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USAID’s case for more family planning funding

A Q&A with USAID officials about funding and future of reproductive health issues and family planning.
Afghan midwife students work on a pregnant woman in labor who is having complications in the delivery room at the Bamiyan Provincial hospital in Bamiyan, Afghanistan. The 18 month midwife program was funded by USAID. (Paula Bronstein/Getty Images)

Funding for family planning continues to come under fire in the US Congress. In a House appropriations bill released this week, family planning funding under the Global Health and Child Survival Account was reduced to $461 million from $525 million authorized in 2011; other smaller pools of funding also support family planning programs overseas. 

Two senior reproductive health officials in the US Agency for International Development – Ellen H. Starbird, Deputy Director of the Office of Population and Reproductive Health and Judy M. Manning, Health Development Officer in the Research, Technology and Utilization Division -- talked with John Donnelly at the end of a conference called Saving Lives at Birth: A Grand Challenge for Development. The interview focused on family planning and reproductive health issues, including new innovations and promising technologies still in the research stage.

What are some of the new innovations in reproductive health that you find exciting?

Judy Manning: One of the things we think is a game changer is expanding access to injectable contraceptives through a (single-use) injection device containing Depo Provera. This is prefilled with a single dose and can be provided by a community health worker. It doesn’t need to be clinic-based and can go out through community health workers. Pfizer holds the license and it was developed by our partner PATH. This is something we consider as a real game-changer because it can greatly expand access to rural populations.

Ellen Starbird: Using community health workers is a really fabulous way to expand access. Because they are already able to do the Depo-Pravera injections – as well provide other methods (of birth control) – this represents a real task shifting. Before only nurses and doctors could give these shots.
Another example, and we saw some of this at the USAID innovators showcase, was using cell phones in various ways, including for natural family planning methods such as cycle beads. They are sending text messages to help women keep track of their fertile period, and advise them around their family planning choices.

The idea of community-based health care is not new. But it seems in recent years that much more of this is happening. Why is there momentum for this now?

Ellen Starbird: One possible reason is that we have increasingly over the past eight years moved more of our money into Africa, where they use this to reach out to underserved communities. Community care began in different ways in previous decades. We were on the forefront (in years past) on mobile delivery with clinics in vans; in Bangladesh, we supported efforts to provide contraceptives at the doorstep, going door to door. So a lot of things led up to this point. What’s also happening is the shortage of health workers has pushed things in this direction. Community members are more likely to stay in their community.”

You hear about more community-based health workers happening in Ethiopia, Rwanda, and Malawi. Where else are their strong movements for community-based care?

Ellen Starbird: Those three places, definitely. It’s also expanding in Mali and Madagascar, for instance.

With more community-based health care, does this lead to greater country ownership of health programs?

Ellen Starbird: It does go along with the country ownership movement, it does contribute to that. It gives the average person much more day-to-day information and interaction with the health sector. It also can help legitimize government services. For countries that are coming out of crisis, re-establishing the legitimacy of government and doing it through health is one of the first priorities. They can make clear that the health system doesn’t stop with a fixed delivery site.

With family planning coming under fire in Congress, how do you make the case that this funding is critical?

Ellen Starbird: We can show how successful our programs have been by proving it is something women want. One of misconceptions is that this program is imposed on people. It’s not. It is clear that many people in developing countries are having more children than they want to have. This program is making possible for women in the developing world the kinds of choices that women all over the developed world have.
Family planning is really a powerful way of opening a lot of other doors and enabling a lot of other development to happen. My boss, Scott Radloff , likes to say what is good for women is good for the world. 

Many in Congress argue that more family planning means more abortions. How do you respond?

Ellen Starbird: The principle cause of abortion is unintended pregnancies. The principal way to prevent unintended pregnancies is to give people access to family planning. The US government does not spend any government funds on abortion. When you make contraceptives more available, abortion rates go down. Family planning is part of the solution to reducing abortions.

One more question on innovation: What is coming down the pike that will be important?

Judy Manning: In terms of family planning, a lot of our resources are looking at filling the gap between the three-month injectable and the five-year implants. We hear from many women who would really like a method that was effective for one year. We are supporting the Population Council, which is in the final stages of developing a one-year contraceptive vaginal ring. That is close to approval, and we hope that it will available at affordable prices. FHI 360 is working on a biodegradable pellet implant system. They implant little pellets the size of a grain of rice, four or six of them, and you would have no need to come back to the health facility for removal of the implant.

Anything else on your mind now?

Ellen Starbird: We could always use more funding.

This was also posted on Ministerial Leadership Initiative for Global Health’s “Leading Global Health” blog.’s-case-more-family-planning-funding