." That includes HIV prevention and reproductive health commodities.

    They pledged to support policies that give special attention to the specific concerns and needs of young people by promoting and protecting their right to "access good quality education at all levels, health, sexual and reproductive services, including comprehensive sexuality education," and to adopt measures to prevent all types of exploitation and abuse against them.

    The conference followed four similar global conferences, in Bangkok in 2006, Strasbourg in 2004, Ottawa in 2002 and Addis Ababa in 2009. doclink

    End of this section pg 1 ... Go to page 2

    Success Stories: Family Planning Works - Growth is Slowing!

    Pakistan: a Tough but Vital Place to Do Family Planning

       August 6, 2015, Impatient Optimists   By: Juan Enrique Garcia

    In the rural Sindh Province of Pakistan, Juan Enrique Garcia (of DKT Pakistan) met a woman so poor that she fed her six children three on one day, and three the next. This reaffirmed the importance of the programs giving Pakistani couples options for healthy spacing and timing of births. The 2012-13 Demographic and Health Survey for Pakistan found that only 26% of married women use a modern method of birth control - lower than the 66% who do so in Mexico and lower than in all neighboring countries, except Afghanistan.

    Pakistan has pledged to increase the contraceptive prevalence rate (CPR) for modern methods to 55% by 2020. That would double the CPR in only eight years. The authors job at DKT Pakistan is to help the government reach that goal.

    Although 20% of married women say they want contraception but cannot access it, it is difficult to discuss the subject openly in Pakistani society. At home women are told to have many children and at least one male child. The pressure can come from the husband, the mother-in-law, other family members or society at large. The reluctance to discuss contraception occurs even inside DKT Pakistan, a family planning NGO. When they hire new sales person, they spend time trying to make the new person feel okay about selling contraception. However some soon leave the job, forcing DKT to find and train a new person.

    DKT Pakistan has built up a social franchising network of 800 midwife-owned and operated Dhanak (rainbow in Urdu) clinics in a little less than three years. They aim to have 1,200 clinics operating in all parts of Pakistan by the end of 2015. Their mission is to provide couples with affordable and safe options for family planning and HIV prevention through social marketing and social franchising. They go to remote and rural areas with difficult access, where many other organizations do not go but where 65% of Pakistanis live. To help families understand the benefits, DKT sponsors tea parties for men and women to relax and converse about long-acting reversible contraceptives. DKT also hold mobile video shows in rural areas, with separate shows for women and men.

    DKT Pakistan, like the other 20 DKT International programs around the world, tries to push cultural boundaries, without violating them, in order to make the greatest impact possible (see their best TV spots from around the world). But still, DKT sometimes ruffles feathers. For example, in 2013, a TV spot featuring the provocative Pakistani model Mathira playing a newlywed trying to please her husband in the bedroom aired only 10 days before the censors banned it. Yet the spot has now been seen millions of times on YouTube and helped increase DKT's sales of Josh condoms.

    Although DKT clinics are in very different regions and cultural settings, they have a few things in common: They share a standard appearance, signage, advertising, quality standards, etc.; they offer training and refresher training to for their clinical staffs; they provide a full line of reproductive health services and products, most of which are offered through DKT Pakistan's parallel social marketing program.

    Since the Dhanak clinics are usually owned and operated by women, the clinics also empower women and provide a model of entrepreneurial self-sufficiency.

    DKT Pakistan has just joined the work led by Aman Health Care Services under the SUKH Initiative with support from the Bill & Melinda Gates Foundation and the David and Lucile Packard Foundation. Their goal is to increase modern contraceptive use by 15% among married women in selected, low-income communities of Karachi. DKT's role will be to identify and franchise 80 private sector clinics as Dhanak clinics and promote family planning. Due to political and ethnic violence, many health providers have abandoned their facilities in some of these areas, so our clinics will help fill that gap. The first 35 clinics are expected to be operational in 2015.

    In Pakistan, many obstacles block greater acceptance and use of family planning. But Pakistani women want it, and DKT's private-sector approach will bring it to them. doclink

    10 Things America Does So Much Worse Than Europe

       July 11, 2015, Salon   By: Alex Henderson

    1. Lower Incarceration Rates

    2. Less Violent Crime Than the U.S.

    3. Better Sex Education Programs, Healthier Sexual Attitudes

    For decades, the Christian Right has been trying to convince Americans that social conservatism and abstinence-only sex education programs will reduce the number of unplanned pregnancies and sexually transmitted diseases. The problem is that the exact opposite is true: European countries with comprehensive sex-ed programs and liberal sexual attitudes actually have lower rates of teen pregnancy and STDs. Looking at data provided by the Centers for Disease Control and Prevention (CDC), the Guttmacher Institute, Advocates for Youth and other sources, one finds a lot more teen pregnancies in the U.S. than in Europe. Comprehensive sex-ed programs are the norm in Europe, where in 2008, there were teen birth rates of 5.3 per 1000 in the Netherlands, 4.3 per 1000 in Switzerland and 9.8 per 1000 in Germany compared to 41.5 per 1000 in the United States. In 2009, Germany had one-sixth the HIV/AIDS rate of the United States (0.1% of Germany's adult population living with HIV or AIDS compared to 0.6% of the U.S. adult population), while the Netherlands had one-third the number of people living with HIV or AIDS that year (0.2% of the Netherlands' population compared to 0.6% of the U.S.' adult population).

    4. Anti-GMO Movement Much More Widespread

    5. Saner Approaches to Abortion

    Logic never was the Christian Right's strong point. The same far-right Christian fundamentalists who favor outlawing abortion and overturning the U.S. Supreme Court's Roe v. Wade decision of 1973 cannot grasp the fact that two of the things they bitterly oppose -- contraception and comprehensive sex education programs -- reduce the number of unplanned pregnancies and therefore, reduce the need for abortions. But in many European countries, most politicians are smart enough to share Bill Clinton's view that abortion should be "safe, legal and rare." And the ironic thing is that European countries that tend to be sexually liberal also tend to have lower abortion rates. The Guttmacher Institute has reported that Western Europe, factoring in different countries, has an average of 12 abortions per 1000 women compared to 19 per 1000 women in North America (Eastern Europe, according to Guttmacher, has much higher abortion rates than Western Europe). Guttmacher's figures take into account Western Europe on the whole, although some countries in that part of the world have fallen below that 12 per 1000 average. For example, the UN has reported that in 2008, Switzerland (where abortion is legal during the first trimester) had an abortion rate of 6.4 per 1,000 women compared to 19.6 per 1000 women in the U.S. that year. And Guttmacher has reported that countries where abortion is illegal or greatly restricted tend to have higher abortion rates than countries where it is legal: back-alley abortions are common in Latin America and Africa.

    Clearly, better sex education, easier access to birth control and universal healthcare are decreasing the number of abortions in Western Europe. So instead of harassing, threatening and terrorizing abortion providers, the Christian Right needs to examine the positive effects that sexually liberal attitudes are having in Switzerland and other European countries.

    6. More Vacation Time

    7. Universal Healthcare

    The U.S. made a small step in the direction of universal healthcare when Congress passed the Affordable Care Act in 2010, but the U.S. is so backwards when it comes to health care that implementing even the modest reforms of the ACA (which doesn't go far enough) has been an epic battle. Meanwhile, every developed country in Western Europe has universal health care, which is implemented in different ways in different countries.

    8.Greater Life Expectancy

    9. Mass Transit Systems

    10. Europeans More Likely to Speak Foreign Languages doclink

    Aggressive Efforts Underway to Abolish Child Marriage in Niger by the Year 2050

       October 2, 2014,   By: Priscilla Masilamani

    The country of Niger has the highest incidence of child marriages in the world, with 77% of the underage girls currently married. One in three girls is married before the age of 15, according to UNICEF.

    Religion, tradition and culture play a part while poverty, gender inequality and weak legislation add fuel to this violation of girl's rights.

    The UNFPA in Niger has been, since 2012, aggressively carrying out ground work in raising awareness to put an end to this practice. "By carrying out strategic development and empowerment training, and by collectively engaging the community leaders and grassroots people, the UNFPA is foreseeing a future where child marriages would be completely abolished by the year 2050," says Monique Clesca, UNFPA Representative. The goal is to abolish the practice by 2050.

    An eight-month educational training program for girls make them aware of the rights they have as children. "Training is provided about how their bodies work, hygiene, and also their reproductive and sexual health." said Clesca. For example, Amina, a 13 year old girl, learned that she, as a child, has her own rights. When she was forced by her parents to get married to a man three times older than her, she stood up for herself and refused to marry. She was beaten and ran away, but she did not bend to the demands of her family. Finally, she was able live in her uncle's house, where she now attends a special school, learning to read and write.

    The UNFPA hopes to reduce domestic and sexual violence, maternal and infant health risks, incidence of STDs and fistula, which are all a few of the direct results of child marriage.

    The UNFPA also targets the men in a program called 'The Husband School,' which brings together men from various communities to help them understand the health consequences of marrying a child.

    "With the husbands being schooled, we are seeing a tremendous change in the attitude of men. Now, girls tell us that the husbands themselves willingly take them to healthcare centers. The men are waking up," Clesca said.

    With success stories on the increase, Clesca hopes to see an enormous difference in the rate of child marriage in the next survey to be conducted by the UNFPA in 2017.

    Clesca tells of the importance of a huge social movement to see a visible change. "We need different sectors of the community to come together at a local, national and international level to make a large, lasting difference." doclink

    How Has the World Changed in the Last 20 Years?

       April 7, 2014, UNFPA - United Nations Population Fund

    Twenty years ago, the international community gathered in Cairo, Egypt, at the the International Conference on Population and Development (ICPD). There, 179 governments signed on to the ICPD Programme of Action, which recognizes that women, their rights and equality are global development priorities. The governments committed to: providing universal access to voluntary family planning, sexual and reproductive health services and rights; delivering gender equality and equal access to education; addressing the impacts of urbanization and migration; and supporting sustainable development.

    Ways our world is different:

    1. The world now has the largest generation of young people ever. Those between 10 and 24 years old accounted for 28% of the world population in 2010. The world must invest in the needs and rights of this group, supporting their access to quality health care and education, opportunities for safe paid work, and freedom from abuses such as early marriage and pregnancy.

    2. The proportion of people living on less than $1.25 per day has fallen from 47% in 1990 to 22% in 2010. But growing inequality could undermine these gains. 8% of the world's population has 82% of the wealth, and over a billion people do not have access to social protections, meaningful work, or public health or education services.

    3. In the last 20 years, the world's population grew by about a quarter, from 5.66 billion to 7.24 billion.

    4. The population growth rate has slowed from 1.52% annually to 1.15%. We can now expect the global population to reach 9.55 billion by 2050.

    5. Women are having fewer children. The average woman had about three children in 1994. Today, the fertility rate is around 2.5 children per woman. However, in 18 countries, fertility rates stand at five children or more per woman.

    6. Adolescent childbearing has fallen by 50% or more in many countries. However, each day 20,000 girls under age 18 give birth and every year, there are 70,000 adolescent deaths from complications of pregnancy and childbirth.

    7. Contraceptive use has increased. But between 2008 and 2012, the proportion of married women in the developing world using modern contraceptives only changed from 56% to 57%. There are about 222 million women without access to modern contraception.

    8. Maternal deaths have dropped by 47% since 1994. Today, 800 maternal deaths occur every day, and the leading causes - postpartum haemorrhage, sepsis, obstructed labour, complications from unsafe abortion, and hypertensive disorders - are all preventable.1,3

    9. Child deaths fell by nearly half. A major factor contributing to this decline is increased education for women and girls.

    10. The number of births occurring under the care of a skilled attendant - a doctor, midwife or nurse - has grown from 56% in 1990 to 67% in 2011. Skilled birth attendance is one of the most critical ways to ensure safe delivery for both mother and child. That, along with increased access to antenatal care, emergency obstetric care and family planning services, accounts for much of the decline in maternal deaths.

    11. Life expectancy has increased by 5.2 years.

    12. Abortion rates have declined, from 35 per 1,000 women in 1995 to 29 per 1,000 women in 2008. Addressing unmet family planning needs would avert 54 million unintended pregnancies and result in 26 million fewer abortions.

    13, 14, 15 - HIV/AIDS, SIDs, non-communicable diseases.

    16. Primary school enrolment rates have jumped from 75% in 1990 to about 90% in 2010. But gender inequality still exists.

    17. The global urban population rose by 1.6 billion between 1994 and 2014. More than half the world's people now live in towns or cities. But too much of this growth is taking place in slums.

    18. More people are migrating than ever before.

    19. The number of older persons increased from 490 million in 1990 to 765 million in 2010.

    20. Record numbers of people are displaced within their countries by conflict or violence, taking a disproportionate toll on women and girls.

    Much more work to be done

    Female genital mutilation/cutting (FGM/C) and child marriage remain prevalent in much of the world, even in countries where these practices have been outlawed.

    Gender-based violence continues to be a global epidemic. An estimated one in three women report experiencing physical or sexual abuse, most commonly by an intimate partner.

    Discrimination against women continues in every society in the world, and belief in gender equality is not yet universal. doclink

    Why it Takes Teens With Condoms to Encourage Family Planning in Africa

       November 2013, Time magazine   By: Alexandra Sifferlin

    This year, Addis Ababa, the capital of Ethiopia, will host the annual International Family Planning Conference. Ethiopia's public health facilities offer several contraceptive options. Usage has grown from 8% in 2000 to 29% in 2011. Combining family planning with immunizations, antibiotics and other health services has reduced Ethiopia's maternal and child mortality rates. Minister of Health, Catherine Gotani Hara, says that women have fewer children when they expect them all to survive.

    The success of programs in Ethiopia, Rwanda, and Malawi show that even poor nations can make family planning work. Contraceptives are free at public health clinics in all three of these nations. Women tend to pick long-acting reversible and discreet contraceptives (like implants and IUDs) over condoms and pills. But clinics offer other options so users can decide for themselves which methods to choose.

    Women often fear their husband's reaction, so health workers often offer birth control outside the clinic so husbands won't know that their wives have visited the program. Where men resist family planning, Ethiopia sends male mentors to their homes to help convince them. Officials in Rwanda encourage male family planning methods such as vasectomies. In Malawi, village campaigns headed by community chiefs promote family planning for couples. They include the voice and perspective of as many men as possible, including respected elders.

    Some programs also focus on teens. Although many 18-year-old girls are already married with children, some national leaders fail to acknowledge that teens have sex. Ethiopian community health centers now include youth services and private offices to educate teens and offer them contraceptives. Boys even learn about family planning in primary school. Since teens may feel uncomfortable discussing sex with adults, some organizations use unconventional approaches to reach them. For example, Planned Parenthood partners with Mary Joy Aid Through Development to train Ethiopian teens as peer health promoters who can talk to other teens about sexual health issues and distribute pills and condoms.

    Ethiopia's constitution makes access to family planning a woman's right, which highlights the critical role it has in that nation. Rwanda also introduced strong policies in support of family planning. It improved access to contraceptives by stocking up all public health clinics and training more family planning providers. This resulted in a 10-fold increase in contraceptive use (from 4% of married women of reproductive age in 2000 to 45% by 2010).

    In Ethiopia and Malawi, health extension workers help get people to clinics. USAID helps these nations fund the Women's Development Army, which trains community mothers as extension workers. In addition to a hospital and small health center in every community, Ethiopia also staffs a health post with two extension workers. They go door to door and they host informal gatherings to promote family planning and answer questions. Before joining the Women's Development Army, Yenenesh Deresa had her first of five children at 15. Now she talks to women about family planning over coffee. She says this empowers women to make their own decisions and have safer pregnancies.

    Countries that lower their fertility rates often experience an economic boost known as the demographic dividend. Family planning allows more women to work and help grow the economy. Where girls can work and support themselves, the nation has fewer dependents, thus adding to its stability. The first step is to lower fertility rates, but for young people of both genders to join the workforce, they must be trained and jobs must exist. This is mainly a problem for girls in low-resource countries since about a quarter of them get pregnant and drop out of school. Roman Tesfaye, First Lady of Ethiopia, says to become a middle income nation, girls "need to be protected from unplanned pregnancies." Zewdtu Areda, who oversees health services in her area, sees significant progress. "You can see that things are changing now for women. I am a woman, and I am a leader here." doclink

    Art says: According to 2013 CIA World Factbook estimates, these three nations still have a long way to go. Ethiopia has 5.31 children per woman. Malawi has 5.26 children per woman, and Rwanda has 4.71 children per woman

    Why I Work on Family Planning and Reproductive Health: Reflections on World Population Day

       July 11, 2013, MSH - Management Sciences for Health   By: Fabio Castaño

    In the 1960s, during Columbia's demographic transition, Fabio's Castaño's father and mother came from large families and consequently never went to college, but instead had to work hard as teens to help their families. At that time Profamilia, a Columbian affiliate of International Planned Parenthood Federation (IPPF), was helping steer the country through successful demographic transition. Fabio's mother wanted an education for her children and convinced her husband that the best way out of poverty was hard work and having a small family.

    Out of their large extended family of 70-plus, Fabio was the first one to graduate from college and medical school. Fabio's two sisters also received an education. Fabio's story exemplifies how access to reproductive health and family planning in a low-income country can have tremendous economic and life-transforming impact for young people and a whole generation -- beyond the reduction in fertility and improvements in health.

    On July 11, World Population Day, we observed the one-year anniversary of the London Summit and the launch of the FP2020 initiative. The momentum for voluntary family planning and reproductive health is growing, However, globally more than 200 million females still have an unmet need. Many of them are adolescents.This unmet need leads to unintended pregnancies and unsafe abortions.

    This unmet need can be met through quality family planning and reproductive health (FP/RH) services. innovative public/private partnerships and high impact, evidence-based interventions, such as through integrating FP/RH with adolescent health and maternal, newborn, and child health services and HIV services, implementing community-based FP, encouraging healthy timing and spacing of pregnancy, and by ensuring contraceptive security.

    MSH - Management Sciences for Health - has over 40 years of experience in bolstering the capacity of local partners to dramatically expand community-based care, especially key maternal, neonatal, child health, adolescent, and family planning services. MSH has been actively engaged in helping end child marriage, such as through promoting equal access to health care for women and girls in more than 135 countries for over four decades.

    Choosing to have a small family-and having access to quality family planning services and information-can lead to a multitude of positive effects for people's health, education, and economic safety. doclink

    DKT International's Social Impact Entrepreneurs Are Transforming Family Planning

       April 25, 2013, Business Wire

    DKT uses social impact entrepreneurship as a tool to sell condoms and other contraceptives and provide reproductive health and family planning services, through innovative marketing and distribution channels, including the Internet, social media sites, midwives, clinics, drug and grocery stores. This approach differs greatly from traditional nonprofits by providing goods and services as normal commercial purchases that offer consumers a benefit at an affordable price.

    In its most recent fiscal year DKT's $130 million in total revenue was balanced by an equal amount spent on programs, with approximately 70% of program costs recovered through sales. The balance of revenue comes from donors, and DKT's revenue generating models greatly leverage donor funds. It's an entrepreneurial model that works. In 2012 DKT programs prevented an estimated 8.2 million unwanted pregnancies, 1.7 million abortions, and more than 14,000 maternal deaths.

    Christopher Purdy, Executive Vice President of DKT International says: "Our strategy depends on recruiting high performing people who are true social impact entrepreneurs. Many country directors have undergraduate or advanced business degrees, and some have served in corporate marketing or business capacities before joining us. They direct a field staff of 1,800 people and have wide autonomy to make decisions quickly."

    DKT International's use of social marketing for reproductive health products and services builds contraception and family planning demand through mass media and non-traditional messaging that reduce social stigma and target all socio-economic groups. Each country director runs his or her custom-tailored, culturally appropriate program designed to reach the maximum number of people in each market segment.

    "Our directors use new approaches in countries where tradition, religious restrictions, government censorship and politics complicate their task," Purdy added. "By providing people with an essential service that they value, and can afford, our country directors create real momentum for social change." doclink

    According to Wikipedia, DKT International is Washington, D.C.-based; was founded in 1989 by Phil Harvey and operates in Africa, Asia, and Latin America. In 2012, DKT sold over 600 million condoms, 76 million cycles of oral contraceptives, 16 million injectable contraceptives and 1.5 million intrauterine devices (IUDs). This is equivalent to 25 million couple years of protection (CYPs), making DKT one of the largest private providers of contraceptives in the developing world. The average cost per CYP was less than US$3.00. Charity Navigator has given DKT a four-star financial rating, with 98.3% of its budget going towards programs and 1.6% towards administration and fund raising in 2010.

    Thailand: Thai Restaurant Offers Family Planning Advice with Meals

       December 20, 2012, Times of India

    Cabbages and Condoms Restaurant Years ago former politician and activist Mechai Viravaidya popularised condoms, family planning and AIDS awareness in Thailand and helped establish a restaurant called Cabbages and Condoms where condoms are distributed along with the bill. Eventually six such restaurants were established across the south east Asian country.

    Now the idea has been brought over to the UK with the new restaurant in Bicester, Oxfordshire, leading the way with all profits from merchandise sales donated to charitable causes in Thailand.

    Diners are given leaflets on protective sex at the end of the meal and even encouraged to buy condom-themed merchandise. The new restaurant even has the slogan 'and remember our food is guaranteed not to cause pregnancy.'

    The name of the eatery refers to the idea that people should buy condoms alongside everyday mundane items such as cabbages.

    Diners at the new restaurant will get the chance to sample traditional Thai food 'in a cosy atmosphere.' Later they are urged to buy unusual condom-themed merchandise such as mugs, keyrings and books and even a mascot made out of the contraceptive. doclink

    Karen Gaia says: I have eaten in the Bangkok Cabbages and Condoms. It is a very nice restaurant with a fun gift shop to browse. Thailand's fertility rate is 1.58 and it's population growth rate is 0.6% and still declining.

    End of this section pg 1 ... Go to page 2 3

    Lack of Funding, Narrow-Minded Policy Makers

    Reproductive Health: the Battle Resumes

       January 8, 2015, Huffington Post   By: Robert Walker

    One the first day of Congress this year, Representatives Trent Franks (Ariz.) and Marsha Blackburn (Tenn.) reintroduced legislation to stop women from terminating pregnancies after 20 weeks.

    The proposed abortion ban is part of a much larger, ongoing struggle over reproductive health and rights in America. The Population Institute recently gave the U.S. a "C" for Reproductive Health Rights in 2014, a slight improvement over last year's grade ("C-"). 15 states received a failing grade.

    Several states enacted arbitrary abortion restrictions that will likely lead to the closure of more family planning clinics, making contraceptive services more difficult to access. Other states approved further cutbacks in funding for family planning clinics, while 23 states still reject the expansion of Medicaid coverage called for by the Affordable Care Act, effectively denying millions of women improved access to contraceptive services.

    It might get worse. If the U.S. Supreme Court overturns key sections of the Affordable Care Act or Congress repeals it altogether, millions of women could be forced to pay a lot more for their contraceptive coverage. And if Congress slashes or eliminates funding for Title X, the federal program that provides family planning services to low-income households, millions of women could suffer a loss of contraceptive services.

    More states could cut funding for family planning clinics or impose arbitrary restrictions on birth control clinics providing abortion services. Unfortunately, contrary to the stated intention of the attackers, the practical effect will be more abortions, not fewer.

    The Institute's report card ranked the states based on measures of effectiveness, including:

    * The teenage pregnancy rate (15% of the score)

    * The rate of unintended pregnancies (15%)

    * Mandated comprehensive sex education in the schools (15%)

    * Access to emergency contraception (5%)

    * Whether states are expanding Medicaid under the Affordable Care Act (10%)

    * Medicaid eligibility rules for family planning (10%)

    * Funding for family planning clinics serving low-income families (10%)

    * Abortion restrictions (10%)

    * Percent of women living in a county without an abortion provider (10%).

    Four states (California, New Mexico, Oregon and Washington) received an "A".

    Fifteen states received an "F": Alabama, Idaho, Indiana, Kansas, Louisiana, Mississippi, Missouri, Nebraska, North Dakota, Oklahoma, South Dakota, Tennessee, Texas, Virginia, and Wyoming.

    Last year could have been a great victory for women's reproductive health with tumbling teen pregnancy rates and increased access to reproductive health care for women under the Affordable Care Act. Unfortunately, setbacks at the state level negated some of the gains.

    The reported teen pregnancy rate continued its historic drop, a 51% decline since its 1990 peak, however America's teenage pregnancy rate is still higher than other industrialized nations. Also 50% of pregnancies are unintended. All women need to have access to affordable reproductive health services and young people need to receive comprehensive sex education in the schools.

    The outlook for 2015 is not positive. Millions of women could experience reduced access to contraceptive services in the next year. We should not let that happen. doclink

    Family Planning Drive Reaches Millions of Women and Girls

    But report warns population growth could outpace family planning programmes in some countries despite range of contraception initiatives
       November 3, 2014, Mail and Guardian   By: Carla Kweifio-okai

    During the London Family Planning Summit donors pledged $2.6 billion to bring contraception to 120 million more women and girls in developing countries by 2020 than would otherwise be served. This year's Partnership in Progress report shows last year the increase was one million below the projected benchmark of 9.4 million. To meet the planned objective, the program will need to reach 120 million more women and girls by 2020. The report said, in some countries population growth may outpace the expansion of family planning programs. "in many countries, an enormous effort is required simply to maintain existing levels of service." The U.N. population fund estimates that the "unmet need" of voluntary family planning will actually grow by 40% in the next 15 years.

    However, several accomplishments are worth noting. The plan calls for, and is, reducing maternal mortality. Widening access to family planning services helped avert 125,000 maternal deaths last year, compared with 120,000 in 2012, and 24 million unsafe abortions, compared with 23 million the previous year. In Bhutan, Djibouti, Kenya and Rwanda growth in contraceptive use exceeded 2.5% last year compared with an average of 0.65% in developing countries. Also, the global contraceptive implant program made agreements with pharmaceutical companies to address the problems of high costs and short supply that blocked women from accessing implants. Cutting the cost of implants by 50% in more than 60 countries has allowed a projected tripling of implants from 2.4 million units in 2011 to 7.7 million this year. The rollout of Sayana Press, an injectable contraceptive with a disposable syringe, allows community health workers to give injections after only two hours' training. Burkina Faso will distribute 250,000 units this year, and Niger, Senegal and Uganda will be next. Also, the mCenas! project in Mozambique educates young people about contraception via text, and a television and online drama series in India highlights family planning.

    Report Director, Beth Schlachter, mentioned two resupply innovations. In Kenya, health clinics send text messages to more quickly resupply empty shelves, and in Senegal a supply truck now stops by regularly to keep clinics and pharmacies from running out of contraceptives. She also said it was promising to see 12 countries host conferences on family planning in the past year. "Countries that have never before endorsed family planning - such as Myanmar and Uganda - are now holding national conferences on the subject, and ministries of health are developing costed implementation plans and adding contraceptive line items to their budgets." Five more countries - Benin, the Democratic Republic of the Congo, Guinea, Mauritania and Burma - last year pledged to expand access to contraception, bringing the tally of committed countries to 29. doclink

    Karen Gaia says: I don't understand the recent emphasis on family planning in Myanmar. Their fertility rate is only 2.18. See

    Ethiopia: New CSIS Report and Video: Family Planning and Linkages with U.S. Health and Development Goals (video)

       April 23, 2014,   By: Janet Fleischman, Senior Associate, and Alisha Kramer

    The video is designed to bring the voices of Ethiopian women and girls as well as champions of family planning into the U.S. policy discussion. Rural women, health extension workers, and an Orthodox priest, along with an official of the Ministry of Health and the First Lady, lend their voices to vividly highlight the importance of family planning as a core component of Ethiopia's development.

    In Ethiopia contraceptive use rose from 15% in 2005 to 29% in 2011, due largely to the government's ambitious Health Extension Program. The U.S. has made significant investments in Ethiopia's health and development programs, and has been a critical partner in its achievements in family planning.

    Ethiopia is the second-most populous country in Africa, with high levels of maternal mortality and extreme poverty. It is imperative to increase access to women's health services and to address the unmet need for family planning. These challenges are compounded by the government's restrictions on civil society and the private sector, especially related to democracy and human rights.

    A delegation composed of bipartisan staff from three congressional offices - Senator Mark Kirk (R-IL), Representative Charlie Dent (R-PA), and Representative Karen Bass (D-CA) - and from the Bill & Melinda Gates Foundation and Hope Through Healing Hands (founded by former Senate Majority Leader Bill Frist) - visited the country to clarify and illuminate the value of family planning through an in-country study of a dynamic national program.

    The delegation's findings underscore the importance of continuing U.S. global leadership in family planning.

    The Obama administration and the U.S. Congress are called upon to use upcoming opportunities in 2014 to demonstrate commitment to prioritizing family planning as integral to U.S. policy on health and development. These include:

    • At the African Leaders Summit in August 2014, President Obama should ensure that women's health and access to family planning are an explicit part of high-level discussions;

    • Secretary of State John Kerry should elevate the importance of family planning for women's and girls' health and empowerment as part of U.S. diplomatic, development, and security strategies. This includes engaging with the African Union, publicly recognizing that family planning is an essential part of the response to gender-based violence and post-rape care; and supporting the inclusion of family planning targets and indicators in the post 2015 development agenda.

    • Congress should prioritize resources for international family planning programs and for linkages between family planning and other health and development programs, such as maternal and child health, HIV/AIDS, gender equity and women's economic empowerment, humanitarian responses, and food security.

    Dr. Tewodros said: "family planning is beyond is beyond a gender issue. In Ethiopia, we consider it as a fundamental rights issue."

    The report is here: doclink

    The Geography of Unintended Pregnancy (infographic)

       September 4, 2013, Huffington Post

    About half of the of the 6.7 million pregnancies in the U.S. each year are unplanned, according to a new state-level analysis by the Guttmacher Institute. The unintended pregnancy rate is a standout in the industrialized world, and has remained nearly flat since the 1980s despite advances in birth control technology and availability.

    Women with incomes at or below the federal poverty line are five times more likely than those at the highest income levels to become pregnant by accident - and unintended pregnancies have become increasingly clustered among the poor in recent years. Most of the births resulting from unplanned pregnancies are publicly funded, and they aren't cheap.

    Unintended pregnancy remains the main reason for abortion, a procedure three in 10 American women have by age 45.


    Family Planning is Key to Healthy Pregnancies and Births

       May 10, 2013, Guttmacher Institute

    Each year in the United States an estimated 11,300 babies die on the day they are born, according to Save the Children. This is the highest first-day death rate in the industrialized world. Investing in and expanding the reach of programs like Medicaid and Title X would make affordable pregnancy-related care and family planning services available to millions of women otherwise unable to obtain such care and would result in fewer first day deaths.

    Contributing factors include preterm, unplanned and teen births. One in eight U.S. babies are born prematurely and U.S. preterm births rank second only to Cyprus in the industrialized world. Half of all U.S. pregnancies are unintended and the U.S. adolescent birth rate is the highest among industrialized countries -- with teenage mothers tending to be poorer, less educated and receiving less prenatal care than older mothers.

    Comprehensive efforts are needed to reduce pervasive economic, social and health disparities, including improving access to high-quality, affordable maternity care for all women and making effective family planning available to every woman who needs it. These interventions are proven to offer direct and positive effects on newborns' and mothers' health.

    Studies show there is a causal link between proper birth spacing and low birth weight, preterm birth and small size for gestational age. There is also an association between pregnancy intention and delayed initiation of prenatal care; women are less likely to recognize a pregnancy early if it is unplanned and therefore have fewer prenatal care visits. Children born from unintended pregnancies are less likely to be breast-fed at all or for a long duration.

    Contraception has played a major roll in the drop of the U.S. teen birth rate, which has declined for nearly two decades and the 2010 rate represents a 44% drop from the 1991 rate.

    Medicaid, Title X and other public programs help women avoid 1.94 million unintended pregnancies each year, which would otherwise result in 860,000 unplanned births and 810,000 abortions. Without these programs, levels of unintended pregnancy would be nearly two-thirds higher among U.S. women overall and among teens -- and close to twice as high among poor women. Ideological and fiscal attacks against these programs are not only counterproductive, but threaten to worsen what is already a severe crisis for U.S. women and newborns. doclink

    The Secret History of Sex, Choice and Catholics

       December 29, 2012, RH Reality Check   By: Jon O'brien

    The organization Catholics for Choice has made a movie called "The Secret History of Sex, Choice and Catholics." Jon O'Brien, who was the one who decided to make the movie, explained that he was talking to a stranger who felt uncomfortable with many of the positions taken by Catholics for Choice, and O'brian told the gentleman that his work in support of reproductive rights was not despite his Catholic faith, but because of it.

    The Catholic "social justice tradition wouldn't let me turn my back on people in need; nor would it allow me to ignore the importance of conscience in moral decision-making. Both issues relate directly to reproductive health: women are in the best place to make the decisions that affect their health, and deserve all the support necessary when life's challenges threaten their well-being, their health, or even their very lives. Those who are rich will always have the means to bypass the obstacles in their way, legal or otherwise, whereas the poor and needy are always the ones who suffer."

    O'Brian asked the gentleman "Why do you deny the truth about all the affirming messages in Catholic theology about women, choice, and sexuality in general?" and was told: "Those issues are too hot to handle." He would have been denied mainstream acceptance and positions if he'd tackled issues like reproductive rights. Rather than pick that fight, he had chosen, as many others do, to keep his head down Apparently those whose understanding and interpretation of core Catholic teachings is a little different the standard teaching are slighted and attacked for raising legitimate points of view about church teaching.

    There is a reason why people like Bishop Kevin Dowling, who tells the truth about Catholics and condoms in the shanty towns of South Africa, do not attain the trappings of power, position, and influence that have been lavished upon so many ultra-conservative American clergymen of late.

    "Telling the truth about Catholic theology really matters. It matters for reasons of self-respect, and it matters for so many who think they have to choose between their faith and how they live their lives. For me, working with theologians and so many marvelous thinkers in the church who are not afraid to stand up and speak out has been an amazing experience. It is truly liberating when you see that it is possible to be both true to yourself and authentically Catholic at the same time."

    And so, after talking to a filmmaker, the "The Secret History of Sex, Choice and Catholics" was born.

    The "secret" is that there is more than one magisterium -- in addition to the hierarchy, there is also the magisterium of the theologians and that of the people. This means that any of us can be called to teach, and for many this can mean doing what the theologians and thinkers in the film have done: bravely speak out. Their paths often lead straight into confrontation with established authority.

    The first day we released the movie, thousands of people worldwide -- from the Philippines to South Africa, from the US to Eastern Europe -- watched the film online. There is clearly a genuine hunger for this message.

    Non-Catholics have learned from the film what the majority of Catholics actually believe. And the story told by "The Secret History" isn't just for Catholics. It gets to the heart of how we all make moral decisions and seek compassionate answers. doclink

    Karen Gaia says: population activists often get accused of being racist. Why do so many people think that family planning is evil? Why can't they see family planning benefits the family primarily, the community secondarily, and the world is behind family and community in importance.

    Philippines Faces Contraception Vote

       August 6, 2012, Wall Street Journal

    There has been controversy in the Philippines as representatives of the Roman Catholic Church and President Benigno Aquino III clash over a proposed reproductive-health bill designed to bring down the country's unusually high birthrate.

    With a population of 104 million people and a birthrate of 25 births per 1,000 every year (compared to 13.7 per 1,000 in the U.S.) economists have suggested that the problems the Philippines has experienced in terms of poverty, pressure on natural resources and overburdened infrastructure will continue to cause hardship unless something is done. Affluent couples in the country have fewer than three children on average but the country's low-income mothers have nearly six.

    The proposed bill, which is being debated in the Philippines House of Representatives, would require the government to make contraceptives available. It would also require officials to provide information on family-planning methods and provide classes on reproductive health and sexuality in schools.

    With the results of a vote from the Philippines House of Representatives expected any day now the Catholic Church has been leading widespread protests, with an estimated 10,000 people protesting the bill in Manila in one day alone. Archbishop Socrates Villegas of Pangasinan province attended the rally and was quoted as saying "Contraception is corruption", "The use of government and taxpayer money to promote contraception is tantamount to corruption." He also expressed concerns that contraception made sex "cheap without responsibility".

    Despite support for the bill from the United Nations, the bill would not only have to pass the vote in the House of Representatives, it would require support from the senate, which analysts say will be difficult.

    Despite these difficulties, President Aquino seems determined to reduce poverty and improve the economy, and has met with some success in this regard. The GDP grew by 6.4% in the first quarter compared with last year (the fastest increase in six quarters) and country has experienced a series of credit rating upgrades.

    In spite of these economic improvements the Catholic Church maintains its opposition, with the belief that economic development does not outweigh their moral concerns. doclink

    FY 2011 Country Operational Plan Guidance Fails to Offer Detailed and Realistic Plan to Support HIV-FP (Family Planning) Integration

       October 12, 2010, Population Action International

    PEPFAR (President's Emergency Plan for AIDS Relief) should ensure that a HIV-positive woman who wants to prevent unintended pregnancy can receive family planning services at any PEPFAR location. The ability to meet the immediate needs of a woman and provide comprehensive prevention of mother-to- child transmission (PMTCT) programs should not be contingent on the presence of another program or funding stream.

    In PEPFAR's annual Country Operational Plan (COP) guidance to the field, the Obama administration in principle continues to support an integrated, women and girl-centered approach to health services, but fails to provide implementers with the tools and guidance needed to make that a reality. This is a surprising development as it is the first COP released after the announcement of the Global Health Initiative (GHI) Plus Countries, and yet is out of step with public statements made by high-level officials touting the women and girl-centered, integrated approach to global health.

    As the COP process, GHI and PEPFAR implementation and additional guidance continue to evolve, we encourage partners in the field to communicate with staff at their mission and in the Office of the Global AIDS Coordinator about what is working and what is not in order to inform their future decisions.

    The FY11 COP guidance says that:

    Any family planning services, including the provision of contraceptives for PMTCT, that are integrated with HIV services, must continue to be funded out of separate accounts. While these integrated activities are encouraged, the family planning commodities must be funded using non-PEPFAR funds.

    "Field teams are expected to prioritize opportunities to link PEPFAR-funded activities with those funded from separate accounts supporting reproductive health and family planning."

    PEPFAR programs are encouraged to provide referrals to family planning programs and to co-locate services. While this is a positive development, it does not address the family planning needs of women living in countries without family planning funding or programs. One-third of the 33 countries required to submit an FY11 COP do not receive any family planning/reproductive health (FP/RH) assistance from USAID.

    Historically the U.S. has underfunded FP/RH programs and even recent important funding increases still leave FP/RH funding nearly 25% below their peak levels in 1995 (when adjusted for inflation) and below the U.S. fair share of addressing the needs of the 215 million women who want to avoid pregnancy, but do not have access to modern contraception.

    Without significant scale up of funding for FP/RH, meaningful integration of these services will not occur using the referral and co-location model articulated in the COP.

    The COP rightly identifies PMTCT programs as an ideal platform to deliver other essential health services, including family planning, but again misses an opportunity to maximize the improved health outcomes through fully supporting the tools needed to prevent mother-to-child transmission.

    The World Health Organization (WHO) has long identified family planning as one of four essential components of PMTCT programs and many countries have both high HIV prevalence rates and high unmet need for family planning.

    While it was encouraging to see that PEPFAR funds could support much-needed PMTCT training for health workers that includes MCH (Mother and Child Health), family planning and reproductive health services for women living with HIV, the impact of having a trained work force and increased demand for these critical interventions is limited if the commodities needed to deliver the services remain unavailable. By issuing a COP that does not account for the increased demand for contraceptives that will likely result from training and community mobilization, PEPFAR falls short of ensuring that HIV positive women will be able to prevent unintended pregnancy and plan the timing and spacing of their pregnancies. doclink

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    Birth Spacing

    'One Key Question' to Revolutionize Reproductive, Public Health

       August 26, 2015, Public Health Newswire

    In Oregon there is a movement where doctors ask every woman of reproductive age "Would you like to become pregnant in the next year?" The movement is called One Key Question.

    The Oregon Foundation for Reproductive Health (OFRH) believes this question "triggers a doctor-patient discussion that will keep women healthier, help eliminate health disparities and save taxpayer dollars."

    The goal is to ensure that more pregnancies are wanted, planned and as healthy as possible.

    This question brings pregnancy intention screening and preventive reproductive health directly in to primary care. It opens the door to providing either preconception, prenatal or contraceptive care in a novel fashion that goes beyond simply asking if she is pregnant or using contraception. One Key Question is a conversation starter, not a checklist. It can initiate a genuine conversation that empowers a woman to plan her health care needs in support of her goals for herself and her family.

    OFRH tested many variations of asking about prenatal care and pregnancy prevention before determining this question to be the most effective. Clinicians implementing One Key Question have found that the majority of women have a clear opinion about whether or not they would like to become pregnant in the next year.

    However, when a woman answers "maybe" or "I don't know," One Key Question often effectively leads to identifying urgent health needs that may otherwise go undetected - such as depression, violence in the home or substance abuse - and leads to negative pregnancy outcomes.

    Women are relieved to be able to talk about their reproductive health needs in a primary care setting rather than through a separate appointment with a specialist. This more streamlined approach can be invaluable for low income women, women of color and those in rural communities, in particular, who have decreased access to reproductive health care.

    OFRH is very aware of the need to establish reliable systems for measuring the impact of One Key Question as it is implemented in sites nationwide.

    Ultimately, because One Key Question encourages women to obtain preconception care, we expect to see a drop-off in public health care costs as earlier identification and management of conditions such as diabetes and hypertension improve pregnancy, delivery and post-natal care and lower long-term costs for all women, but particularly for those with decreased access to specialized care. doclink

    Karen Gaia says: After I gave birth to my first child 50 years ago, my doctor asked me if I wanted to get pregnant right away. Of course I said 'No'. That's when I was introduced to contraception. In Bangladesh, the health care worker tells the pregnant woman to come back after the birth and when she comes back, she is offered birth control to space her pregnancies. That is how Bangladesh lowered its fertility rate so quickly.

    At Niger's School for Husbands, the Lesson is 'Space Your Children'

       August 13, 2014, NPR National Public Radio   By: Marc Silver

    Niger is a country that depends on agriculture, but since much of it is a desert, it has only a limited amount of land that can be farmed. This is a problem for a country that has the world's highest birthrate -- more than seven children per woman on average. It's current population will double in 20 years at that rate.

    The United Nations Population Fund began the school for husbands program in 2011 to help bring down the birth rate. In different communities, men meet twice a month, under a tree or in an open-air classroom, to talk about maternal health and contraception.

    In this society you have to convince the men that it's OK because that's how the decision is going to get made.

    Contraception is fairly controversial in Niger so much of the time they talk about child spacing. In Niger, you're a big man if you have a big family, yet this is becoming a huge problem. Even the president talked about it being shameful this month for people to have 20 kids if they're not able to feed them.

    The government is going to make contraception available in all the health clinics and get the word out that not only is it OK for women to use contraception but that they should be using contraception. Male condoms, female condoms, IUDs, injections, the pill will be available. In fact they are now available.

    Younger men are expecting a smaller family than previous generations. So that change is happening.

    There is also a push to have women get married later, not at 12 or 13 or 14 but in their late teens, early 20s. That shortens the period when they would be having children. In one case a girl went to court to stop her family from forcing her to marry her uncle in Nigeria. Ultimately, she was successful.

    Infant mortality is going down, so kids are surviving longer. But people don't yet understand that they don't need to have as many kids because most of the kids are now going to survive to adulthood. doclink

    How Bangladesh's Female Health Workers Boosted Family Planning

    Contraception delivered through female community health workers has helped to reduce birthrates and infant mortality
       June 6, 2014, Guardian   By: Kenneth R Weiss

    This interesting article is somewhat long but worth reading in its entirety (by clicking on the link in the headline), so here is the gist of it:

    Bangladesh established Matlab -- an experimental village -- in the 1960s and there trained a cadre of female community health workers who have been carefully maintaining one of the longest-running and most detailed health and population data sets in the developing world.

    These health care workers make house calls to administer child and maternal health and are widely credited for demonstrating how poor Muslim women with little or no formal education can plan their families.

    Ubaidur Rob, the non-profit Population Council's Bangladesh director said "Women were employed as field workers in the 1970s, when fertility was very high and female employment was virtually zero. This is where change began."

    In the mid-70s researchers divided 149 villages into two groups. One half participated in the Matlab centre's maternal and child healthcare initiatives, including home delivery of modern contraceptives, while the other had access only to government services.

    At that time, contraception was denounced by Islamic clerics. Dr Mohammad Yunus, who ran the Matlab centre for nearly 40 years said that what worked "was a comprehensive doorstep service with trained female health workers making regular follow-up visits to help mothers pick a method of contraception that was best for them, treat side-effects and provide basic maternal and child healthcare."

    In the Matlab half, married women were more likely to use contraceptives and, over time, had an average of 1.5 fewer children than their counterparts in the comparison area. Their children were healthier, fewer women died of pregnancy-related causes, and child mortality fell. Parents accumulated more farmland, built more valuable homes and gained access to running water. Their children stayed in school longer, and women enjoyed higher incomes.

    By the early 80s, when other areas using the Matlab approach had experienced a similar increase in contraceptive use, the government trained tens of thousands of female health workers using the Matlab model.

    Since then, average birthrates have fallen from six children a woman to slightly more than two; projections for Bangladesh's population in 2050 (currently 160 million) have dropped from 265 million (forecast in 2000) to 200 million, and stabilizing soon after. Also Bangladesh has become one of the first impoverished countries to meet the UN millennium development goal of reducing child mortality by two-thirds. doclink

    Karen Gaia says: one of the things that helped this program work was that new mothers were asked to come back after the baby was born, and during that visit, were asked if they wanted to have another baby soon. If the mother said 'No', the health care worker was prepared to give here one of an assortment of contraceptives.

    Nigeria: Bundling Child Spacing and Immunization Into One Integrated Service

    TSHIP Advancing Health in Bauchi and Sokoto Targeted States High Impact Project
       October 9, 2013, Vietnam News Agency

    Child spacing is a crucial aspect of improving the overall health of women in developing countries - helping to reduce unwanted pregnancies and the health risks associated with giving birth to many children. For children under-five years, a critical live saving measure is immunization.

    Bundling these two services together as TSHIP is doing provides a continuum of care - from child spacing, antenatal and postnatal needs of women to the care of children under-5 years.

    Raising awareness of child spacing is a tricky issue, especially in communities where conservative values are still strong. In an area of Sokoto such "cultural sensitivity" has been softened by making it a community-led exercise. The members of the WDC help start the needed dialogue at the community level, bringing health education and the issue of child spacing to locations as diverse as markets, gathering places and even places of worship.

    Another approach is the practice of holding child spacing education at the same time as immunization or antenatal services in health facilities. This takes less time and money, with local people keen to make the most of the health services offered. Maryam Umar, a worker at the Shuni dispensary, said 'I provide immunization and child spacing services to women when they bring their children for immunization, because of fear that the women will not come back on the child spacing session day. Some will even report us to the WDC if we do not provide them with all necessary services'.

    The changes in Shuni are just a small drop in the sea of change happening in Sokoto. The state has over 70% of its health facilities holding integrated child spacing and immunization sessions. As more women bring their children for immunization, the opportunity to reach these women with child spacing messages and services has equally increased.

    TSHIP = Targeted States High Impact Project: increases the use of health services and strengthens health systems to be more responsive to the basic health needs of households in Northern Nigeria doclink

    India: Family Planning After Childbirth Is Critical to Women's Health

       April 15, 2013, Impatient Optimists

    In India, Anita Devi had five children in nine years of marriage; three of her children were born within a year of each other. As part of India's postpartum family planning effort, the nurse-midwife encouraged Anita to choose contraception after the birth of her fifth child. Anita chose intrauterine contraception.

    "My mother-in-law was against any form of contraception," Mrs. Devi explained when asked about her previous births. "Though my second child was a son, she said that I should try for more sons. But my next children were girls. I was tired and felt I had nothing left in my body."

    In Bihar province, families have on average 3.7 children, and only 32.4 percent of women use any family planning method.

    With the support and technical expertise of Jhpiego (affiliate of Johns Hopkins University) and under the PPFP (Post Partum Family Planning) initiative supported by the Bill and Melinda Gates Foundation, India's nurse-midwives are educating and counseling women about their family planning options during antenatal visits and introducing them to the intrauterine contraceptive device (IUCD). This long-acting method lasts for 10 years and can be inserted within 48 hours after giving birth. 16 states are participating in the program.

    She has seen firsthand the challenges women and their families face when burdened with too many children, often struggling to provide them with food and clothing. "Only if we have smaller families will we be able to have healthier families where the children will get better nutrition and opportunities to educate themselves. Only then can we ultimately have a better and healthier society." doclink

    South Sudan Women Choose Family Planning, Longer Lives

       November 8, 2012, Voice of America News   By: Hannah Mcneish

    South Sudan has been cut off for nearly 50 years by Africa's longest running civil war, and, due to a lack of basic health and education, early marriage, and a culture that values big families have led to alarming child mortality rates, has seen the highest maternal mortality rate in the world. The average woman has seven children and at 1.7%, South Sudan has one of the lowest contraceptive availability rates in the world, plus early pregnancy has increased from one-fifth to one-third of teenagers in recent years.

    Now newly-independent South Sudan has been building a health service from scratch with the help of international aid agencies and South Sudanese women are getting the chance to improve their chances for a long life. South Sudan hopes to increase the contraceptive availability rate to 20% by 2015, as the new nation's population grows at three percent a year and it struggles to get a grip on providing basic services. Family planning charity Marie Stopes International (MSI) started programs in South Sudan's three southern states.

    One woman is getting a hormone implant that will space her children and give her a five-year break. Another woman has a husband earning a paltry and irregular salary, and she is determined to educate her children in a hope that one may someday lift the family out of poverty.

    Over 80% of South Sudan women have no education and 16% are married off by the age of 15.

    A clinical officer Jude Omal at one of the clinics said, "When we were beginning, we had a lot of resistance as people think when you provide family planning to a mother, or a lady of reproductive age, she may most likely turn into a prostitute. You say 'no, these services helps her to have children at a time when she thinks she's ready,' so this family planning is like an empowerment to women and girls of reproductive age."

    He said both men and women are increasingly aware about the links between a quick succession of pregnancies and lack of health care to high instances of maternal mortality. doclink

    Solutions to Poverty, Population Growth, Global Warming

       September 19, 2012, Los Angeles Times

    Experts from three continents convened last week at UC Berkeley to discuss rapid population growth, climate change and other intractable problems. Before the conference, the Los Angeles Times held an online video discussion with some of the conference attendees.

    The article in the Los Angeles Times newspaper explored such issues around the world in its recent five-part series on population growth in the developing world. Among other topics, the "Beyond 7 Billion" series examined chronic hunger and mass migration in East Africa -- trends that Dr. Malcolm Potts believes will soon extend across the Sahel, an arid region of Africa just below the Sahara desert.

    Malcom Potts, a UC Berkeley professor of public health who co-organized the conference said, "What you've been seeing from Somalia is going to happen in all those countries, all the way across from the Red Sea to the Atlantic Ocean." .. "You've just seen a fraction of what's going to happen in the next 10 or 20 years." The goal of the online broadcast before the conference was to discuss solutions to the problems facing this part of Africa and other impoverished nations with soaring populations. He was joined by Dr. Ndola Prata of UC Berkeley, William Ryerson of the Population Media Center and Fatima Adamu from Usmanu Danfodiyo University in Sokoto, Nigeria. Kenneth R. Weiss was the moderator.

    Dr. Potts: The Sahel is dry dusty region in Africa which is affected by climate change and has rapid population growth, and the status of women is low. It is where there are many cases of drought and famine. Other areas are also in trouble: Afghanistan will double by 2050; people there are growing poppies instead of food. Child brides are a problem in both areas.

    Dr. Prata: Women need control over number and timing of their births; Over 200 million women don't want to have a child in the next two years or don't want to have children at all. They need access to family planning. Family planning is very cost effective and has a beneficial impact on maternal and child mortality. Women want to be able to send their children to school, and family planning helps this.

    Ryerson - Only 1% of people who don't use contraception cite lack of availability as the reason. 40% of non-users cite religion, husband, or personal, 17% want as many children as possible, a sizable number cite fear of side effects, and another large number are fatalistic - 'God will determine how many children I have'. We must be very careful to avoid cultural imperialism. What is important is people's perception of what is normal. This can be changed. Population Media Center uses serialized entertainment mass media featuring role modes of various types of people. PMC models behavior such as delaying marriage and childbearing until adulthood, prevention of HIV, spacing births, and communication between husbands and wives concerning health and number of children. Of those who were interviewed, 67% of clients of a family planning clinic gave the PMC radio show as the reason for patronizing the clinic.

    Dr. Adamu - Agrees with the need to give women information and the culturally sensitive way that is needed to introduce these issues. There must be no coercion of any kind. Every woman wants to improve her life. It is important for the woman to have information of where to get services. The majority of our women lack basic information. We must invest in the woman and empower her. Many times religion allows women to space their births.

    Dr Potts: The best contraception is 'what the woman wants'. Even illiterate women can get family planning. A woman in the poorest countries have a 1 in 12 chance of dying in childbirth compared 1 in 5,000 for a developed country. Family planning could prevent most of these deaths. The current cost to Americans for international family planning funding is the cost of one hamburger. To provide adequate family planning and reproductive health for all the women who have an unmet need, it would take the cost of two hamburgers. It is shameful that we let so many women die for the cost of a hamburger. And what we avoid by family planning is the great cost of war and the cost of feeding so many people.

    Dr. Potts: Education has been considered one of the best contraceptives, but in the Sahel the population is growing so rapidly that schools cannot keep up. But education is not absolutely necessary. The women in Bangladesh were illiterate when they reduced their fertility rate so quickly.

    Dr Prada worked in Angola where the birth rate was 5 children per woman. Women want to improve their lives; they want to send their children to school; they want to feed their children. A family planning program will educate to allow women to make the best use of contraception. It is difficult to get contraception on a regular basis. Many want a long-acting injection but all they can get are condoms and pills. Dr. Prada suggests couple counselling before marriage.

    Dr. Adamu: Too many girls get married early. We must delay those marriages. The government must be working on poverty reduction and saving the woman's life. Let us not approach it in terms of 'population control' but more for saving lives. No husband wants his wife to die. Dr. Adamu works with adolescent mothers - some are age 12. They work in peer groups and involve the husbands and mother-in-laws. Giving them information on how to control their reproduction and get health care - and that there is a choice - empowers them and gives them the self-esteem to choose the number and the spacing of their children.

    Dr Potts: If you respect women and give them a choice, they will tend to have fewer children.

    Ryerson: Coercion is a terrible idea. However we must still realize that population is a key threat posing a real threat to human survival. Yet the U.S. Congress tried this year to stop all funding for international family planning.

    Dr Adamu: We have to understand the woman in the village where her respect lies in the number of children she has. There is still the question of how many children will survive, and so she values having many.

    Ryerson: People need to know that children will survive. Infant mortality rates are continuing to come down, but knowledge of that lags. Part of education must include the health of infants and ways they can survive.

    Dr Prada: The desired number of children does come down. Often the number of children a woman has is below the number she said she desired.

    Ryerson: The U.S. is not immune to population problems. It has the third largest population in the world and the highest per capita energy consumption. It promotes endless growth which is not possible. We need a whole new paradime for our economy. doclink

    U.S.: Early, Adequate Prenatal Care Linked to Healthy Birthspacing

       March 1, 2012, Guttmacher Institute

    The findings of a study called "Prenatal Care and Subsequent Birth Intervals," by Julien O. Teitler, "provide strong evidence that earlier and more intensive exposure to prenatal care during a first pregnancy is associated with more optimal spacing and thus, most likely, better fertility control."

    The authors used birth records from New Jersey women who had a first birth between 1996 and 2000, and examined the relationship between the timing and adequacy of prenatal care prior to a woman's first birth and the timing of her second birth. Most women (85%) had initiated prenatal care during the first trimester. However, 12% of women had initiated prenatal care in the second trimester, and 3% in the third; fewer than 1% had had no care. The later prenatal care was initiated, the more likely women were to have had a second birth within 18 months. Additionally, the likelihood of having a second birth soon after the first was greater if women had had inadequate rather than adequate prenatal care.

    The authors suggest that providers should take advantage of their encounters with women who initiate prenatal care later in pregnancy in particular, to ensure that these women receive family planning information and services during their prenatal visits. By doing so, providers could bridge the gap left by funding and service cuts to the family planning program; the potential impact on public health is large. doclink

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    Childbirth Complications, Maternal and Infant Mortality

    Infant Mortality and Birth Rates


    It has been shown that providing reproductive health care, lowering the infant mortality rate and the maternal death rate have had a positive correlation to reducing birth rates. In the case of infant mortality, when a women thinks that many of her children will not survive childhood, she wants to have extra children as insurance that she will have enough children. When death rates are high, as in the case of HIV/AIDS, families try to have more children to replace family members who will die, even if the result is a growing population. Women who are given attention in basic health matters begin to see themselves as more than just baby machines, and they gain more respect for their own lives. Then they can look beyond birthing babies and see themselves in other ways: as income-earners, as community workers, as valuable human beings who do not have to produce babies to show their worth. doclink

    Bill Gates - Saving the Lives of Children Reduces Population Growth

       November 2010, Bill Gates at a TED (Technology, Entertainment, Design) conference

    While most of us assume that saving the lives of children will contribute to overpopulation, Gates said the contrary is true. "The key thing, the most important fact that people should know and make sure other people know: As you save children under 5, that is the thing that reduces population growth. That sounds paradoxal. The fact is that within a decade of improving health outcomes, parents decide to have less children."

    "As the world grows from 6 billion to 9 billion, all of that population growth is in urban slums," he said. "Slums is a growing business. It's a very interesting problem."

    He said no matter what we care about-the environment, schools, nutrition, conflict-the issues are insoluble at 3 percent population growth per year. "Nobody can handle that type of situation, so the best thing you can do is avoid those deaths." doclink

    Karen Gaia says: There are people who twist this very concept into accusations that Bill Gates is practicing eugenics with his vaccine. See In fact, it has been long known that reducing infant deaths by any means (treating diarrhea, and pneumonia, for example), have made mothers more confident about, and desirous of, having fewer children.

       August 28, 1999, Werner Fornos

    It is well-known that high infant and child mortality in poor countries, where 97% of world population growth occurs, is a principal reason that women in less developed regions give birth to two and three times as many children as do women in industrialized regions.

    Women in poor countries tend to believe that the more children they have, the greater their chances that the number they actually want will survive. It is a tragic commentary on the health risks to infants and children in developing regions, among them: births too closely spaced, air and water pollution, lack of nutritious food and a shortage of medical supplies and personnel. doclink

    Impact of Child Mortality and Fertility Preferences on Fertility Status in Rural Ethiopia

       July 9, 2005, East African Medical Journal

    Child mortality is an overwhelming factor in determining fertility among rural Ethiopian women. According to a study conducted by physicians among over 1100 Ethiopian women, those who were older when they married and had their first child tended to have fewer children.

    Moreover, women who did not lose children in infancy had far lower fertility rates than those who lost one or more children. doclink

    Report Ranks U.S. Last Among Developed Countries for Maternal Health

       May 7, 2015

    An annual report by Save the Children provides a global ranking of the best and worst countries for maternal health and other motherhood-related measures, Time magazine reports. In addition to maternal health, the report considers economics, education, children's well-being, and women's political status.

    Averaging all measures, the U.S. ranked as the 33rd best country for mothers out of 179 surveyed countries, down from 31st the previous year (2014). But on maternal health the U.S. ranked 61st. One per 1,800 U.S. women experience a pregnancy-related death, 10 times the rates for Austria, Belarus and Poland. What's more, U.S. infant mortality (death of baby within the first year) is 6.1 per 1,000 live births. (compare to 2.13 in Japan). Washington, D.C. had the highest infant mortality rate among the 25 surveyed capitals of high-income nations, and some U.S. cities -- including Cleveland and Detroit -- had even higher rates. Time magazine correlated high infant mortality with premature births, inadequate prenatal care, low incomes, education, race, age and marital status. doclink

    Recognize Effective Ways to Save the World's Children

       November 23, 2013, Durango Herald

    Two of my recent columns dealt with child deaths. The sad fact is that, worldwide, 19,000 children die every day - mostly in poor regions, and mostly related to inadequate nutrition.

    The first column (Herald, Aug. 25) told the story of two boys I took care of in Nicaragua when I was in medical school. Miguel hadn't been fed enough protein and recovered with good food. Van was just skin and bones, and died from starvation.

    The second article (Herald, Oct. 27) mentioned that there is hunger in the United States. Our country doesn't have a universal safety net to catch people in need.

    Sending food to poor countries does not help in the long run because it increases people's dependence. Indeed, well-meaning people may do more harm than good. This is made clear (in a religious context) in the book When Helping Hurts. It points out that many actions that might seem helpful have the opposite effect.

    Unfortunately, despite the best of intentions, transferring technology from rich to poor countries can have bad effects. Supplanting breast-feeding with artificial formula is a good example. Contaminated water may be used to mix the formula, and poor parents cannot afford to buy the formula after breast milk has dried up.

    Nepal, where villages had an epidemic of deaths, provides another example of unintended consequences. Metal cookware appeared to be a boon to the Nepalese because food cooked more rapidly than in old-fashioned earthenware pots. This meant less denuding forests for firewood and less smoke from cooking fires. But it also meant that pork wasn't uniformly well-cooked. Pork tapeworms lodged in people's brains and killed them. Fortunately, cooking pork adequately can prevent this disease, cysticercosis. Sanitary toilets are also important in separating human waste from pigs. We must try to foresee and prevent unintended consequences when trying to help others.

    There are many examples of programs that are very effective in reducing child deaths. Brazil, which has experienced a remarkable transformation, is one.

    Nancy Scheper-Hughes first went to a favela (Brazilian shanty town) in 1964 as a Peace Corps volunteer. She is now a professor of medical anthropology. Her article "No More Angel-Babies on the Alto" is available at:

    Nancy found that many babies in the favela died, and she was shocked that their mothers didn't grieve their deaths. The average woman gave birth to eight children, of whom almost half died. One woman put it this way: "Why grieve the death of infants who barely landed in this world, who were not even conscious of their existence?"

    When Nancy returned to Brazil recently she was surprised to find that the under-5 death rate in that same city had decreased from 110 to 25 per 1,000. How had this radical drop been achieved? She cites several factors. Brazil's president's wife was a strong advocate for women's rights. They started a system of care for all, including "barefoot doctors" to identify children at risk. The "zero hunger" campaign provides food for the most vulnerable. Safe water supplies and prenatal clinics improved the health of pregnant women. Women's literacy is a universal theme in social change, especially for improving child survival.

    Along with the decrease in child mortality has come an amazing decrease in family size. The average number of children a Brazilian woman will bear is 1.8 - fewer than in the U.S., and less than replacement. Each child born can be expected to live to adulthood and is therefore valued from birth. This favela has gone through the demographic transition in less than 40 years!

    What is the difference between good aid programs and not so good? The best programs tune in to what the local people want rather than imposing agendas that are not culturally sensitive. They are sustainable - meaning that the aid recipients will be motivated to maintain the work with little or no help from donors.

    Back to Nicaragua. People there are still impoverished; it is the second poorest country in the Western Hemisphere, with 80 percent living on less than $2 per day. Less than 40 percent of people in rural areas have improved sanitation. Fortunately, the country is receiving sustainable assistance. El Porvenir (a nonprofit organization) partners with rural Nicaraguans to build sanitation and pure water infrastructure and protects the water supply through reforestation. Their school hand-washing facilities make kids healthier and increase school attendance by 20 to 30 percent!

    These improvements have raised the standards of living and health. Better-educated women have healthier and fewer children. Development has helped Nicaraguans in many ways, including reducing the average number of children a woman has from seven when we visited in 1968 to just 2.6 now.

    Note: this article was first published in the Durango Herald doclink

    Kenya's Maternal Death Rate May Fall Thanks to Free Services for Women

       July 15, 2013, Vietnam News Agency   By: Katy Migiro

    Last month Kenya began offering free maternity services for women, and some hospitals report a 50% increase in deliveries. A 10% increase was estimated around the country. However Kenya will not meet the MDG of a 75% drop in deaths between 1990 and 2015. Giving birth with the help of a trained professional is critical for reducing maternal mortality, but 56% of Kenyan women give birth at home. 42% reported that services were too far away or there was no transport, 20% said it was unnecessary, 19% said that their labour was too quick to have time to get there, and 17% said services were too expensive.

    Wambui Waithaka, a doctor at Nairobi's Pumwani maternity hospital said the government is giving the hospital extra money each week to buy the things they need to treat patients. However, in Pumwani, there is a shortage of incubators.

    The next step is to educate women about their care. "The most critical thing in improving maternal health is educating the woman herself and the community around her," said Waithaka. "If she doesn't know that her labour is going a dangerous way, we are not going anywhere."

    Almost 28% of women give birth at home with the assistance of traditional birth attendants, the same percentage as are helped by a nurse or midwife. The region where the use of traditional birth attendants is highest - at 64% also has the highest maternal mortality rate, twice the national average.

    In Kenya, 43% of pregnancies are unwanted due to limited access to contraceptives, poverty and high rates of sexual violence. Unsafe abortions account for 35% of maternal deaths compared to the global average of 13%. Rich women easily access safe abortion in private facilities. But the poor and uneducated risk their lives using backstreet doctors as government hospitals are reluctant to treat them.

    A high proportion of maternal deaths are among adolescents. Shahnaz Sharif, the government's director of public health and sanitation said. "They tend to hide their pregnancies. They don't come to the clinic," ... "Or they'll go for abortion." Teenagers also tend to have more complications because their bodies and minds are not ready to give birth. doclink

    3 Unexpected Ways to Improve Food Security in Sub-Saharan Africa

       July 31, 2013, World Resources Institute - WRI   By: Tim Searchinger and Craig Hanson

    Sub-Saharan Africa would need to increase crop production by 260% by 2050 in order to feed its projected population.

    The UNs' new population growth projections say that the world will reach nearly 9.6 billion by 2050. Unless we control dietary shifts to more meat and reduce food loss and waste, the world will need to produce about 70% more food by 2050 to meet global demands. Plus we would need to do this without converting millions more hectares of forests into farmland if we don't wish to contribute to more climate change.

    The population of Sub Saharan Africa is expected to more than double by 2050 and quadruple to 3.9 billion people by 2100. Even today FAO says that over 25% of Sub-Saharan Africa's people are undernourished, and the region already imports roughly 20%of its staple calories. Yet Sub-Saharan Africa has the world's lowest grain yields and extensive areas of degraded soils.

    One way to help meet the food challenge would be to hold down population growth.

    Most of the world's regions have already achieved or are close to replacement level fertility, but Sub-Saharan Africa has a total fertility rate was 5.4 children per woman - double the fertility rate of any other region. While the regions fertility rate is projected to decline to 3.2 by 2050, this is not enough to avoid the large projections of population growth.

    Go to the link in the headline to see the interactive maps.

    What can be done?

    *Increase educational opportunities for girls. In general, the longer girls stay in school, the later they start bearing children, and the fewer children they ultimately have. In countries where 80-100% of the women have attained at least a lower secondary education level, total fertility rates are around 2.1

    *Increase access to reproductive health services, including family planning. Millions of women want to space and limit their births, but do not have adequate access to reproductive health services. The World Health Organization (WHO) found that 53% of women in Africa who wish to control their fertility lack access to birth control, compared with 21-22 percent in Asia and Latin America.

    *Reduce infant and child mortality. Reducing infant and child mortality assures parents that they do not need to conceive a high number of children in order to assure survival of a desired number. Better health care, sanitation, and food will accomplish this.

    Botswana has a country-wide, free system of health facilities that integrates maternal and child healthcare, family planning, and HIV/AIDS services. Mortality rates for children under five declined from 81 per 1,000 in 2000 to 26 per 1,000 in 2011. Contraceptive use increased from 28% in 1984 to 53% in 2007. Botswana has long provided free education to all, and still exempts the poorest from school fees, resulting in an 85% literacy rate and a rate of 88% of girls enrolled in lower secondary education. Botswana's fertility rate has fallen from 6.1 in 1981 to 2.8 by 2010.

    Advantages to achieving replacement level fertility in Sub Saharan Africa:

    *Gender equity will be advanced, giving people more control over life decisions, and save millions of lives.

    *About 9% of the gap between food available in 2006 and the amount needed in 2050 would be closed and and the projected growth in food demand in Sub-Saharan Africa would be reduced by 25% in the same period.

    *A "demographic dividend" could be achieved. During and after a rapid decline in fertility, a country simultaneously has fewer children to care for and a greater share of its population in the most economically productive age bracket. Researchers estimate that this type of demographic shift was responsible for up to one third of the economic growth of the East Asian "Tigers" between 1965 and 1990.

    *Agriculture's impact on the environment would be reduced since, according to FAO projections for yield gains in the region, Sub-Saharan Africa will need to add more than 125 million hectares of cropland from 2006 levels to meet the region's projected food needs in 2050. Achieving replacement level fertility would cut that needed cropland expansion in half, sparing from conversion an area of forest and savannah equivalent to the size of Germany. doclink

    End of this section pg 1 ... Go to page 2 3 4

    Maternal, Infant, and Child Health Care

    Publicly Funded Family Planning Services in the United States

       July 2015, Guttmacher Institute

    The typical American woman, who wants two children, spends close to three years pregnant, postpartum or trying to become pregnant, and 30 years trying to avoid pregnancy.

    50% of all pregnancies in the United States each year -- over 3m -- are unintended. By age 45, more than 50% of all American women will have experienced an unintended pregnancy, and 30% will have had an abortion.

    Of the 67 million U.S. women of reproductive age (13-44) in 2013, 38m of these women were sexually active and able to become pregnant, but were not pregnant and did not wish to become pregnant and thus they were in need of contraceptive care. 20m of these were below 250% of the federal poverty level and in need of publicly funded services and supplies or they were younger than 20 and in need of publicly funded services and supplies. 77% were low-income adults, and 23% were younger than 20. 9.8 million were non-Hispanic white, 3.6 million were non-Hispanic black and 4.9 million were Hispanic.

    The need for publicly funded services grew 17% between 2000 and 2010. With inflation is taken into account, public funding for family planning client services increased 31% from FY 1980 to FY 2010.

    Public expenditures for family planning services totaled $2.37 billion in FY 2010, with Medicaid accounting for 75%, state appropriations 12%, and Title X 10%.

    The joint federal-state Medicaid program reimburses providers for contraceptive and related services delivered to enrolled individuals. The federal government pays 90% of the cost of these services.

    Title X of the Public Health Service Act, the only federal program devoted specifically to supporting family planning services, subsidizes services for women and men who do not meet the narrow eligibility requirements for Medicaid, maintains the national network of family planning centers and sets the standards for the provision of family planning services.

    More than half of centers (57%) report that they are unable to stock certain contraceptive methods due to cost.

    The availability of long-acting reversible contraceptive methods increased significantly between 2003 and 2010. IUD provision increased from 57% to 63%, and the implant, which was unavailable in 2003, was offered by 39% of centers in 2010

    Centers with a reproductive health focus offer a greater range of contraceptive methods on site and are more likely to have protocols that help clients initiate and continue using methods, compared with those that focus on primary care

    Virtually all safety-net health centers provide pregnancy testing, and the vast majority offer STI testing (97%) and treatment (95%), HIV testing (92%) and HPV vaccinations (87%).

    More than six in 10 women who obtained care at a publicly funded center that provides contraceptive services in 2006-2010 considered the center their usual source of medical care

    In 2013, publicly funded family planning services helped women to avoid 2 million unintended pregnancies, which would have resulted in about 1 million unintended births and nearly 700,000 abortions. Without these services, the number of unintended pregnancies, unplanned births and abortions occurring in the United States would have been 60% higher.

    The services provided at publicly funded family planning visits in 2010 resulted in a net savings to the federal and state governments of $13.6 billion. The services provided at Title X-supported centers alone accounted for $7.0 billion of that total. Every $1.00 invested in publicly funded family planning services saved $7.09 in Medicaid and other public expenditures that otherwise would have been needed.

    There is much more to this report. Follow the link in the headline to read it. doclink

    U.S.: Calif. Assembly Passes Bill Making Pregnancy a Qualifying Event for Insurance Enrollment

       June 8, 2015, National Partnership for Women and Families

    The California Assembly approved a bill (AB 1102) that would make pregnancy a qualifying event to purchase health coverage through California's insurance marketplace (under the Affordable Care Act) outside of the exchange's open enrollment period. The bill would require insurers to allow individuals who do not have minimum essential coverage to enroll or change their health plan when they become pregnant.

    The proposal now proceeds to the state Senate for consideration (AP/Sacramento Bee, 6/4).

    The measure would take effect in 2017 doclink

    Karen Gaia says: Health care for pregnant women is a good way to ensure the health of mother and infant, and a time to introduce effective and affordable methods for birth spacing needed for the health of future babies as well as the health and well-being of the mother and family. When these birth methods are started, it is likely they will be used throughout a woman's child-bearing years so that she can have children when she is ready, emotionally, financially, and for the good of her family.

    Publicly Funded Family Planning Yields Numerous Positive Health Outcomes While Saving Taxpayer Dollars

    Three New Resources Make the Case for Investing in These Services
       January 16, 2015, Guttmacher Institute

    In "Beyond Preventing Unplanned Pregnancy: The Broader Benefits of Publicly Funded Family Planning Services," the Guttmacher Institute's Senior Public Policy Associate Adam Sonfield provides research findings which prove that, by reducing unintended pregnancies, abortions, disease, and pre-term or low-birth-weight births, public investment in family planning can save taxpayers billions of dollars. In October, the Institute reported on the following benefits of services provided by publicly funded family planning centers in 2010 -- the most recent year for which comprehensive data are available:

    • Contraceptive care helped women avert 2.2 million unintended pregnancies, 1.1 million unplanned births, 761,000 abortions and 164,000 preterm or low-birth-weight births.

    • STI testing averted 99,000 chlamydia infections, 16,000 gonorrhea infections, 410 HIV infections, 1,100 ectopic pregnancies and 2,200 cases of infertility.

    • Pap and HPV testing and HPV vaccination prevented 3,700 cases of cervical cancer and 2,100 cervical cancer deaths.

    Congress and the President should not ignore these benefits when they set their priorities for the next two years. All told, the net public savings was $13.6 billion, or $7.09 saved for every public dollar spent. Congress must protect the Title X national family planning program and the national network of safety-net family planning centers while protecting and expanding Medicaid coverage of family planning; and breaking down barriers that deny people services

    A series of fact sheets titled Facts on Publicly Funded Family Planning Services covers each state and the District of Columbia. They provide state-level policymakers, advocates, and providers with data and graphics showing the need for publicly funded family planning; the services provided by safety-net family planning centers, including those funded by Title X; the range of health benefits accrued from these services; and the costs and public savings associated with their provision.

    The Institute also offers Health Benefits and Cost Savings of Publicly Funded Family Planning. This tool enables family planning centers and other end users to estimate the impact of and cost-savings resulting from publicly funded family planning services in their state or service area. It estimates by state the number of contraceptive clients served and the number of STI and cervical cancer screening tests. This data can help family planning providers looking to contract with Medicaid and private health plans, and advocates and policymakers looking to defend and expand public investment in family planning services.

    The full analysis, "Return on Investment: A Fuller Assessment of the Benefits and Cost Savings of the US Publicly Funded Family Planning Program," by Jennifer J. Frost, Adam Sonfield, Mia R. Zolna and Lawrence B. Finer, is currently available online and appears in the December 2014 issue of The Milbank Quarterly. doclink

    U.S.: Is Inequality Killing US Mothers?

       January 16, 2015,   By: Andrea Flynn

    It is no surprise that maternal mortality rates (MMRs) have risen in tandem with poverty rates. Women living in the lowest-income areas in the United States are twice as likely to suffer maternal death, and states with high rates of poverty have MMRs 77% higher than states with fewer residents living below the federal poverty level. Black women are three to four times as likely to die from pregnancy-related causes as white women, and in some U.S. cities the MMR among Black women is higher than in some sub-Saharan African countries.

    In terms of economic inequality it might as well be 1929, the last time the United States experienced such an extraordinary gulf between the rich and everyone else. Today 30% of Blacks, 25% of Hispanics (compared to only 10% of whites) live in poverty, and in certain states those percentages are even higher. Since 2008, the net worth of the poorest Americans has decreased and stagnant wages and increased debt has driven more middle class families into poverty. Meanwhile, the wealthiest Americans have enjoyed remarkable gains in wealth and income.

    The Affordable Care Act is providing much-needed health coverage to many poor women for whom it was previously out of reach and if fully implemented could certainly help stem maternal deaths. But nearly 60% of uninsured Black Americans who should qualify for Medicaid live in states that are not participating in Medicaid expansion. doclink

    U.S.: Where Immigration and Healthcare Meet

       November 19, 2014, Hill   By: Shivana Jorawar

    Open enrollment for the Affordable Care began for a second time last week. The number of people who take advantage of the ACA this time around is projected to be low. 9.1 million people are expected to enroll by the end of the enrollment period in February, just 1.8 million more than the number enrolled in August.

    But unfortunately there has been little talk among government officials and healthcare advocates about the people locked out of healthcare because of their immigration status.

    More than 10 million people have gained access to health insurance since it Obamacare began. Insurance companies can no longer discriminate against people based on a preexisting condition or charge more because of gender, and they are now required to cover prevention and wellness benefits at no charge.

    112,000 people lost their ACA coverage this year because they did not verify their eligibility based on citizenship and immigration status. More than 11 million people living in the United States are ineligible for the ACA at the national level due to their immigration status.

    550,000 of them are young people, often called "Dreamers," who came to the United States as children and are, at present, lawfully residing here. These Deferred Action for Childhood Arrivals (DACA) program recipients, who have been given reprieve from deportation, were explicitly carved out of the ACA through announcements made by CMS and HHS on Aug. 28, 2012, issued as federal regulations and guidance. The announcement altered federal rules for DACA-eligible people by excluding them from health insurance options available to others with deferred action status.

    Immigrants work, pay taxes, and contribute to our communities and our economy. They should have the same responsibilities and opportunity to participate in health care as their friends and neighbors. Further, it's better and more affordable for all of us when immigrants can participate in the health care system their tax dollars support. Affordable health coverage improves access to preventive care, protects public health, prevents suffering, and puts less strain on under-resourced and costly emergency services. The impact of the large number of uninsured on our economy is huge. It results in a loss of $65 billion to $130 billion annually, consisting of lost wages, absenteeism, and family leave. doclink

    Karen Gaia says: and the failure to cover contraception for everyone of reproductive age results in more unintended pregnancies, a higher fertility rate, and a high population growth rate.

    The Case for Advancing Access to Health Coverage and Care for Immigrant Women and Families

       November 19, 2014, Health Affairs Blog   By: Kinsey Hasstedt

    Many lawfully present immigrants are ineligible for coverage through Medicaid and the Children's Health Insurance Program during their first five years of legal residency. Undocumented immigrants are largely barred from public coverage, and the Affordable Care Act (ACA) prohibits them from purchasing any coverage, subsidized or not, through its health insurance marketplaces.

    In 2012, the administration created the Deferred Action for Childhood Arrivals (DACA) Program, enabling many so-called DREAMers to lawfully remain in the United States. Unfortunately those with DACA status are essentially treated as if they were undocumented and expressly carved out of nearly all public and private health coverage and affordability programs. Also, the immigration reform bill passed by the Senate in 2013 failed for the most part to address the legitimate health insurance and health care needs of immigrants, denying those eligible for provisional status access to public coverage and the ACA's subsidies.

    Among women of reproductive age (15-44), 40% of the 6.6 million noncitizen immigrants are uninsured, compared with 18% of naturalized citizens and 15% of U.S.-born women.

    Of reproductive-age women living below the poverty level (a group in which immigrant women are overrepresented), 53% percent of noncitizen immigrant women lack health insurance -- about double the percentage of U.S.-born women. Further, only 28% of poor noncitizen women of reproductive age have Medicaid coverage, compared with 46% of those born in the United States.

    Only half (52%) of immigrant women at risk for unintended pregnancy received contraceptive care, compared with two-thirds (65%) of U.S.-born women.

    Consistent contraceptive use is critical to helping women prevent unintended pregnancies, plan and space wanted pregnancies, and achieve their own educational, employment, and financial goals. Without coverage, immigrant women and couples may well be unable to afford the method of contraception that will work best for them, which is critical to realizing these benefits.

    In addition, preventive sexual and reproductive health services are effective in helping women and couples avoid cervical cancer, HIV and other STIs, infertility, and preterm and low-birth-weight births -- all while saving substantial public dollars. Notably, cervical cancer disproportionately afflicts and causes deaths among immigrant women, particularly Latinas and women in certain Asian communities, likely because many go without timely screenings. doclink

    A Closer Look: Myanmar

       November 5, 2014, Family Planning 2020

    The Myanmar Family Planning Best Practices Conference met this summer in the new capital of Myanmar: Nay Pyi Taw.

    Everything from condom cue cards for teenagers to the finer points of IUD insertion and removal was discussed. Local OB/GYNs compared notes with technical advisors from global NGOs.

    After decades of international isolation, Myanmar is rejoining the world community and embarking on modern development goals. Myanmar made a bold commitment to family planning at the 2013 International Conference on Family Planning in Addis Ababa, where country representatives vowed to halve unmet need for contraception by 2020 and to raise the contraceptive prevalence rate to 60%.

    Myanmar's budget for contraceptive commodities was increased from US$1.29 million in 2012/2013 to US $3.27 million in 2013/2014. The government has begun efforts to strengthen supply chains and improve service delivery. Health providers are being trained in a greater range of contraceptive methods: state obstetricians and gynecologists are being trained in IUDs, and doctors in private networks are learning about contraceptive implants.

    The Ministry of Health hosted the event, welcoming representatives from the World Health Organization (WHO), UNFPA, the Gates Institute, Stanford University, the Government of Indonesia, and Pathfinder.

    The announcement of our commitment to FP2020 was an occasion of great hope for Myanmar. Access to contraception is the fundamental right of every woman and community, and we aim to expand family planning services to reach all who need and want them. This journey will not be easy, but thanks to FP2020, we have many partners around the world to help us on our way. doclink

    Karen Gaia says: I repeat: I don't understand the recent emphasis on family planning in Myanmar. Their fertility rate is only 2.18. The country already has a health plan. See

    States with More Abortion Laws Have Less Support for Women and Children's Health

       October 1, 2014, Huffington Post   By: Laura Bassett

    A study by Ibis Reproductive Health and the Center for Reproductive Rights found that a state's performance on indicators for women and children's health and well-being is inversely proportional to the amount of anti-abortion laws in that state. States with mandatory ultrasound laws, mandatory waiting periods and shorter gestational limits on abortion, for example, generally have higher rates of obesity, child and maternal mortality, teen births and women and children without health insurance.

    States enacted more abortion restrictions between 2011 and 2013 than they had in the entire previous decade, and more than 250 anti-abortion bills have been introduced in state legislatures this year alone. These include mandatory waiting periods, counseling and ultrasounds before abortions, harsh building standards for abortion clinics, insurance coverage restrictions, gestational limits and restrictions on non-surgical medication abortions.

    Most states with more than 10 abortion restrictions in effect, including Mississippi, Oklahoma, Arizona, Indiana, Florida, Arkansas, Alabama, Louisiana, Missouri and Texas, scored near the bottom.

    The report considered a wide variety of indicators of well-being for women and children, such as asthma prevalence, the percentage of adult women who had received a pap smear in the past three years, drug abuse, HIV and domestic violence incidence, maternal and infant mortality rates, children receiving dental and mental health care, high school graduation rates and the number of suicide deaths among women. The report also considered policies that support women and children's health, such as whether a state had moved forward with Medicaid expansion, requires reasonable accommodations for pregnant workers and implements strong family and medical leave policies.

    "This report exposes the flimsy claims of politicians who have been shutting down women's health care providers under the patently false pretext of protecting women's health," said Nancy Northup, president and CEO at the Center for Reproductive Rights. "It clearly demonstrates how women and families have suffered as politicians put their ideological agenda before the real needs of their constituents." doclink

    End of this section pg 1 ... Go to page 2 3

    Reproductive Choice

    Decisions about Sexual Activity

       October 2, 2000, New York Times*

    The new annual report of the UNFPA says "If women had the power to make decisions about sexual activity and its consequences," ... "they could avoid many of the 80 million unwanted pregnancies each year, 20 million unsafe abortions, some 750,000 maternal deaths and many times that number of infections and injuries." And: "They could also avoid many of the 333 million sexually transmitted infections contracted each year." doclink

       October 2003, UNFPA

    Meeting the need for contraception services could reduce maternal mortality by 20%. doclink

    I Love My IUD

       July 15, 2015, Women At the Center


    U.S.: Birth Control for Beginners: What's Preventing Women From Getting Access to the Full Range of Contraceptive Options?

    Long-acting contraceptives get left out of the conversation, in favor of methods with a higher human-error factor
       June 28, 2015, Salon   By: Valerie Tarico

    Birth control is a big deal for couples who would rather avoid an abortion or another baby.

    From 2011 to 2013, Planned Parenthood and the Bixby Center for Global Reproductive Health at the University of California, San Francisco (UCSF) conducted a study with a goal to ensure that women get full information about all available birth control methods and that they can get the method of their choice in the same visit.

    In 20 Planned Parenthood affiliate clinics participating in the study, the entire staff, including receptionists, counselors and doctors, received a half-day training on how to provide excellent access to IUDs and implants. Twenty other clinics continued business as usual.

    In the 20 clinics that received the training, 71% of providers discussed IUDs and implants with their patients, and 28% of the women receiving the additional information chose IUDs or implants. In the control group only 39% of providers discussed IUDs and implants with their patient and only 17% of the women chose IUDs or implants. In both settings 99% of women felt that the decision was theirs, meaning that providers maintained respect for patient autonomy and choices. In the year following, the rate of pregnancy among patients seeking contraception in the intervention clinics was half what it was in the control clinics.

    On the pill, nearly 1 in 10 women gets pregnant each year, and for couples relying on condoms that number is 1 in 6! With the rhythm method or abstinence or no protection at all the annual pregnancy rate was over 8 in 10.

    By contrast, for state-of-the-art IUDs and contraceptive implants the annual pregnancy rate is below 1 in 500. With every-day and every-time methods things like forgetting, fights, finances and fumbling - make it virtually impossible for couples to use pills, condoms or intermittent abstinence with perfect consistency; and the more chaotic a person's life, the more likely he or she will end up facing a surprise pregnancy.

    Hormone-free copper IUDs, hormonal IUDs and implants are long-acting reversible birth control methods that can be reversed. They can last from three to 10+ years; but a quick, easy removal restores normal fertility at any point.

    Currently only 7.2% of women used a long-acting contraceptive in the U.S. from 2011-2013. IUDs and implants are rapidly gaining popularity, thanks in part to Obamacare, which eliminates high upfront cost as a barrier.

    In the 1970s, a defective IUD traumatized women and providers alike. Today modern IUDs are the healthiest method available for most women. In the U.S. and Canada there is a dismaying level of misinformation about IUDs and implants among doctors. According to the National Campaign to Prevent Teen and Unplanned Pregnancy, most young people between the ages of 18 and 29 said they had never heard of the implant.

    Researchers at Washington University in St. Louis provided comprehensive information and then offered 9,000 women and youth the birth control of their choice for free. Three-quarters chose a state-of-the-art IUD or implant, and the rate of teen pregnancy and abortion plummeted.

    Upstream USA was launched by Peter Belden and Mark Edwards in 2014 to provide expanded on-site training and technical assistance so that many health centers across the country can offer their patients the full range of contraceptive methods including implants and IUDs. A woman can receive any family planning method she wants on the day she walks into the clinic.

    Helping young women achieve their own goals and become pregnant only when they want to is central to improving high school graduation rates (82% of pregnancies to teens are unintended). A Gates Foundation survey found that 47% of girls who dropped out of high school listed pregnancy as a reason. Unintended pregnancy is a significant issue affecting community college completion. The intervention in the UCSF study cut the pregnancy rate in half.

    The training model draws on evidence-based "best practices" from across the country:

    The "One Key Question" integrates family planning into routine medical care and medical records by prompting doctors during routine medical care to annually ask all female patients, "Would you like to get pregnant in the next year?" and providing counseling about either pre-conception care or pregnancy prevention.

    Streamlined same day service as recommended by the American College of Obstetricians and Gynecologists ensures that busy women don't face the scheduling, travel and childcare obstacles that have prevented many in the past from getting IUD's.

    Including removal costs in the insertion fee ensures that no woman will get a LARC and then face a financial barrier to getting it removed when she is ready.

    Unless all methods are available to all women, improvements in contraception may worsen America's growing economic divide. Mark Edwards says: "Women should be able to achieve their own goals and become pregnant only when they want to. It is unconscionable that women are not offered the very best care, no matter how they enter the healthcare system." doclink

    U.S.: I Am the Population Problem

       September 27, 2011, Grist   By: Lisa Hymas

    Note: see my comment below

    People see the population problem as Africans and Asians who have "more kids than they can feed, immigrants with large families, and even single mothers. But actually the population problem includes middle-class Americans like me - those most likely to say "I'm the sort of person who should have kids."

    People harm the environment by what they consume. My U.S. carbon footprint exceeds that of an average Brit by 100%, an average Indian by over 1,200%, and an average Ethiopian by over 10,000%. A poor Ugandan child may challenge its family and community to provide clean water and safe food, but its impact on the global environment does not compare to that of an American child. American's have big houses; drive big cars; use lots of oil, coal and gas; and consume many products that require non-replenishable or overused resources, long-distance shipping, pesticides, etc. We Americans consume resources from around the globe, then expel them as pollution.

    In 2009, a study from Oregon State University found that the climate impact of having one less child in America is almost 20 times [5.7 times ??] greater than the impact of adopting a series of eco-friendly practices for a lifetime, things like driving a high-mileage car, recycling, and using efficient appliances and CFLs. Since even our most conscientious citizens consume at unsustainable rates, the best contribution I can make to a cleaner environment is to not have children who might, in turn, go on to have more children.

    I don't fault those who do have kids, but it should be easier for people to choose not to have kids if they wish. The Pill has been available for more than 50 years, and most people accept that women can use it to delay, space out, or limit childbearing. But a pro-natal bias runs deep. At some point, family, friends, coworkers, and even strangers push you toward having at least one child. They pester women in their thirties about the regrets they will have if they have no children. Even people I know whose careers are dedicated to making birth control and reproductive health care available to all women do this!

    U.S. women find that doctors will not do tubal ligations on a woman who has not already had children (and sometimes even if she has). They warn that sterilization is an irreversible, life-altering decision - as if having a child is not an irreversible, life-altering decision. This prejudice in the medical profession and the rest of society implies that all women should have children - even single women, gay couples, and women over 40. Going child-free may be the strongest remaining taboo.

    I am the population problem, but I want to be part of the solution. Let's make it easier for others to join me. Putting less pressure on those who decline to have kids reduces the stigma on people who wish to have kids but don't get the chance, it also means fewer ambivalent or unhappy parents, and it gets us closer to the goal of "every child a wanted child." Having no children allows a little more breathing room for those of us who are already here or on the way. doclink

    Karen Gaia says: 50% of pregnancies in the U.S. are unintended. The pill is not the most effective form of birth control. It is about 5 times less effective than the IUD or implant. Many women are unnecessarily wary of the IUD, due to inaccurate information. Many doctors are unnecessarily reluctant to give the IUD if a woman has no children, even though the American College of Obstetricians and Gynecologists has recently recommended the IUD as a first contraception for teens. These things can be fixed!! Not all women chose to be childless. Such women may spend many years trying not to get pregnant, but if she is on the pill, an 'oops' baby is a strong possibility; then, if she is unmarried, she may wait until she has a husband and perhaps another child before getting herself sterilized.

    I believe the study said a child has 5.7 times the impact, not 20. Even so, that is a lot!

    Art says: Both the author and editor chose to have no children. At 70, this editor has no regrets. There are plenty of children, but not enough good parents. I work with kids and later married into a family with kids. One can be a good parent and mentor without having children.

    These Are the Birth Control Methods Family Planning Doctors Use

       May 19, 2014, Huffington Post   By: Rachael Rettner

    A survey of female family planning providers found that obstetricians, gynecologists, midwives and nurses are seven times more likely than other women to choose IUDs (intrauterine devices) for their own use. Of about 550 family planning providers surveyed, 335 used contraception and, compared to only 6% of women in the general population, 42% of that group used a long-acting method of birth control (40% used IUDs, and 2% used implants that release hormones to prevent pregnancy). Just 12% used the pill, compared with 21% of women in the general population.

    Another 2012 poll of just female obstetricians and gynecologists found that these doctors are three times more likely than the general public to use IUDs.

    The Centers for Disease Control and Prevention claims that less than 1% of women who use IUDs and implants become pregnant each year, making these devices among the most effective forms of birth control. About 9% of women using pills become pregnant each year largely because they don't always take them as directed every day. About 18% of condom users become pregnant each year.

    Dr. Jill Rabin of the Long Island Jewish Medical Center in New Hyde Park, New York said the new findings make sense because health care providers tend to use the best available methods of care and have the fewest barriers to access. Researcher Dr. Ashlesha Patel, System Director of Family Planning at Cook County Health & Hospital System in Chicago, referred to family planning providers as "theoretically, the most educated group of people in this arena who would choose the most effective birth control methods." In addition to knowing more about birth control, family planning providers may have better access to long-acting birth control methods. What's more, Patel said, some doctors are not comfortable with the procedures for inserting the devices (which requires some expertise) so women who see these doctors may get birth control pills or patches instead of IUDs or implants.

    The Affordable Care Act covers long-acting birth control, but that coverage is not yet in place for all women, Patel said. So cost may still be a barrier for some. Planned Parenthood estimates that if an IUD is not covered by insurance, women must pay between $500 and $1,000.

    In a study where 2,500 women were told about long-acting birth control methods and offered them free, about two-thirds chose to use them. Dr. Rabin said, "This finding speaks to the need for greater educational effort and the reduction of the barrier of costs in so far as possible, if we are serious about reducing the rate of unintended pregnancy." doclink

    Transformation Doesn't Happen Over Night

       January 27, 2014, Population Action International

    Since the 2012 London Summit, the concept of reproductive rights has begun to permeate family planning commitments and implementation plans. These rights apply as much to the freedom to choose appropriate contraceptive options as the freedom to use or not use contraceptives, and they should emerge from citizen and community discussions, rather than by official policy decree.

    Of the 28 developing countries that made FP2020 commitments, 15 made specific references to improving choice, expanding the range of methods, or reproductive rights. Having committed to a rights-based approach to family planning and reproductive health, these nations may now need assistance in fulfilling their pledges. The commitments stress voluntarism, informed choice and diversifying the mix of family planning methods. To exercise their rights, people need clear information and quality services, which includes the ability to freely choose among a range of methods. Programs must offer these options to meet the needs of women at all stages-pre-conception, postpartum and post-abortion. For example, women's reproductive rights are fulfilled when, 1) Providers are trained to provide implants and IUDs so that women can select a long-acting method. 2) After abortions, women can freely choose an effective, modern method of family planning as a result of quality, family planning counseling, and 3) a couple can choose gender based contraceptive methods because their health facility stocks a full range of options. Eight nations specifically mention offering the full range of contraceptive methods as part of their FP2020 commitments.

    The commitments of South Africa, the Philippines, and Myanmar specifically refer to reproductive or human rights. They will need monitoring and support to translate these commitments into action. But to ensure success, the commitments and implementation plans must be their own. Nations with limited experience may not know how to proceed. They must learn to prioritize their objectives and ensure active community participation.

    Those who call for rights-based family planning programs and policies must realize that each nation is starting from a different point and has different needs. Some may not yet appreciate the vital role that informed choice and voluntarism play in making programs successful. Supporting programs can best help nations meet their commitments by offering tools to help. We should try to make the current set of frameworks and guidance documents for policymakers, civil society organizations, and program designers and implementers more useful and practical.

    In short, we need to provide the support needed to ensure that each nation: 1) Embraces a comprehensive approach to rights-based family planning 2) Prioritizes the need to offer a selection of options 3) Has the training and equipment required to fulfill its pledges. doclink

    Art says: As used here, choice and rights refer largely to the community owning the program. An imposed program will not succeed as well as one that involves community leaders in planning and implementation.

    Karen Gaia says: While it is important that communities are involved in the planning of family planning programs, it is even more important that the individual or couple who are planning their family have choice and rights.

    The Long-term, Extremely Positive Effects of Birth Control in America

       October 7, 2013, Business Insider   By: Max Nisen

    According to University of Michigan economist Martha Bailey, many family and social benefits have occurred since birth control was legalized and made more readily accessible. Enabling people to control whether and when to have children helped to facilitate upward mobility for both parents and their children. Birth control usage seemed to improve college completion rates, job quality, wages, the ability of women to work, and family investment in children. Bailey also claimed that birth control allows people to delay marriage, perhaps due to fewer "shotgun" weddings. This, she says, allows for better marriage choices.

    In effect, family planning can reduce poverty rates. Since delaying parenthood allows women to work and parents to train for better jobs, family incomes improve. And, when parents have fewer unwanted or "ill-timed" children, they have more time and resources to spend on each child. Bailey charted these improvements statistically. As contraception became more common, adults improved their incomes by 2 - 3%, and their children were 2 -7% more likely to complete college. Nisen concluded, "When people are able to delay having children and have fewer of them, they tend to be more financially secure and better able to help their children succeed."

    When birth control pills were first introduced, only some of the states legalized their use, and states where "the pill" was legal had far lower fertility rates. But after the Supreme Court case Griswold vs. Connecticut prevented any state from restricting contraceptive sales, lower fertility rates soon occurred more uniformly throughout rest of the country.

    Follow the link to see the chart that shows the difference in fertility rates between states that allowed the Pill to be used and those that prohibited it. doclink

    End of this section pg 1 ... Go to page 2

    Media and Availability of Contraception

    Save Lives -- and Money!

       September 26, 2015, Durango Herald   By: Richard Grossman Md

    Can you think of any state-funded program that can save seven dollars for every dollar spent? Voluntary family planning programs for teens and young women offer that wide a margin of benefit!

    Indeed, family planning can do much more than just save money. It has the ability to change the prospects for people, especially young women. By allowing people to postpone parenthood, they have the opportunity to mature emotionally, complete their education and improve job skills. An experiment, the Colorado Family Planning Initiative (subsidized by a generous grant) has shown the benefit of making effective contraception available to all women.

    OK, I have to admit, women bear an unjust proportion of responsibility for family planning. That is the way it is now; I hope that the future will hold more in the way of birth control for men other than just condoms and vasectomy.

    An anonymous donor (reported to be the Susan Thompson Buffet Foundation) gave money to fund contraception for women who otherwise couldn't afford it. This program started in 2009 and finished this summer. It paid about $5 million each year for more than 36,000 women to receive contraceptive information, services and supplies.

    Fortunately, during this interval the need for funding decreased because the Affordable Care Act (Obamacare) picked up perhaps 25,000 Colorado women who didn't have prior coverage. Unfortunately there are still many people who don't have any insurance coverage and cannot afford contraception. They are especially unable to pay for Long-Acting Reversible Contraceptive (LARC) methods that are so effective, but have an initial cost of about $1000. LARCs include four IntraUterine Devices (IUDs) and one hormonal implant.

    In the long run, LARCs are actually less expensive than less reliable methods if you look at the monthly cost over their lifespan of 3 to 10 years. DepoProvera© is almost as effective, but this shot has to be administered every three months, so requires more action on the user's part.

    How did this program save money? If they had gotten pregnant, many of these women would have been on Medicaid or other state-supported programs. Their children would also likely be on taxpayer-funded programs, including children of undocumented women who are citizens as soon as they are born in the USA. The estimate of the amount of money the grant saved just for obstetrical services is $79 million.

    The most important savings is in the decrease in the teen pregnancy rate. It is true that all over the country fewer teens became pregnant during the past few years, so not all of the decrease in our state is due to the Initiative. However, Colorado's teen pregnancy rate dropped an outstanding 40% from 2009 to 2013, largely because of this Initiative.

    No one is in favor of unintended pregnancies. This Initiative illustrates what we have known all along: the best way to prevent abortion is with good contraception-and this has been proven over the past 5 years. From 2009 to 2013 the abortion rate for Colorado teens fell 42%, and for women aged 20 to 24 it also dropped significantly.

    Good things come to an end, and the Initiative's grant ended in July. Don Coram, a Republican state representative from Montrose, tried to garner support to continue the program-but unfortunately failed. In stepped private foundations to assure that funding is available.

    So far 12 foundations have collaborated to pay $2 million during the next year to continue the Initiative. It remains to be seen whether this will be enough to provide services to all who need them, but it is hoped that more funding will follow. Optimistically the State Legislature will see that this program is saving money and empowering young women to become healthier, more productive citizens and will finally fund this program. And maybe then other states will then get on the bandwagon to follow Colorado's lead by funding similar programs.

    Dr. Eve Espey is chair of the department of OB-GYN in Albuquerque where I trained many years ago. Her paper "Feminism and the Moral Imperative for Contraception" documents the importance of contraception in the modern world. Not only does family planning provide social benefits to individuals and to their societies, but also it saves lives. Spacing the births of babies promotes healthier children and decreases infant deaths. "It is estimated that, in 2008," she writes "44% (272,040) of maternal deaths were prevented in 172 developing countries owing to use of contraceptives...." Not only does contraception save money; globally it saves a quarter million women's lives yearly!

    First published in the Durango Herald doclink

    Female Condoms Are Power, Protection, Pleasure

       September 2015, Pathfinder International

    To these young women, the female condom is a game changer

    In some parts of the world, a woman asking a man to wear a condom is counter to cultural practices. A condom for women puts the power and protection in her hands. Pathfinder International is on the ground around the world working to tear down these barriers and we need your help.

    September 16 was Global Female Condom Day. Join us in spreading the word about condoms for women! doclink

    The Affordable Care Act and Cost of Contraception

       September 3, 2015, Journalist's Resource   By: Kathryn M. Barker

    Under the ACA, private health plans must cover birth control methods that are approved by the Food and Drug Administration without charging out-of-pocket costs. In the Hobby Lobby case, the Supreme Court ruled that some businesses can claim religious objections and forgo birth-control coverage for employees. However the importance of contraceptive coverage under the ACA has been shown by several new studies: The proportion of women who paid nothing out of pocket for birth control pills rose from 15% in 2012 - before the federal requirement took effect - to 67% in 2014 - after it was implemented. Women saw large decrease in out-of-pocket spending for contraceptives after ACA mandate removed cost sharing. doclink

    US: My Turn: the Miracle of Family Planning

       September 3, 2015, Concord Monitor   By: John Warner

    Large families were common back in last half of the 19th century, when the authorr's great grandfather had 10 children. This made sense then, since in agrarian America, farmers needed labor, and children could supply it. As America became urban and industrial, needs changed and family size changed. The current generation typically has only two children.

    The change fit both American families and American society, because continuation of these earlier rates of proliferation would have resulted in an unsustainable population.

    If all families after my great grandfather's generation had all had 10 children, the U.S. population could have gone from 76 million in 1900 to as much as 7 billion today, demonstrating the power of exponential growth. With such a big population our country would have experienced massive poverty, intense starvation and extensive death. And, that is what the larger world has in store if it is unable to stabilize its currently burgeoning population.

    Researchers have concluded that to live at an American or European standard of living, a sustainable population for the Earth is between 1 and 2 billion people; now we are over three time that much.

    In the intense religious fervor of the Third Great Awakening in 1800's brought with it the Comstock Act (1873), which declared contraception and birth control to be "obscene and illegal." Despite Comstock, many families (women primarily) opted to ignore the law, to plan their families, to obtain and use contraception (and to get abortions). If these women had actually followed the dictates of the Comstock Act, we would be an overpopulated, impoverished nation today.

    The Comstock Act was fully overturned in 1965 after it was noted that lower-class birth rates far exceeded upper-class rates, especially as wealthier women became educated, wanted careers, and limited and delayed having children.

    Now we are facing the threat of going back to the Comstock days. Our media is now filled with stories about the evils of Planned Parenthood and efforts to eliminate this valuable resource.

    Republican presidential candidate Ted Cruz wants a constitutional amendment to make most forms of contraception illegal. Virtually all of the Republican candidates support the Religious Right's desire to make family planning more difficult. And here in New Hampshire, our governing body has denied funding for Planned Parenthood.

    This situation was spurred on by some religious zealots who duped some Planned Parenthood workers into discussion about their work so that they could collect surreptitious video heavily edited to suggest (but not actually prove) that Planned Parenthood was doing something illegal and unethical. They are now using this video material in an attempt to destroy the best resource available to women in this country.

    It is time to denounce the attempts by a narrow religious minority and its political henchmen to force its ill-conceived beliefs on the 300 million citizens of this country and to wrench us all back to my great grandfather's time.

    Our planet has increasingly limited resources. Family planning and contraception are the miracles that have up to now both allowed and enhanced American prosperity and that will in the future make a critical difference as to whether the human race survives. Educating women worldwide and making women's health facilities and contraception available to all are vital to human sustainability.

    Failing to do these things invites human tragedy. But failing to do them in the name of religion is the biggest folly of all. Given the inevitable misery and death that would ensue from putting barriers in the way of women's right to make their own choices and in effect forcing women to have children - this sounds a lot like some Middle Eastern countries that we read about in our newspapers every day. In America this smacks of a theocracy, not a democracy. It certainly does not represent any version of the religion of peace and love that I believe in. doclink

    Foundation Pledges of $2 Million Save Colorado IUD Program as Fight Continues Over Public Funding

       August 2015, Business Journals

    A Colorado birth control program that has cut unplanned pregnancies and abortions by nearly half since 2009 will stay alive for at least one more year thanks to $2 million in donations from 12 private foundations. Earlier this year Republican lawmakers -- some of them claiming that IUDs are abortifacients, and some saying that the program promotes promiscuity -- had killed a bill that would have provided $5 million in public funding for IUDs and other long-acting reversible contraceptives for low-income teens and young women.

    Five years prior to that, the Susan Thompson Buffett Foundation had funded a pilot effort in Colorado that provided teens and young women with long-acting birth control devices, resulting in a 48% drop statewide in unintended pregnancies and abortions. That's up from a 40% drop through 2013.

    Colorado health officials estimate that the IUDs and other devices have saved at least $79 million in Medicaid costs for unplanned births.

    "I feel fortunate that we have that community to turn to in what I considered an emergency situation," said Dr. Larry Wolk, Colorado's top health official.

    IUDs and other long-acting forms of contraception cost more initially, but are the most effective form of birth control, especially for teens who can struggle to get refills of birth control pills or forget to take them every day.

    Kelly Conroy, nurse manager for clinic services for Jefferson County Public Health, said "The word is definitely getting out. We have a lot of patients who come in and specifically ask for the devices by name. ... A friend will be on Mirena (an IUD). They will know which one they want - hormonal or non-hormonal. People are coming in way more educated."

    "Our ultimate goal is empowering not just woman, but families with the ability to know that they can make the choice (to have a baby) when they're ready," she said.

    Cutting teen pregnancy rates has also been found to reduce high school dropout rates. Those who get a good education go on to earn higher incomes, thus reducing poverty rates and cutting reliance on Medicaid and other programs for people living in poverty.

    "Other states are very excited about the results from Colorado," said Lisa Waddell, chief of community health and prevention for the Association of State and Territorial Health Officials. "All states are results-oriented and want the best outcomes for adolescents, women and families. At least 14 other states are working on some kind of boost to the use of IUDs or similar devices.

    Waddell said, "These are highly effective devices...You're seeing a systems change." The failure rate with IUDs and other long-acting devices is less than 1%, while birth control pills fail at a 9% rate and condoms don't work 18% of the time.

    Six states that have already changed their policies on long-acting birth control led the way. Georgia, Iowa, New Mexico, Massachusetts and South Carolina have already changed their policies on long-acting birth control.

    50% of pregnancies in the U.S. are unplanned. One of the programs that has been most popular in other states is to offer women who have just given birth an IUD or other long-acting device while they're still in the hospital after having had a baby. Medicaid will pay for those devices.

    South Carolina health officials have been focusing on using long-acting birth control as a method for driving down stubbornly high infant mortality rates. Premature births that can put babies in jeopardy are higher among teens and others who get pregnant unexpectedly. doclink

    Where Teens Don't Get Sex Ed, IUD Goes Unmentioned

    After Colorado's teen birth rate marked a steep decline tied to the IUD, you'd expect teens across the country to be talking about the pros and cons of this particular method. Instead, few teens at this school have even heard of it.
       August 24, 2015, Women's eNews   By: Angela Roberts

    Out of the 14 teens interviewed at Peters Township High School in Western Pennsylvania during school hours last spring, only two recognized the name of the IUD, a contraceptive device.

    It's not as though IUDs are off limits -- free IUDs are available, just as much as any other contraceptive device, to all teenage girls living in Pennsylvania through the Maternal and Child Health Services Block Grant, according to Wesley Culp of the state's Department of Health.

    But Pennsylvania is among the 22 states that do not require sexual education to be taught in schools or for information about contraceptive options to be provided. Since in 2010, more than $1.6 million in federal funds was provided to Pennsylvania for abstinence-only education programs, Peters Township embraces these programs strongly.

    "The scope and content of the topics we are permitted to address in our personal wellness classes do not include these various forms of birth control methods," said John Vavala, a health and physical education teacher at the high school.

    Sophomore Mila Shadel said, "All we learned was not to have sex," ... "That's it. No methods of protection or anything."

    Although they all have chosen to be abstinent in high school, 14 girls who were interviewed expressed interest in using an IUD in the future once a reporter explained what it was.

    "Although I'm not sexually active now, I would definitely use one if I am in the future," said one girl. "It sounds like a safe, long-term option that I would prefer over getting my tubes tied."

    In 2014, out of the 3.2 million teenage girls using contraceptives, only 3% relied on an IUD while 53% used the pill, finds the Guttmacher Institute.

    In the 1970s and '80s people were leary of IUDs due to reports of septic abortions, pelvic inflammatory infections, and perforations of the uterus caused by Dalkon Shield IUDs.

    30% of health providers are still wary of the device, according to the CDC but school nurse Kowalczyk says: "IUDs got a bad rap after the health problems surrounding them in the 70's," ... "But they are well researched and a safe option" for teens.

    This story is part of Teen Voices at Women's eNews. doclink

    Addressing U.S. Population Growth Through Better, More Accessible and More Affordable Contraception

       April 8, 2015, WOA website   By: Karen Gaia

    50% of pregnancies in the U.S. are unintended. Why? Mostly because of ineffective contraception (i.e. the pill and condoms) and not being able to afford effective contraception. Another reason is that many doctors still discourage women with no children from using the IUD.

    In 2009, the estimated number of pregnancies was 6,369,000 (4,131,000 live births, 1,152,000 induced abortions, and 1,087,000 fetal losses). Eliminate half of those by meeting the unmet need for affordable, accessible, effective contraception and accurate information about it, and you have only 2,050,000 (2.05 million) live births.

    In 2009 there were 307 million Americans. The U.S. was growing by 0.9% at that time, or 2.76 million people. If we had cut the birth rate in half by using effective contraception for all who wanted it, we would have had a population growth of only .71 million, or about 0.35%.

    However, the population growth rate has declined to 0.7% in 2013, probably due to lowered desired family size, so we could expect an even faster decline if every woman of child bearing age got effective contraception, if desired.


    Access to Contraception

       March 24, 2015, ACOG - American Congress of Obstetricians and Gynocologists

    Nearly all U.S. women who have ever had sexual intercourse have used some form of contraception at some point during their reproductive lives. However, multiple barriers prevent women from obtaining contraceptives or using them effectively and consistently.

    The American College of Obstetricians and Gynecologists (the College) recommends full implementation of the Affordable Care Act (ACA) requirement that new and revised private health insurance plans cover all U.S. Food and Drug Administration (FDA)-approved contraceptives without cost sharing.

    Also recommended:

    * Easily accessible alternative contraceptive coverage for women who receive health insurance through employers exempted from the contraceptive coverage requirement.

    * Medicaid expansion in all states, an action critical to the ability of low-income women to obtain improved access to contraceptives

    * Adequate funding for the federal Title X family planning program and Medicaid family planning services to ensure contraceptive availability for low-income women

    * Sufficient compensation for contraceptive services by public and private payers to ensure access, including appropriate payment for clinician services and acquisition-cost reimbursement for supplies

    * Age-appropriate, medically accurate, comprehensive sexuality education that includes information on abstinence as well as the full range of FDA-approved contraceptives

    * Confidential, comprehensive contraceptive care and access to contraceptive methods for adolescents without mandated parental notification or consent, including confidentiality in billing and insurance claims processing procedures

    * The right of women to receive prescribed contraceptives or an immediate informed referral from all pharmacies

    * Prompt referral to an appropriate health care provider by clinicians, religiously affiliated hospitals, and others who do not provide contraceptive services

    * Evaluation of effects on contraceptive access in a community before hospital mergers and affiliations are considered or approved

    * Efforts to increase access to emergency contraception, including removal of the age restriction for all levonorgestrel emergency contraception products, to create true over-the-counter access

    * Over-the-counter access to oral contraceptives with accompanying full insurance coverage or cost supports

    * Payment and practice policies that support provision of 3-13 month supplies of combined hormonal methods to improve contraceptive continuation

    * Provision of medically accurate public and health care provider education regarding contraception Improved access to postpartum sterilization

    * Institutional and payment policies that support immediate postpartum and postabortion provision of contraception, including reimbursement for long-acting reversible contraception (LARC) devices separate from the global fee for delivery, and coverage for contraceptive care and contraceptive methods provided on the same day as an abortion procedure

    * Inclusion of all contraceptive methods

    * Funding for research to identify effective strategies to reduce health inequities in unintended pregnancy and access to contraception

    The CDC named contraception one of the 10 great public health achievements of the 20th century because of it's contribution to improved health and well-being, reduced global maternal mortality, health benefits of pregnancy spacing for maternal and child health, female engagement in the work force, and economic self-sufficiency for women. 87.5% of U.S. women who have been sexually active report use of a highly effective reversible method.

    The College supports women's right to decide whether to have children, to determine the number and spacing of their children, and to have the information, education, and access to health services to make those choices. Women must have access to reproductive health care, including the full range of contraceptive choices, to fulfill these rights.

    The U.S. has higher pregnancy and abortion rates than most other developed countries. Low-income women have even higher rates. The Healthy People 2020 goal is to decrease the rate of unintended pregnancies from 49% to 44%.

    Women with unintended pregnancies must choose between carrying the pregnancy to term, putting the baby up for adoption, or to undergo abortion. Medical, ethical, social, legal, and financial reasons come into play. U.S. births from unintended pregnancies cost taxpayers approximately $12.5 billion in 2008. Each dollar spent on publicly funded contraceptive services saves the U.S. health care system nearly $6.


    * The emphasis on abstinence-only education may have in part led to widespread misperceptions of contraceptive effectiveness, mechanisms of action, and safety that can have an effect on contraceptive use and method selection. Many individuals believe that oral contraceptives are linked to major health problems or that IUDs carry a high risk of infection, or that certain contracptives may be abortifacients. None of the FDA-approved contraceptive methods are abortifacients because they do not interfere with a pregnancy.

    * Many clinicians are uncertain about the risks and benefits of IUDs and lack knowledge about correct patient selection and contraindications.

    * Legal rulings and legislative measures can impede access to contraceptives for minors and adults and interfere with the patient-physician relationship by impeding contraceptive counseling, coverage, and provision. Hobby Lobby is an example.

    * Supporters of "personhood" measures argue erroneously that most methods of contraception act as abortifacients because they may prevent a fertilized egg from implanting; if these measures are sucessful, hormonal contraceptive methods and IUDs could be illegal.

    * While the Title X family planning program and Medicaid require that minors receive confidential health services, currently, 20 states restrict some minors' ability to consent to contraceptive services.

    * More than one half of the 37 million U.S. women who needed contraceptive services in 2010 were in need of publicly funded services, either because they had an income below 250% of the federal poverty level or because they were younger than 20 years. 25% of women in the United States who obtain contraceptive services seek these services at publicly funded family planning clinics.

    * There was a 17% increase (about 3 million) in the number of women needing publicly funded contraceptive services from 2000 to 2010. As the ACA goes into effect, obstetrician-gynecologists can be strong advocates for continued expansion of affordable contraceptive access, which has been shown to be cost neutral at worst and cost saving at best.

    * In 2000, the federal Equal Employment Opportunity Commission concluded that a company's failure to cover contraception is sex discrimination under the 1978 Pregnancy Discrimination Act. However, even when contraception is covered, women pay approximately 60% of the cost out of pocket compared only 33% for noncontraceptive drugs.

    * Under the ACA, all FDA-approved contraceptive methods, sterilization procedures, and patient contraceptive education and counseling are covered for women without cost sharing by all new and revised health plans and issuers. This requirement also applies to those enrolled in Medicaid expansion programs. However, many employers are now exempt from these requirements because of regulatory and court decisions, leaving many women uncovered. In addition unauthorized immigrants remain uninsured in spite of the ACA. For these women the most effective methods, such as IUDs and the contraceptive implant, likely will remain out of reach.

    * Another barrier is the distribution of only a month's supply of contraception at one time. Data show that provision of a year's supply of contraceptives is cost effective and improves adherence and continuation rates.

    * Some policy makers also require women to "fail" certain contraceptive methods before an IUD or implant will be covered.

    * Allowing over-the-counter access to oral contraceptive pills is a good strategy for improving access, but only if over-the-counter products also are covered by insurance or other cost supports in order to make them financially accessible to low-income women.

    * Ten of the 25 largest health systems in the country are Catholic-sponsored facilities which object to contraception.

    * Another barrier is the pharmacist who refused to fill contraceptive prescriptions or provide emergency contraception. For women in areas where pharmacies and pharmacists are limited, such as rural areas, this obstacle may be insurmountable.

    * There is no benefit to a routine pelvic examination or cervical cytology before initiating hormonal contraception. However some doctors insist on one, in order to deter a woman, especially an adolescent, from having a clinical visit that could facilitate her use of a more effective contraceptive method than those available over the counter.

    * Another common practice is requiring two visits to place a LARC device when one is all that is really needed.

    * A study showed that almost 50% of women who did not receive a requested postpartum sterilization were pregnant again within 1 year. Twenty seven percent of reproductive-aged women choose to undergo permanent sterilization once they have completed childbearing, and many of them want the procedure to take place immediately after birth. However often the hospital is not always prepared for this, or the insurance does not cover it. Medicaid regulations require signed consent 30 days before sterilization, eliminating immediate postpartum sterilization as an option in many cases. The regulation was created to protect women from coerced sterilization, but it also can pose a barrier to a desired sterilization.

    * Highly effective LARC methods are underutilized, mostly by adolescents and women who have not had children. Providing effective contraception postpartum and postabortion can be ideal because the patient is often highly motivated to avoid pregnancy, but appropriate reimbursement for LARC methods at these times can be difficult to obtain.

    * Unintended pregnancy rates for poor women are more than five times the rate for women in the highest income bracket and this number has increased substantially over the past decade. Publicly funded programs that support family planning services, including Title X and Medicaid, are increasingly underfunded and cannot bridge the gap in access for vulnerable women. To address these barriers, the ACA has encouraged states to expand Medicaid eligibility for family planning services to greater numbers of low-income women. In states that choose to expand Medicaid under the ACA, fewer poor women will lose Medicaid eligibility postpartum.

    All women should have unhindered and affordable access to all U.S. Food and Drug Administration-approved contraceptives as an integral component of women's health care. doclink

    Karen Gaia says: My daughter was told by her doctor that she couldn't have an IUD because she didn't have any children yet. So she had to go to another doctor to get it. Her friend was told by her doctor that the IUD promoted slutty behavior.

    End of this section pg 1 ... Go to page 2 3

    Benefits of Family Planning

    Save Lives -- and Money!

       September 26, 2015, Durango Herald   By: Richard Grossman Md

    Can you think of any state-funded program that can save seven dollars for every dollar spent? Voluntary family planning programs for teens and young women offer that wide a margin of benefit!

    Indeed, family planning can do much more than just save money. It has the ability to change the prospects for people, especially young women. By allowing people to postpone parenthood, they have the opportunity to mature emotionally, complete their education and improve job skills. An experiment, the Colorado Family Planning Initiative (subsidized by a generous grant) has shown the benefit of making effective contraception available to all women.

    OK, I have to admit, women bear an unjust proportion of responsibility for family planning. That is the way it is now; I hope that the future will hold more in the way of birth control for men other than just condoms and vasectomy.

    An anonymous donor (reported to be the Susan Thompson Buffet Foundation) gave money to fund contraception for women who otherwise couldn't afford it. This program started in 2009 and finished this summer. It paid about $5 million each year for more than 36,000 women to receive contraceptive information, services and supplies.

    Fortunately, during this interval the need for funding decreased because the Affordable Care Act (Obamacare) picked up perhaps 25,000 Colorado women who didn't have prior coverage. Unfortunately there are still many people who don't have any insurance coverage and cannot afford contraception. They are especially unable to pay for Long-Acting Reversible Contraceptive (LARC) methods that are so effective, but have an initial cost of about $1000. LARCs include four IntraUterine Devices (IUDs) and one hormonal implant.

    In the long run, LARCs are actually less expensive than less reliable methods if you look at the monthly cost over their lifespan of 3 to 10 years. DepoProvera© is almost as effective, but this shot has to be administered every three months, so requires more action on the user's part.

    How did this program save money? If they had gotten pregnant, many of these women would have been on Medicaid or other state-supported programs. Their children would also likely be on taxpayer-funded programs, including children of undocumented women who are citizens as soon as they are born in the USA. The estimate of the amount of money the grant saved just for obstetrical services is $79 million.

    The most important savings is in the decrease in the teen pregnancy rate. It is true that all over the country fewer teens became pregnant during the past few years, so not all of the decrease in our state is due to the Initiative. However, Colorado's teen pregnancy rate dropped an outstanding 40% from 2009 to 2013, largely because of this Initiative.

    No one is in favor of unintended pregnancies. This Initiative illustrates what we have known all along: the best way to prevent abortion is with good contraception-and this has been proven over the past 5 years. From 2009 to 2013 the abortion rate for Colorado teens fell 42%, and for women aged 20 to 24 it also dropped significantly.

    Good things come to an end, and the Initiative's grant ended in July. Don Coram, a Republican state representative from Montrose, tried to garner support to continue the program-but unfortunately failed. In stepped private foundations to assure that funding is available.

    So far 12 foundations have collaborated to pay $2 million during the next year to continue the Initiative. It remains to be seen whether this will be enough to provide services to all who need them, but it is hoped that more funding will follow. Optimistically the State Legislature will see that this program is saving money and empowering young women to become healthier, more productive citizens and will finally fund this program. And maybe then other states will then get on the bandwagon to follow Colorado's lead by funding similar programs.

    Dr. Eve Espey is chair of the department of OB-GYN in Albuquerque where I trained many years ago. Her paper "Feminism and the Moral Imperative for Contraception" documents the importance of contraception in the modern world. Not only does family planning provide social benefits to individuals and to their societies, but also it saves lives. Spacing the births of babies promotes healthier children and decreases infant deaths. "It is estimated that, in 2008," she writes "44% (272,040) of maternal deaths were prevented in 172 developing countries owing to use of contraceptives...." Not only does contraception save money; globally it saves a quarter million women's lives yearly!

    First published in the Durango Herald doclink

    The Faces Behind the Numbers

       July 11, 2015, Sierra Club   By: Michael Brune, Executive Director, Sierra Club

    On World Population Day it's easy to focus on the numbers -- over 7 billion humans now sharing our planet, and 10 billion later. But it is about much more than the numbers -- it's about the needs of the people behind those statistics.

    Even though it has been 20 years since the United Nations defined voluntary family planning as a basic human right, 225 million women around the world today want to plan, space, or delay childbirth but have no access to modern contraceptive methods. That means these women have little power to control their own lives or escape the cycle of poverty.

    If women and families are going to gain ground economically, politically, or environmentally, we need to address not only access to voluntary family planning but clean energy access, clean water access, and the right to an education.

    Helping those in need will help all of us. For instance, if we simply filled the unmet demand for family planning, the resulting reduction in CO2 emissions would be equivalent to eliminating deforestation worldwide, doubling the fuel economy of every car on the planet, or replacing every coal-fired power plant with solar energy.

    We can't have a healthy planet without healthy families.

    To mark World Population Day, the Sierra Club's Global Population and Environment Program has released its second POP Quiz -- . Test your own knowledge of the connection between the health of women and families and our environment. doclink

    Birth Control Isn't a 'Women's Issue' - It's An Economic Issue

       July 8, 2015, Yahoo! News   By: Julia Sonenshein

    Birth control is not only the biggest asset to female autonomy in modern history, it is also an economic issue that is in all of our best interests. Almost half of pregnancies in the U.S. are unplanned. Significantly reducing unintended pregnancies would save taxpayers an estimated average of $5.6 billion per year.

    Giving women early access to birth control pills accounted for 10% of the narrowing in the gender gap during the 1980s and 31% during the 1990s, allowing for women to have higher lifetime incomes and education. 51% of women surveyed reported that contraception allowed them to complete their education, and 50% said contraception enabled them to work.

    Women have saved a staggering $1.4 billion on birth control pills since the Affordable Care Act required insurance companies to cover birth control at no cost to the consumer, while spending on IUDs has fallen 68%.

    Until recently, if your workplace chooses not to cover your birth control because of ethical or religious reasons, you were stuck paying for your contraception out of pocket, which for many could be prohibitive, even if an unintended pregnancy could be especially financially devastating.

    Access to birth control is an economic necessity, and it's an issue our country can't afford to sleep on. doclink

    Karen Gaia says: 1) There is hope that new rules coming from the Obama administration will provide an alternative coverage for birth control methods. 2) No sources were quoted for the statistics in this article. They could very likely be from the Guttmacher Institute

    Improving Nutrition and Food Security Through Family Planning

       June 2015

    The goal of "Improving Nutrition and Food Security Through Family Planning" is to raise awareness and understanding among decision makers about how family planning can help improve key measures of nutrition for mothers, infants, and children, as well as improve food security on a broader scale. Ultimately, the aim is to start a critical policy dialogue to encourage integration of family planning into nutrition and food security policies, strategies, action plans, and programs throughout the world, particularly in Asia and Africa. As such, this presentation can be used as a tool to not only raise awareness, but also to mobilize political commitment and resources.

    Developed under the USAID-funded Informing DEcisionmakers to Act (IDEA) project, this presentation is part of a series of ENGAGE presentations that examine the relationship between family planning and the Millennium Development Goals in developing country contexts. doclink

    A Woman in Guediawaye: Family Planning for Health and Development in Senegal

       April 29, 2015

    The CSIS Global Health Policy Center produced a new video, A Woman in Guédiawaye: Family Planning for Health and Development in Senegal. The video follows a young woman, Anta Ba, from Guédiawaye, a poor urban area of Dakar, who explains why she decided to access family planning, despite her husband's opposition, and why these services matter for her own life and for women's health and empowerment in Senegal. Through her story, and through the voices of other champions of family planning in Senegal-government and NGO health workers, an imam, and the Minister of Health-the video illustrates new approaches to expanding access to family planning as well as the challenges ahead. doclink

    U.S.: Unintended Pregnancies Cost Federal and State Governments $21 Billion in 2010

       February 27, 2015, Guttmacher Institute   By: Adam Sonfield and Kathryn Kost.

    A study "Public Costs from Unintended Pregnancies and the Role of Public Insurance Programs in Paying for Pregnancy-Related Care: National and State Estimates for 2010," showed that U.S. government expenditures on births, abortions and miscarriages resulting from unintended pregnancies nationwide totaled $21 billion in 2010. In 19 states, public expenditures related to unintended pregnancies exceeded $400 million in 2010. Texas spent the most ($2.9 billion), followed by California ($1.8 billion), New York ($1.5 billion) and Florida ($1.3 billion); those four states are also the nation's most populous.

    51% of the four million births in the United States in 2010 were publicly funded, including 68% of unplanned births and 38% of planned births.

    Prior research has shown that investing in publicly funded family planning services enables women to avoid unwanted pregnancies and space wanted ones, which is good not only for women and families, but also for society as a whole. In the absence of the current U.S. publicly funded family planning effort, the public costs of unintended pregnancies in 2010 would have been 75% higher.

    Adam Sonfield, one of the authors, said. "Reducing public expenditures related to unintended pregnancies requires substantial new public investments in family planning services." ... "That would mean strengthening existing programs, such as the Title X family planning program, as well as working to ensure that the Affordable Care Act achieves its full potential to bolster Medicaid and other safety-net programs. We know we can prevent unintended pregnancies and the related costs. There are public programs in place that do it already, but as these data show, there is significantly more progress to be made." doclink

    Provide Family Planning in Congo

       February 21, 2015   By: Richard Grossman Md

    The London Summit on Family Planning was the start of something big. If kept, an array of promises made at the groundbreaking July 11 2012 event could have a major impact on the lives of women and girls for years to come ... Susan A. Cohen, Guttmacher Institute

    In a prior article I wrote about how it was possible for one doctor to perform hundreds of tubal ligations in one day-but probably not honor the rights of the patients. The next column was about putting human and reproductive rights first and foremost. Today's column focuses on one country where FP2020 is making amazing improvements in the lives of women and children.

    FP2020 is the nickname of the ambitious program started in 2012 at the London Summit on Family Planning. Its goal is to reach 120 million women of the 225 million who are unable to access modern contraception, but wish to regulate their fertility. These are women in developing countries who currently have little or no access to reproductive health care. Typically they have high fertility rates and high rates of child deaths, illegal abortion and maternal mortality. Often these women are the poorest of the poor, have little schooling and are subservient to men. Many of these women live grim lives.

    A very high percentage of people in wealthy countries already use family planning (FP); indeed, that is part of how we became wealthy. It is time to share that knowledge and technology with our less fortunate brothers and sisters. Unfortunately where access to FP is limited, infrastructure is also challenging-transportation, sanitation and communication are often poor. Reaching these people will be difficult.

    Providing full reproductive health care for every woman in the world who does not currently have access to those services would cost a whopping 40 billion dollars annually-about the same amount as the US military spends in a month. The lives saved by such an investment would make that money very well spent, however. Reaching all people in developing countries with FP and with maternal and newborn care would prevent 79,000 maternal deaths, 26 million abortions and 21 million unplanned births each year.

    The cost of providing just FP services for these people would be about nine billion dollars a year. Because moms will be healthier, improved birth spacing alone would prevent over a million infant deaths globally each year!

    Funding is a major challenge for FP2020. The programs are jointly supported by developing countries and by donor (wealthy) countries. In addition, generous funding has come from foundations; the Bill and Melinda Gates Foundation is a major source of financial support as well as being a prime mover. Assistance also comes from the UN and the US Agency for International Development, among many other organizations.

    One of the FP2020 programs is in the Democratic Republic of the Congo. This beleaguered country has had a miserable history of colonialism, dictators and civil war. Average income there is less than two dollars per day. Only 53 % women are literate, and only one in twenty married women uses a modern method of contraception. Indeed, a 1933 law makes contraception illegal! The average woman bears over 6 children in her lifetime and the country will double in population every 23 years-exacerbating many of its economic and political problems.

    Despite these challenges, FP2020 is seeing successes in DRCongo. One project was to map existing FP resources, using a sophisticated system of data collection with cell phones. They now know where there are trained FP personnel and which pharmacies have pills or injectable birth control. Fortunately, all sites offer condoms.

    Women in DRCongo have been relying on traditional methods of FP for years, with too many unintended pregnancies-more than a million in 2013. Contraceptive implants (such as Nexplanon©) were introduced in 2014 with great success. So far, the program has recruited almost 200,000 new users of modern contraception.

    What FP2020 has meant to women in DRCongo is telling. More than 300,000 unintended pregnancies were averted in 2013. Calculations suggest that 1481 women's lives were saved, and 76,000 unsafe abortions were prevented by the use of modern contraception.

    FP2020 offers hope for the future, especially for people in countries such as DRCongo. I am optimistic that FP2020 can help women and families lead healthier and happier lives and will be a model for the future of family planning. And I expect it and future programs will be built on respect for the people that they serve. doclink

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