Family Planning: Our Position

What is family planning?

Family Planning refers to the process by which individuals or couples are able to determine freely the number, timing and spacing of their children and to select the means by which this may be achieved.

Family planning is a component of reproductive health which is defined as:

…a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity, in all matters relating to the reproductive system and to its functions and processes. Reproductive health therefore implies that people are able to have a satisfying and safe sex life and that they have the capability to reproduce and the freedom to decide if, when and how often to do so. Implicit in this last condition are the right of men and women to be informed and to have access to safe, effective, affordable and acceptable methods of family planning of their choice, as well as other methods of their choice for regulation of fertility… (Programme of Action, International Conference on Population and Development, 1994, paragraph 7.2)

Family planning services typically provide counselling on managing fertility, delaying pregnancy and birth spacing; provide and distribute contraception; develop and distribute information, education and communication materials related to family planning; treat involuntary fertility; and provide family planning services in relation to HIV/AIDS.

Context, challenges and impact on children

History and current situation

During the last several decades, great progress has been made in providing safer and more effective contraception as well as affordable and accessible family planning services. As a result, more individuals and couples are now choosing to have fewer children than previous generations, with the average number of children born per woman declining in every major region of the world since the 1990s. Globally, 56 per cent of women who are married or in union use a modern method of contraception compared to 47 per cent in 1990.

Although the use of modern contraceptive methods has increased, there still remains a high unmet demand for family planning services in many countries. According to the United Nations Population Fund (UNFPA), there are more than 200 million women in the world (approximately one in six women of reproductive age) who want to delay or stop having children but who are not using a modern method of contraception. This huge unmet need for contraception results in substantial numbers of unplanned, mistimed and/or unwanted pregnancies.

The need for family planning is greatest among women in developing countries. Approximately 76 million women in developing countries experience unintended pregnancies each year, with women in Sub-Saharan Africa and South-Central Asia representing those in greatest need.

Reasons for a lack of family planning

The reasons for not using contraception or family planning services are numerous and varied. High quality family planning services and appropriate contraception may be unavailable, inaccessible or unaffordable for many people, especially in developing countries. Many developing countries face a critical shortage of contraception due to increased demand as a result of population growth, a growing desire for smaller families and fear of the spread of HIV, combined with a lack of funding and/or manufacturing capability for contraceptive supplies.

Where family planning services are available, some people may be deterred from utilizing such services for fear of humiliation or unpleasant questions and procedures. In some cases, choices for contraception may be limited due to cost or other reasons, and individuals may distrust or dislike the only methods that are available. There may also be health concerns regarding the possible side-effects of certain contraceptive methods. In many cases, individuals simply lack knowledge and access to information regarding modern contraception including what types of contraception are available, how to obtain them and how to use them effectively.

Social, cultural and gender-related norms can also play significant roles in preventing individuals from participating in family planning. At the community level, individuals may fear social disapproval for accessing family planning services or lack support from extended family or the wider community. In some cases, contraception may be seen as contributing to female promiscuity. At the individual level, women may lack support from their partner or fear disapproval or retribution for seeking contraception. Married women may require their husband’s permission to access family planning services while both male and female adolescents may require parental consent to obtain contraception. In many cases, teenagers and single women may be barred from accessing any family planning services. Similarly, men may be excluded from family planning programs which traditionally focus only on women.

Consequences of a lack of family planning

Regardless of the reasons, the consequences of a lack of family planning are severe. Every year, more than 500,000 women die of causes related to pregnancy and childbirth, with 90 per cent occurring in Africa and Asia. Having a child remains among the most serious health risks for women and each pregnancy multiplies a woman’s chance of dying or suffering severe disability, especially if the pregnancy is less than two years after giving birth.

While a woman’s ability to space and limit her pregnancies directly impacts her health and well-being, it also impacts the survival of her children. When a woman becomes pregnant less than six months after a previous birth, her baby is 2.5 times more likely to die in the first month of life than a child conceived three years after the previous birth.

In many cases, a lack of family planning leads to unwanted pregnancies which end in abortion. Of the 76 million women in developing countries who experience unintended pregnancies each year, 19 million resort to unsafe abortions. Globally, 13 per cent of maternal deaths annually (68,000 deaths) are attributed to unsafe abortion combined with a lack of skilled follow-up. In Sub-Saharan Africa, however, unsafe abortions account for up to 30 - 40 per cent of all maternal deaths.

A lack of access to family planning and its consequences are felt most acutely among women living in developing countries, especially the poor, people with less education, people living in remote or rural areas and urban slums, Indigenous people, people with disabilities and people living with HIV.

Young unmarried women represent a particularly vulnerable group with poor or no access to contraception and family planning, resulting in disproportionately high numbers of unwanted pregnancies. Such pregnancies carry greater health risks for both mothers and their unborn children. The number of women worldwide facing unintended pregnancies has steadily grown since the mid-1990s and is expected to increase dramatically as the largest cohort of adolescents in history enters their reproductive years. Without proper access to family planning, these adolescents will enter adulthood with inadequate information and few skills to protect themselves from unintended pregnancies as well as from sexually transmitted infections such as HIV.

Benefits of family planning

There are multiple health, social and economic benefits of family planning. First and foremost, family planning can reduce maternal and child deaths and long-term disability related to pregnancy. Family planning reduces mortality by: decreasing the total number of pregnancies, each of which places a woman’s life at risk; preventing unwanted pregnancies that are more likely to end in unsafe abortion; and reducing the proportion of high-risk births due to a mother’s age, number of previous births or birth spacing, which in turn, contributes to increased survival of infants.

It has been estimated that one-fourth to one-third of maternal deaths related to pregnancy and childbirth (140,000 -150,000 deaths) and one-fifth to one-third of infant deaths could be avoided each year if all women had access to contraceptive services.

Family Planning also promotes gender equality and reduces poverty by allowing women to control their fertility, which allows them greater opportunities for education, training and employment - which in turn increase their financial security, ability to contribute to household income, family decision-making power, and status in the community. With fewer children, families are better able to provide for their existing children in terms of resources, better healthcare and increased opportunities for education.

Fewer children also promotes education by allowing girls who would otherwise drop out of school due to pregnancy to continue their education. Family planning contributes to economic growth and development not only through female productivity but also because healthy, well-educated children will contribute to a more viable workforce. Family planning can also help to slow the spread of HIV by preventing both the transmission of HIV and unwanted pregnancies among women living with HIV. Finally, family planning helps protect the environment by reducing population growth and the pressures it places on natural resources.

Global action

In September 1994, at the International Conference on Population and Development (ICPD), 179 governments from around the world adopted a 20 year program of action to address population and development issues, including those related to reproductive health. The reproductive health rights of individuals, including the right to determine the number, timing and spacing of children, were endorsed at the conference as fundamental human rights.

One of the goals set at the ICPD is to ensure universal access to reproductive health care, including family planning, by 2015. In order to achieve universal access, the ICPD calls on governments around the world to help couples and individuals meet their reproductive goals by preventing unwanted pregnancies and reducing high-risk pregnancies; making quality family planning services affordable, acceptable, accessible and convenient to all; improving the quality of family planning information, counselling and services; and increasing men’s participation in family planning.

More recently, achieving universal access to reproductive health by 2015 was added as a target of Millennium Goal Five which aims to improve maternal health.

Save the Children’s position on family planning

Save the Children supports the view that reproductive health, including the freedom to determine the number, timing and spacing of one’s children, is a fundamental human right to which everyone is entitled. All persons have the right to access family planning services and to choose freely from a wide range of family planning methods in order to achieve their desired number of children.

Save the Children is committed to the ICPD’s goal and the Millennium Development Goal Five target of “achieving universal access to family planning by 2015.” To this end, Save the Children advocates for and supports the provision of family services in countries around the world.

Save the Children also endorses and adheres to the Australian Agency for International Development (AusAID)’s “Family Planning and the Aid Program: Guiding Principles.”

Save the Children believes that women, men and young people should be able to freely determine the number, spacing and timing of their children and have access to the means to exercise their choice. Family planning services should be of high quality, comprehensive, voluntary, affordable, culturally-appropriate, non-discriminatory and accessible to all women, men and young people.

We believe that family planning services should:

Provide accurate and relevant information and education regarding family planning options including the use, health benefits and risks of particular contraceptive methods, safer sex information, and pregnancy options including safe abortion;
Provide confidential and responsive counselling, and follow-up advice, if desired;
Provide access to the widest possible range of safe, effective and affordable family planning methods and contraception;
Respect an individual’s purposes and preferences in selecting a family planning method;
Encourage individuals and communities to participate fully in family planning and to define the services that are appropriate to their needs; and
In the case of developing countries where we work, provide the same range of family planning services available to individuals in Australia, subject to national laws.

Save the Children does not promote abortion as a method of family planning but rather supports family planning as a means to prevent unwanted pregnancies which minimises the need for abortion. In the case of abortion, Save the Children believes that all women should have access to high-quality services including safe pre- and post-abortion medical services, counselling, education and family planning services which may help to avoid future abortions.

What is Save the Children doing?

In Laos, Save the Children’s Primary Health Care project has been providing family planning services, education and contraception through mobile health clinics to 395 remote villages since 1992, contributing to increased contraceptive use and decreased fertility in the region.

In Bangladesh, Save the Children provides sexual and reproductive health education to adolescents and women through its comprehensive life skills education program.

In the Pacific, Save the Children works with the Ministry of Health in Vanuatu to provide and support sexual and reproductive health services for young people within existing health clinics and to advocate for the sexual and reproductive health needs of adolescents. In the Solomon Islands, Save the Children provides sexual and reproductive health education (including family planning information) in the context of HIV/AIDS, to primary school-age children.

Resources and Further Reading

Australian Agency for International Development (AusAID), Family Planning and the AID Program: Guiding Principles, AusAID, Canberra, 2009, viewed 23 April 2010.

United Nations Population Fund (UNFPA), Improving Reproductive Health, UNFPA, New York, viewed 23 April 2010.

World Health Organisation (WHO), Sexual and Reproductive Health, Geneva, 2010, viewed 23 April.