The International Conference on Family Planning drew to a close this afternoon in a plenary that included a partners panel, award presentations, re-affirmation of global commitments to family planning, votes of thanks and comments by the Honorable Doctor Syda Bumba, Uganda Minister of State for Finance.
The closing sessions iterated and many of the points oft-heard during the last four days. Dr. Michael Mbizvo, of the WHO, called for action: “There is a sense of urgency. We have lost ground.”
Representing the Gates Foundation, Jose Rimon emphasized that the family planning community must spend money “the right way,” toward achieving the Millennium Development Goals, and he called for more and louder voices from sub-Saharan Africa.
Scott Radloff of USAID stressed a need for better strategies for reaching the poor, the undereducated, and those living in rural areas, suggesting that social marketing would be one effective measure.
Anthony Daly, of the UK Department for International Development, echoed a sentiment consistently throughout the conference: “We need integration [of family planning and HIV services] and harmonization,” he said, “and we need to have a mechanism to hold everyone accountable so we can better harmonize and integrate.”
Honorable Doctor Syda Bumba echoed the re-affirmations of commitment to family planning, acknowledging Uganda’s recognition of its importance.
The Johns Hopkins Bloomberg School of Public Health, the David and Lucile Packard Foundation, USAID and the Bill and Melinda Gates Foundation announced on Wednesday at the ICFP conference a new three-year, $12 million project to advance reproductive health and family planning efforts in regions with the greatest need. The project, Advance Family Planning, will focus on sub-Saharan Africa and Asia.
“If we are serious about achieving the health component of the Millennium Development Goals,” said Jose Rimon, of the Gates Foundation, “we need to reinvest in and revitalize family planning and reproductive health. … This project can succeed only if the southern countries [of Africa] are united in owning the issues themselves.
Duff Gillespie, a professor at the Johns Hopkins Bloomberg School of Public Health, said, “The people who will really do the work and make it a success are individual champions in the countries they’re working in. We see our role as facilitating. We want to identify local champions and help them.”
For more information about the announcement, please visit http://www.jhsph.edu/publichealthnews/press_releases/2009/klag_family_planning.html
After two full days sharing research, ideas and knowledge, the question today at the ICFP is how to put the knowledge to action. Ward Cates, of Family Health International, opened today’s plenary by asking, “How do we do it?”
Cates spoke about the “pearls”—of knowledge, of wisdom—gathered over the last days. (Cates’s turn of phrase is more than appropriate: Uganda is known as the pearl of Africa.) Cates’s 10 points outline the areas of focus that he hopes will bring family planning renewed success and interest.
“Family planning is essential to achieving all of the Millennium Development Goals,” he said. Among the core issues discussed that deserve greatest attention are policies that address unmet contraceptive need; consistent and correct contraceptive use; contraceptive technology that makes adherence easy and cost-effective; and increased service delivery, so that all who wish to receive family planning have access to it.
Cates also tackled several of the newer issues that consistently surfaced at the conference. “I think we’ve reached a tipping point,” he said, in terms of getting countries on board with integrating family planning and HIV services. He also noted the growing acceptance of family planning as an effective HIV prevention strategy; the effectiveness of integrating family planning into other services such as postnatal and maternal and child health services; the need to get youth and men involved, particularly in reducing the taboos around vasectomy; reducing duplication among programs; and the importance of ownership of efforts by African leaders.
“Now, we can say that the state of family planning in Nigeria is having a brighter look. Now acceptance is increasing, both among men and women, and even religious leaders. It all depends on the language you use, how you call it. In traditional parts of the country, we call it ‘healthy timing,’ or ‘childbirth spacing.’ ‘Family planning’ is not a good way to call it in those places. It is very important to change your language to suit the culture. … We need to get men involved not only in family planning, but in total reproductive health for the couple. When men are involved, the whole family benefits, and the country benefits.”
“I’m a champion of women’s health interests. … Our main challenge in Nigeria is human resources. We don’t have enough nurses or doctors. We can build the most beautiful clinics, but if we don’t have enough health care providers, we cannot help the 52,000 women who die every year in childbirth in Nigeria. … We are training 100,000 teachers to empower girls toward zero tolerance of maternal death. We are training teachers to talk to girls about their bodies, about health. Parliament is on the vanguard of committing to zero tolerance of maternal death. … I want to develop a Population and Development advocacy group within Parliament to promote maternal and child health.”
Usman Gwarzo is a Family Health International, Nigeria program manager and country adviser for reproductive health and prevention of HIV transmission from mother to child. His organization is the largest PEPFAR-funded program in the world, and he is currently conducting research on a reproductive health and HIV integration project.
“Men are not the ones against vasectomy, but the myths are that vasectomy is castration. … When a man has more than one wife, he needs to have multiple negotiations about family planning. … The resistance to family planning is men, but vasectomy can be easily accepted so that the man does not have to worry about what happens to your children when you have more than you can support.”
Until recently, a dearth of data has made it difficult to counsel HIV-infected women about contraceptive options. In Africa, where the preferred birth control products are hormonal contraceptives such as pills and injectables, there has been some question about whether these methods would have an adverse effect on women who are already infected with HIV.
When Chelsea Polis, who just finished her doctoral degree at the Johns Hopkins Bloomberg School of Public Health, sought to answer this question, she found inconclusive research. Almost a dozen observational studies have provided mixed evidence, and the data’s validity is questionable. To design a new data collection effort, she would need to track women from the time of HIV seroconversion until they presented with AIDS or until they died—this could take 10 years or more. Fortunately, she Rakai Community Cohort Study had all the necessary data.
Using the wealth of data from the Rakai study, Polis found that hormonal contraception appears to be safe for use in HIV-infected women; HIV did not progress any faster in women who used the hormonal methods than it did in those who use other methods.
This finding provides good news on two fronts: family planning and HIV prevention. On the first front, HIV-infected women who wish to prevent pregnancies may now be soundly counseled that hormonal contraceptives are safe to use. The second ramification is that, in preventing unintended pregnancies in HIV-infected women, there are fewer babies born at risk of acquiring HIV through exposure in utero or through breastmilk—and thus HIV prevention is increased. Bolstering that good news is the fact that hormonal contraception as a means of preventing the spread of HIV is significantly more cost-effective than the HIV prevention strategy that involves providing pregnant, HIV-infected women with antiretroviral therapy prophylaxis.
In this case, contraception meets not only family planning needs, but supports HIV prevention efforts.