Population Matters-USA – Page 4 – working for a sustainable world

Last month I wrote about the coalition of rich and poor countries, of foundations and nonprofits that delivered family planning to 46 million women—FP2020. Its successor, FP2030, has continued the same work, but with some changes.

One of the involved nonprofits, the Margaret Pyke Trust (MPT), has introduced a new direction for FP2030. It has connected the growth of the human population with the decrease in biodiversity, and is doing something about it.

Population, Health and Environment (PHE) programs are not new. The recent book “Walking with Gorillas” was written by the first wildlife veterinarian in Uganda, Dr. Gladys Kalema-Zikusoka. The growing human population threatens wildlife in at least two ways. People take over the habitat of the animals, and some human diseases, such as scabies, were passed to animals. Of course, wildlife also threaten people! As humans push into areas where the animals had lived, the animals sometimes attack humans or destroy their gardens. They also have introduced diseases to humans, such as Ebola. Kalema-Zikusoka was so concerned about conflict between wildlife and humans that she started a PHE program which provides basic healthcare, contraception and environmental education, to the farmers.

Several years ago, I wrote about a PHE program on the bank of the Amazon River. It had a small health clinic with educational programs. Their family planning program was unique. There are no roads in the area—all transportation is by boat. Because the clinic worked on a shoestring budget, a long-acting contraceptive method would be advantageous. Villagers couldn’t afford a trip to the clinic except for an emergency. The solution was to have a boat go up and down the river 4 times a year. A health worker gave DepoProvera shots (which last 3 months) to women who wanted birth control.

The Margaret Pyke Trust is a British organization that specializes in education about reproductive health and contraception. Their new campaign, “Thriving Together”, started recently and already has over 150 organizations supporting it. Its goal is to build a movement recognizing “…that family planning is critically important not only women and girls, but also for the environment.” Furthermore, the head of MPT wrote: “…the existence of barriers to family planning is the most important ignored environmental challenge of our day.”

I cannot agree more! I remember when two of the top environmental nonprofits in the USA (National Audubon Society and the Sierra Club) recognized the effect of overpopulation on the environment and had active population groups. Now, the Center for Biological Diversity is the only major organization with that recognition; there are 6 people on its Population and Sustainability Team.

Although MPT will not provide clinical services as a part of FP2030, they will probably have a greater impact than if they did. Instead, they will be working with national governments to develop policies. Specifically, they plan to work with all the countries that have signed the UN Convention on Biological Diversity, which requires each state to have a biodiversity plan. MPT will offer their expertise with a new document “Reproductive choice in national biodiversity policy”.

One of the goals of this MPT program is to increase reproductive choice knowledge for several thousand people working in the fields of biodiversity and climate. They have made this possible by joining a number of international organizations, including the United Nations Framework Convention on Climate Change. They are the first and only group in these organizations with reproductive health expertise.

To me, one of the best parts of the MPT is that they talk about “removing barriers to family planning”; they are careful to not pressure people into using contraception. Moreover, they are working to slow the extinction crisis.

©Richard Grossman, MD

What if every woman in the world had access to her choice of safe, effective contraception? So far, this is a dream, but two programs are helping this dream come true.

In the past, only members of the rich elite had access to family planning (at least among English-speakers). Francis Place in England (1823) and Margaret Sanger in the USA (1916) brought Family planning to disadvantaged people. Sanger is accused of having racist or classist motivation, but Place, a revolutionary thinker, was a commoner. He learned how the rich controlled their fertility and spread that knowledge through a series of pamphlets. Both of these pioneers realized that limiting a couple’s fertility would be likely to improve their well-being.

The London Summit on Family Planning in 2012 was organized to continue Place’s work, on an international scale. People gathered in London from 120 countries and included doctors, social scientists and financial donors who came up with an international program, Family Planning 2020 (FP2020). In those few years between 2012 and 2020 they hoped to provide 120 million women (and men) with contraceptive information and supplies.

One of UN2020’s initial concerns was that it not coerce people to use contraception, as happened in China and India. Social scientists drew up rules to try to avoid any semblance of coercion—all motivation had to be strictly voluntary. Thus, there would be no undue incentives nor any quotas. These steps would help ensure that all adaptors of contraception did so without pressure. In the organization’s own words, it “…is a global movement that supports the rights of women and girls to decide—freely and for themselves—whether, when, and how many children they want to have.” It is amazing that FP2020 functioned in some very patriarchal societies in Asia and Africa.

The governments of more than 30 of the world’s richer countries pledged money to support FP2020. Major funding included the US Agency for International Development, the Gates Foundation and the United Nations Population Fund. Although FP2020 worked in some of the least wealthy countries in the world, each of the 69 countries where they provided care also had to provide some funding.

The Covid 19 pandemic started just as FP2020 was ending. Despite the risk of spreading the virus, the program found ways to deliver high quality reproductive health care. The program was able to continue its outreach using strict precautions.

How successful was FP2020? The program fell short of its ambitions goal. The final tally is that it increased the number of modern contraception users by 46 million. Nevertheless, this is a pretty amazing feat! An impressive way of measuring the program’s success is that it doubled the number of users in 13 African countries. The use of modern contraception in these poor countries is estimated to have prevented millions of unsafe abortions and over a hundred thousand maternal deaths. What intervention could be more humane?

Because populations were growing rapidly where FP2020 worked, the need for family planning increased faster than FP2020 could reach potential users. It is estimated that the number of women of reproductive age grew by 15 million each year! That is the challenge for the program that succeeded FP2020, unsurprisingly labeled “FP2030”. The successor has more local direction and less management from donor countries, and has expanded to 82 countries. Funding is its biggest problem, unfortunately, especially since some funders have reneged on promised donations. FP2030 is directing its focus on adolescent pregnancy. If a woman is empowered by modern family planning when she is young, it is likely that she’ll be a lifelong user.

There is a success story here. The teen pregnancy rate is already dropping globally, thanks to programs such as FP2020 and FP2030.