Family planning
Family planning is the consideration of the number of children a person wishes to have, including the choice to have no children, and the age at which they wish to have them. Things that may play a role on family planning decisions include marital situation, career or work considerations, financial situations. If sexually active, family planning may involve the use of contraception (birth control) and other techniques to control the timing of reproduction.
Other aspects of family planning aside from contraception include sex education,[1][2] prevention and management of sexually transmitted infections,[1] pre-conception counseling[1] and management, and infertility management.[3] Family planning, as defined by the United Nations and the World Health Organization, encompasses services leading up to conception. Abortion is not typically recommended as a primary method of family planning.[4]
Family planning is sometimes used as a synonym or euphemism for access to and the use of contraception. However, it often involves methods and practices in addition to contraception. Additionally, many might wish to use contraception but are not necessarily planning a family (e.g., unmarried adolescents, young married couples delaying childbearing while building a career). Family planning has become a catch-all phrase for much of the work undertaken in this realm. However, contemporary notions of family planning tend to place a woman and her childbearing decisions at the center of the discussion, as notions of women's empowerment and reproductive autonomy have gained traction in many parts of the world. It is usually applied to a female-male couple who wish to limit the number of children they have or control pregnancy timing (also known as spacing children).
Family planning has been shown to reduce teenage birth rates and birth rates for unmarried women.[5][6][7]
Providers[edit]
Direct government support[edit]
Direct government support for family planning includes providing family planning education and supplies through government-run facilities such as hospitals, clinics, health posts and health centers and through government fieldworkers.[35]
In 2013, 160 out of 197 governments provided direct support for family planning. Twenty countries only provided indirect support through private sector or NGOs. Seventeen governments did not support family planning. Direct government support has continued to increase in developing countries from 82% in 1996 to 93% in 2013, but is declining in developed countries from 58% in 1976 to 45% in 2013. Ninety-seven percent of Latin America and the Caribbean, 96% of Africa, and 94% of Oceania governments provided direct support for family planning. In Europe, only 45% of governments directly support family planning. Out of 172 countries with available data in 2012, 152 countries had implemented realistic measures to increase women's access to family planning methods from 2009 to 2014. This data included 95% of developing nations and 65% of developed nations.[35]
Private sector[edit]
The private sector includes nongovernmental and faith-based organizations that typically provide free or subsidized services to for-profit medical providers, pharmacies and drug shops. The private sector accounts for approximately two-fifths of contraceptive suppliers worldwide. Private organizations are able to provide sustainable markets for contraceptive services through social marketing, social franchising, and pharmacies.[36]
Social marketing employs marketing techniques to achieve behavioral change while making contraceptives available. By utilizing private providers, social marketing reduces geographic and socioeconomic disparities and reaches men and boys.[36]
Social franchising designs a brand for contraceptives in order to expand the market for contraceptives.[36]
Drug shops and pharmacies provide health care in rural areas and urban slums where there are few public clinics. They account for most of the private sector provided contraception in sub-Saharan Africa, especially for condoms, pills, injectables and emergency contraception. Pharmacy supply and low-cost emergency contraception in South Africa and many low-income countries increased access to contraception.[36]
Workplace policies and programs help expand access to family planning information. The Family Guidance Association of Ethiopia, which works with more than 150 enterprises to improve health services, analyzed health outcomes in one factory over 10 years and found reductions in unintended pregnancies and STIs as well as sick leave. Contraception use rose from 11% to 90% between 1997 and 2000. In 2016, the Bangladesh Garment Manufacturers Export Association partnered with family planning organizations to provide training and free contraceptives to factory clinics, creating the potential to reach thousands of factory employees.[36]
Non-governmental organizations[edit]
Non-governmental organizations (NGOs) may meet the needs of local poor by encouraging self-help and participation, understanding social and cultural subtleties, and working around red tape when governments do not adequately meet the needs of their constituents. A successful NGO can uphold family planning services even when a national program is threatened by political forces. NGOs can contribute to informing government policy, developing programs, or carry out programs that the government will not or can not implement.[37]
Family planning programs are now considered a key part of a comprehensive development strategy. The United Nations Millennium Development Goals (now superseded by the Sustainable Development Goals) reflects this international consensus. The 2012 London Summit on Family Planning, hosted by the UK government and the Bill and Melinda Gates Foundation, affirmed political commitments and increased funds for the project, strengthening the role of family planning in global development.[38] Family Planning 2020 (FP2020) is the result of the 2012 London Summit on Family Planning where more than 20 governments made commitments to address the policy, financing, delivery, and socio-cultural barriers to women accessing contraception formation and services. FP2020 is a global movement that supports the rights of women to decide for themselves whether, when and how many children they want to have.[39] The commitments of the program are specific to each country, as compared to the generalized main goals of the 1995 conference program of action. FP2020 is hosted by the United Nations Foundation and operates in support of the UN Secretary-General's Global Strategy for Women's, Children's and Adolescent's Health.
The world's largest international source of funding for population and reproductive health programs is the United Nations Population Fund (UNFPA). In 1994, the International Conference on Population and Development set the main goals of its Program of Action as:
The World Health Organization (WHO) and World Bank estimate that $3 per person per year would provide basic family planning, maternal and neonatal health care to women in developing countries. This would include contraception, prenatal, delivery, and post-natal care in addition to postpartum family planning and the promotion of condoms to prevent sexually transmitted infections.[40]
Injustices and coercive interference with family planning[edit]
Inequities in family planning within the United States[edit]
Historically, the capacity to control one's reproductive abilities has been unequally distributed across society. Long-acting reversible contraception (LARCs), including intrauterine devices and progestin implants, and permanent sterilization have been implemented to limit reproduction in communities of color, the lower socioeconomic class, and among individuals with intellectual disabilities.[41] Multiple studies have reported disproportionate recommendations of LARCs to individuals from marginalized communities compared to white, high-income individuals.[42] With the eugenics movement of the 20th century, 60,000 people were sterilized in 32 states across the US with state-sanctioned sterilizations peaking in 1930-40's.[43] More recently, unwanted sterilizations have been performed on over a thousand women in California prisons between 1997 and 2010.[44] Protocols have been established to protect against unwanted permanent contraception through Medicaid Laws, but there has not been a widespread declaration by the Supreme Court ruling forced sterilization unconstitutional.[45]
World Contraception Day[edit]
September 26 is designated as World Contraception Day, devoted to raising awareness of contraception and improving education about sexual and reproductive health, with a vision of "a world where every pregnancy is wanted".[132] It is supported by a group of international NGOs, including:
Asian Pacific Council on Contraception, Centro Latinamericano Salud y Mujer, European Society of Contraception and Reproductive Health, German Foundation for World Population, International Federation of Pediatric and Adolescent Gynecology, International Planned Parenthood Federation, Marie Stopes International, Population Services International, The Population Council, The USAID, Women Deliver.[132]
Abortion[edit]
The United Nations Population Fund explicitly states it "never promotes abortion as a form of family planning".[4] The World Health Organization states that "Family planning/contraception reduces the need for abortion, especially unsafe abortion."[16]
The campaign to conflate contraception and abortion is rooted on the assertion that contraception ends, rather than prevents, pregnancy. This is due to the notion that preventing implantation implies an abortion, when considering fertilization as the initial moment of pregnancy. According to an amicus brief submitted to the U.S. Supreme Court in October 2013 led by Physicians for Reproductive Health and the American College of Obstetricians and Gynecologists, a contraceptive method prevents pregnancy by interfering with fertilization, or implantation. Abortion, separate from contraceptives, ends an established pregnancy.[133]