Heidi Worley
Former Program Director
Zika Crisis Highlights Importance of Family Planning
Date
February 27, 2017
Authors
Kristin Bietsch
Senior Demographer at Avenir Health
One year after the Zika global health emergency, World Health Organization (WHO) director-general, Margaret Chan, urged sustained attention to two important weaknesses in global health preparedness revealed by the Zika crisis—insufficient national mosquito control programs and poor access to family planning services.1
Zika was declared a global public health emergency in 2016 because the situation met several criteria:
- The suspected link between Zika infection and a sharp rise in cases of microcephaly.
- The ability of the virus to spread rapidly especially through widespread international travel.
- The number of people potentially at risk because their daily environment was host to the Aedes mosquito species that carried the virus—half the global population.
Many women in affected areas were warned by their governments to delay or postpone pregnancy. Yet significant shares of women who were at risk did not have access to family planning services that would allow these women to avoid getting pregnant.
The United Nations Sustainable Development Goals (SDGs) for 2030 call for universal access to family planning. Progress is monitored through an indicator that measures the demand for family planning satisfied by modern methods. Targets for this indicator set the bar at 75 percent. In other words, a country should aim to reach 75 percent of women of reproductive age who want to avoid or delay pregnancy with modern methods of contraception. This measure, together with an indicator that measures unmet need for family planning, gives a good snapshot of whether a country’s family planning programs are healthy and strong. As Chan mentioned, shortfalls in this measure indicate weaknesses in global health preparedness.
Women Cannot Postpone Pregnancy Without Access to Family Planning
The table below shows the number of women of reproductive age in the countries and territories that have reported active Zika virus transmission according to the U. S. Centers for Disease Control and Prevention, and each country’s status on two indicators—unmet need and demand for family planning satisfied by modern contraceptives. In one-quarter of these Zika countries, demand satisfied is less than 75 percent.
TABLE
More Than One-Quarter of Zika Countries Do Not Reach Benchmark
| All Countries and Territories With Active Zika Virus Transmission | # of Women of Childbearing Age | Unmet Need (%) | Demand Satisfied (%) |
| Antigua and Barbuda |
26,000 |
13.8 |
81.9 |
| Argentina |
10,804,000 |
9 |
—- |
| The Bahamas |
106,000 |
11.9 |
84.8 |
| Barbados |
68,000 |
16.0 |
74.3 |
| Belize |
99,000 |
17.8 |
75.8 |
| Bolivia |
2,748,000 |
18.0 |
50.4 |
| Brazil |
56,749,000 |
7.7 |
86.8 |
| Colombia |
13,203,000 |
8.2 |
83.0 |
| Puerto Rico, US territory |
927,000 |
6.0 |
81.5 |
| Costa Rica |
1,278,000 |
6.2 |
89.1 |
| Cuba |
2,755,000 |
8.7 |
89.4 |
| Dominican Republic |
2,739,000 |
10.7 |
83.1 |
| Ecuador |
4,227,000 |
9.1 |
75.1 |
| El Salvador |
1,744,000 |
11.9 |
77.9 |
| Grenada |
28,000 |
13.5 |
82.4 |
| Guadeloupe |
111,000 |
16.2 |
68.2 |
| Guatemala |
4,281,000 |
17.3 |
64.1 |
| Guyana |
193,000 |
26.5 |
60.9 |
| Haiti |
2,854,000 |
32.9 |
47.5 |
| Honduras |
2,212,000 |
10.6 |
76.5 |
| Jamaica |
753,000 |
9.7 |
83.1 |
| Martinique |
91,000 |
15.2 |
71.0 |
| Mexico |
34,528,000 |
10.5 |
81.0 |
| Nicaragua |
1,688,000 |
7.2 |
87.0 |
| Panama |
1,023,000 |
15.6 |
75.0 |
| Paraguay |
1,735,000 |
6.4 |
81.4 |
| Peru |
8,310,000 |
9.0 |
89.2 |
| Saint Lucia |
50,000 |
16.1 |
78.4 |
| Saint Vincent and the Grenadines |
28,000 |
12.7 |
79.4 |
| Suriname |
138,000 |
19.4 |
71.1 |
| Trinidad and Tobago |
353,000 |
19.0 |
63.4 |
| United States |
73,394,000 |
7.1 |
91.2 |
| U.S. Virgin Islands |
22,000 |
10.8 |
78.2 |
| Venezuela |
8,225,000 |
12.0 |
77.8 |
Note: Countries and territories with no data for the indicators were not included in the table.
Sources: Centers for Disease Control and Prevention, “All Countries & Territories with Active Zika Virus Transmission,” accessed at www.cdc.gov/zika/geo/active-countries.html, on Feb. 23, 2017; and United Nations (UN) Population Division, World Contraceptive Use (New York: UN, 2015).
Investments in Family Planning Critical for Women’s HealthThe Zika emergency may have passed, but the family planning emergency has not. According to Family Planning 2020 (FP2020), an initiative to increase the share of women using modern contraceptives by an additional 120 million by 2020, the trajectory to meet global goals in family planning access was off course at the mid-point.2 Some countries are on track, but the global efforts have yielded almost 20 million fewer users than was hoped.
Haiti and Bolivia are two of the countries with reported Zika cases that are also focus countries for FP2020. Many countries in Latin America have done well providing family planning services to women of reproductive age, but these two countries fall far short of the 75 percent goal for meeting women’s family planning demand, at 47.5 percent and 50 percent respectively. Moreover, both of these countries are poor performers on measures of unmet need.
Global research suggests that meeting 90 percent of women’s unmet need for contraception could prevent 22 percent of maternal deaths, 22 percent of stillbirths, and 8 percent of child deaths around the world.3 In Bolivia, where two thirds of the country is covered by the Amazon rainforest that is host to the Aedes mosquito species, almost 20 percent of women had unmet need for family planning in 2015. Sustained attention to countries like Bolivia and Haiti are critical.
But sustained attention can only come with more commitment from country governments and the donor community. FP2020 is focused on country-level goals and challenges and has developed new tools that galvanize the data for better-honed strategies. Family planning advocates must secure the promises made by the world’s biggest donors, particularly now when that promise is threatened.