Progress toward the Goals of FP2020

Bibliographic Data

ID10797657
AuthorsJohn Stover (0000-0001-7236-1989, corresponding author), Emily Sonneveldt (0000-0001-8756-3946)
Year2017
Volume48
Issue1
Pages83-88
Publication date2017-03-01
Open AccessYes
TypeARTICLE
VenueStudies in Family Planning (JOURNAL)
Journal identifiersISSN: 0039-3665 • E-ISSN: 1728-4465
PublisherWiley (PUBLISHER • GB)
DOI10.1111/sifp.12014
PMID28195416
OpenAlexW2588673979
LanguageEN
Citations received7

At the 2012 London Summit on Family Planning, more than 100 national leaders, donors, NGOs, and civil society and private-sector representatives pledged a renewed commitment to family planning. That initiative, known as FP2020, seeks to revitalize the field of family planning by scaling up efforts to expand knowledge, access, use, and quality of family planning services. The commitment includes increased resources and new approaches for increasing the use of modern contraception in order to address unmet need among couples in developing countries. We are now at the half-way point in the initiative, and it is appropriate to consider what progress has been made and whether we are on track to achieve the goals. The focus of FP2020 is the 69 poorest countries in the world at the time of the 2012 Summit. These countries and partner organizations were asked to make formal commitments to contribute to the effort. At the London Summit 18 of the 69 countries plus South Africa made such commitments. The pledges included increased financial contributions, improvements in equity by expanding services to underserved populations, changes to government policies, respect for human rights, and increases in method mix. Since 2012 an additional 20 countries have made commitments, bringing the total to 38—more than half of the focus countries. The London Summit also saw commitments of funding and other support from ten donor countries and organizations: Australia, Denmark, European Commission, France, Germany, South Korea, the Netherlands, Norway, Sweden, and the United Kingdom. Commitments were also made by six foundations, 20 civil society organizations, and UNFPA and the World Bank. Together these commitments form the basis on which future progress is expected. It is noteworthy that so many countries and organizations have made specific pledges to support this initiative, and it is clear that some pledges have been realized. A number of countries have increased domestic spending on family planning, and several have started new programs to expand access to underserved populations. A major recent development is the decision by India to add new contraceptive methods, including injectable contraceptives, to its national program. In many countries family planning has gained a higher profile among decision-makers. However, it has not been easy to track fulfillment of the commitments, especially pledges of increased funding, since funding is not identified as FP2020-specific. The partners involved in establishing FP2020 set up a structure to provide guidance and coordination related to implementation. Overall guidance is provided by a Reference Group composed of high-level representatives of key partners, including national governments. The FP2020 Secretariat, established in 2013, is responsible for producing an annual FP2020 report and coordinating efforts of all partners. FP2020 focal points have also been established in all commitment-making countries to coordinate national responses. FP2020 established a numerical goal for only one indicator: serving 120 million additional modern method users by 2020. This ambitious global goal was based on the assumption that all countries could improve on their historical growth rates in contraceptive use. It was estimated that if all countries continued at their historical rates of growth before 2012, there would be 48 million additional users of modern contraception by 2020. Thus, the goal of 120 million represents more than a doubling of past trends. To be on track to achieve the 120 million goal, the FP2020 countries should have added about 49 million users by 2016 (see Figure 1). Our best current estimate is that about 34 million users have actually been added. Thus progress is lagging behind what is needed to achieve the goal, but is about one-third more than the 24 million that would have been achieved with historical growth rates. There is no way of knowing how much of the increased growth is due to FP2020, but FP2020 was never intended to be a separate effort but instead is expected to support programs and partners to achieve global and national goals. Most countries have set their own FP2020 goals. Kenya achieved its 2015 goal and is on track for its 2020 goal. The nine countries of the Ouagadougou Partnership achieved their goal of one million additional users by 2015 (originally set in 2011 at the start of the Partnership) and have now adopted a new goal of an additional 2.2 million by 2020. Progress has been less rapid in other countries. Three of the largest countries, India, Indonesia, and Bangladesh, have already reached high levels of contraceptive use. More than half of the states in India have reached replacement-level fertility or below. Because growth normally slows as contraceptive prevalence reaches high levels, it may be unrealistic to expect an acceleration of growth in these countries. Although the numbers of users are lower than desired, there are clear advancements in family planning use in many countries. An important milestone was achieved in 2016, as more than 300 million women are using modern contraception in the 69 FP2020 countries. Some countries in east and southern Africa (Kenya, Malawi, Zimbabwe) have reached levels of modern contraceptive use (mCPR) similar to those seen in Asian countries. Countries are now discussing contraceptive use among unmarried women, with many countries reporting both married and all-women mCPR. At the time of the London Summit, it was estimated that US$14.3 billion would be required through 2020 to meet the goal. This includes $10 billion to maintain the 2012 base of 260 million modern method users and an additional $4.3 billion to reach another 120 million women. Donors were expected to contribute an additional $2.3 billion, and $2 billion would be provided by national governments. At the Summit, donors pledged an additional $2.6 billion—somewhat more than the target—and further commitments since 2012 have added to that amount. It is difficult to know exactly how much has been spent on family planning, as data sources on expenditures are incomplete. The Kaiser Family Foundation, which conducts an annual assessment of donor spending, has found that annual donor spending on family planning increased from $1.1 billion in 2012 to $1.4 billion by 2014, dropping slightly to $1.3 billion by 2015. This amounts to additional spending over 2012 levels of $820 million, about 30 percent of the pledged increase. UNFPA and NIDI (Netherlands Interdisciplinary Demographic Institute) began monitoring expenditures by domestic governments in 2013. They report that government expenditures in the 69 FP2020 countries rose from about $480 million in 2013 to $660 million in 2014. The Track20 Project combines these data with estimates of out-of-pocket expenditures on family planning to estimate total family planning expenditures in FP2020 countries. These estimates suggest that annual spending from all sources has increased from $2.2 billion in 2013 to $2.7 billion in 2014. Of those totals, 24 percent is from domestic governments, 17 percent from international donors, 51 percent from out-of-pocket expenditures by consumers, and 8 percent from NGOs and corporations. Some of the components necessary to track global family planning expenditures are in place, but more work remains to validate these estimates at the country level and make the effort sustainable. One of the biggest changes since the London Summit relates to the data being used at the country and global levels to monitor and estimate annual progress. In 2012 the family planning community relied almost exclusively on periodic national household surveys conducted under the Demographic and Health Surveys (DHS) Project to monitor progress on key indicators such as modern contraceptive prevalence, method mix, and unmet need. Some countries, such as Indonesia, conducted their own surveys on a more frequent basis but most did not. Service statistics were inconsistently used in most countries, and issues related to quality limited the ability to accurately measure progress. Because DHS surveys are normally conducted every five years, it was not possible to monitor trends with greater frequency. In 2012 the latest national survey was more than five years old in a number of countries, such as India. There was no systematic effort to collect, analyze, and report on core indicators at the country level. FP2020 has stimulated innovations in family planning measurement. It developed a conceptual framework and used it to select 17 core indicators. All countries are encouraged to track these indicators and use them for their planning and annual monitoring and to report them to FP2020 for the global annual report. While DHS data remain a main source of data for monitoring progress, these data are now supplemented by information from new sources. (1) The Gates Foundation has funded the PMA2020 Project to implement sentinel surveillance for key family planning indicators. PMA2020 is now active in ten countries, where it supports surveys every six months in selected communities. These data provide more frequent assessments of progress. (2) The Family Planning Estimation Tool (FPET) has been developed through a collaboration of the United Nations Population Division, the University of Massachusetts, and the Track20 Project. It uses sophisticated statistical techniques to combine data from national surveys (DHS, MICS, and national surveys), PMA2020 surveillance, and service statistics to produce the best current estimates and uncertainty ranges for modern contraceptive prevalence, unmet need, and total demand. FPET is now being used to produce up-to-date estimates for all 69 countries and is used by a number of countries to develop estimates at provincial and district levels. (3) Service statistics are now being used in increasing numbers of countries to provide more up-to-date information about progress. This has been aided by the widespread adoption of the DHIS2 electronic system for collecting and reporting service statistics and by the ability to use these data in the FPET (which adjusts for the inherent biases in this type of data) to indicate trends since the last national survey. As countries move toward more active management of their family planning programs, having access to annual estimates is crucial. Having to wait five years makes it very difficult to effect rapid course corrections or identify problems in implementation. Work under FP2020 has also led to agreement on new indicators to track stock-outs, quality, choice, expenditures, and policies and guidelines. With the support of the Track20 Project, national program staff have been trained and supported to conduct annual meetings of all stakeholders to review new data and reach agreement on targets for both the FP2020 core indicators and additional indicators that correspond to country-specific implementation and priorities. These indicators allow national programs to monitor their progress more frequently and identify problems more quickly. Country reports to FP2020 form the basis for the data reported in the annual report. FP2020 advocates for a human-rights-based approach to family planning: supporting the rights of individuals to decide the number and timing of children for themselves and empowering couples with full information about contraception and choices. To further this goal, FP2020 has developed a conceptual framework and a user's guide to assist national program managers to evaluate their programs and identify actions to enhance human rights within their family planning programs. The tools were piloted in several countries in 2014 and made available for wider application in 2015. Three indicators that measure choice and participation in decision-making about family planning are included in the core indicators and are tracked and reported in the FP2020 annual reports. The situation is mixed with regard to the provision of complete information about family planning methods, with many countries falling short. In many countries the proportion of women who receive any information about family planning is low, and large differences are seen by wealth quintile. The development and use of these rights-based indicators has highlighted the gaps and challenges, but since these indicators are generally measured by DHS it will be a few more years before we know whether the situation is improving. Prior to FP2020, many countries had strategic plans but few had quantitative goals, costs, or plans for monitoring and evaluation. FP2020 has encouraged programs to develop implementation plans with clear goals and with actions linked to the current situation in each country. These plans are intended to form the basis for guiding the national program as well as discussions with donors about funding support. The first round of these plans introduced a collaborative process that produced a common understanding of country needs and strategies. The process was led by governments and included donors, implementation partners, and other collaborators. As the first round of plans is expiring, the priority in the second round is to build on this process with a greater focus on identifying strategic opportunities related to selection of activities to be included in the country plans. The progress achieved and the gaps remaining vary widely across countries. FP2020 seeks to more effectively support country objectives and needs by providing a platform for coordination among major donors and implementers. Challenges remain, however. Progress has been hampered by the lack of a global funding agency. Although there were discussions during the design of FP2020 about establishing a funding agency similar to the Global Fund for HIV, TB and Malaria, in the end such an agency did not materialize. Instead, national governments still work with donors on a one-to-one basis to negotiate funding. At times, this failure has left national program managers uncertain about how to obtain the increased funding that has been pledged, and it has made the benefits of FP2020 less visible at the country level. It has also made it more difficult for countries to depart from “business as usual,” with little ability to redirect funding and amend longer-term agreements. On a positive note, in 2014 FP2020 established a Rapid Response Mechanism with funding from the Bloomberg Philanthropies that provides short-term grants to meet urgent needs and new opportunities. All FP2020 partners agree on the need to ensure that family planning services are scaled up within a rights-based approach. There is broad agreement on the key elements of that approach—empowerment, informed choice, and quality services—but the measurement of these elements is difficult since quantitative measures do not always identify all important aspects. Much work remains to be done to ensure that the data needed to monitor these elements are available at the national level and that governments have the capacity to analyze and use the data effectively. Advances in data analysis, at both the global and country level, help countries identify the specific barriers to improving their programs and increasing their mCPR. Still, more needs to be done to ensure that solutions are based on country needs and not on general solutions that are assumed to be applicable for all countries. The lack of accountability, among both countries and donors, in meeting country mCPR goals also poses an important challenge. Most countries have not yet found a balance between setting mCPR goals that are ambitious but achievable and those that are overly ambitious and not achievable. They receive many conflicting messages from donors, partners, and government counterparts. This has led to a pattern in many countries of frequent changes in strategy, resulting in a lack of accountability. Contraceptive discontinuation for reasons other than a desired pregnancy is a widespread problem. When users discontinue use because of method- or service-related problems, they are at risk for unintended pregnancies. Improving continuation is a particular challenge because it requires advances in many areas simultaneously, including logistics, counseling, quality of care, and choice. Today, at the mid-point of the FP2020 initiative, there are disappointments and successes. The major disappointment is that the number of additional users of modern contraception is below the pace required to achieve the 2020 target. But that target is very ambitious, and the increase in users is above the historical trend. Further, the lack of a global funding agency makes it more difficult for national programs to obtain additional funding and track the effect of FP2020 on expenditures. One the other hand, a large number of countries and organizations have pledged to contribute to FP2020 goals. Many countries have seen significant increases in contraceptive use. Countries are actively monitoring progress toward their stated contraceptive prevalence goal. Discussions about the importance of a rights-based approach to family planning has been reinvigorated and expanded at the country level. Structures are in place globally and nationally to provide coordination and assistance. And there have been major advances in monitoring that include new data sources, indicators, and tools for tracking progress and identifying success and weaknesses. FP2020 has clearly contributed to a reinvigoration of family planning efforts and brought about many positive changes

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