On Family Planning, Financing, and Fine Lines: Recapping ICFP 2016

Last week, more than 3,000 policymakers, practitioners, researchers, donors, and advocates descended upon Nusa Dua, Indonesia, for the 4^th International Conference on Family Planning (ICFP). From the opening gong to the closing plenary, Nusa Dua hummed with experience, learning, and new ideas, originating in 100-plus countries and converging in a single conference center.

I was pleased to attend the conference on behalf of CGD, and with good reason: we’ve recently convened a new Working Group on Alignment in Family Planning, looking to better optimize the allocation and distribution of resources toward the FP2020 goals. We’re also undertaking some new research on the links between access to family planning (FP) and women’s economic empowerment. So I was there to listen, learn, and absorb this important moment for the family planning community. Below are some of my initial reactions to what I heard—and I’d love to hear from others in the comments.

There are many good reasons to support family planning, each implying a different set of priorities with limited resources.

Throughout the conference, speakers and delegates extolled FP’s many virtues. (Check out the #FPvoices hashtag for a hefty sample.) Among them: family planning saves the lives of mothers and children. It empowers women with the right to make their own reproductive choices and control their own bodies. Through those choices, it empowers women to enter the workforce and pursue economic opportunities. At the macro level, FP can help countries reduce their youth dependency rations and realize the demographic dividend, kick-starting economic growth. And some countries look to FP to help manage other demographic pressures, like rapidly growing populations amid scarcity of land, water, or other resources.

These are all great reasons to support family planning, but they do imply very different priorities for funders and policymakers with limited fiscal and human resources. For example, if you prioritize women’s reproductive and sexual rights, FP funds might best flow to comprehensive sexuality education, prevention of child marriage, sensitive service delivery, and perhaps even safe abortion, with a particular focus on the extreme poor, married and unmarried adolescents, and other marginalized groups—whether or not these groups have particularly high fertility rates. If you prioritize maternal and child health, your resources might first flow to areas with the highest maternal mortality, including far-flung, sparsely populated rural areas with limited access to health services. In contrast, if you’re concerned about population dynamics, you might be better served to focus narrowly on those regions or populations with particularly high fertility rates and resource pressures, investing in behavior change communication to shift social norms and preferences about ideal family size. There’s no right answer, but there are real tradeoffs—and it’s important to understand that different priorities imply different optimal allocations of scarce resources.

The family planning advocacy community is a "big tent" with some shared goals, but also clear tensions.

Just as there are many different reasons to support family planning, there are many different constituencies within the FP advocacy community. The "big tent" identity of FP advocacy was clearly on display at the conference, where traditional religious leaders from West Africa mingled with youth activists, a World Vision delegation, demographers, medical professionals, economic researchers, and safe abortion advocates. It’s wonderful to see these communities put their differences aside in pursuit of a clear shared goal: better access to family planning to advance maternal and child health. But it’s also clear that major differences of opinion linger below the surface on important related issues like youth sexuality, gender roles, the desirability of lower fertility rates, and the legality and availability of safe abortion.

We still need to generate and disseminate better evidence.

The conference served to showcase a cornucopia of new family planning research. But presenters stressed that there are still big holes in the evidence base—and to accelerate the pace of progress, we need to learn more. Some priorities should be to determine: What are the best strategies to reach adolescent girls? (A subject of a 2013 CGD paper and a recent report from Greene and Merrick.) Can we better track the distribution of FP resources, from their source to their final beneficiaries? (A work in progress by researchers from Avenir Health, the Kaiser Family Foundation, and the Netherlands Interdisciplinary Demographic Institute.) And how does family planning change women’s life trajectories? Can we show, empirically, the intuitive links between family planning access and women’s economic participation and life expectations?  (A CGD priority for the coming year.) Overlaying all these questions: how can we better disseminate the data and evidence that does exist, but which, too often, remains outside the public domain?

Interested in hearing more? Stay tuned! We look forward to sharing our findings and recommendations later this year.