There can be No Universal Health Coverage without Family Planning

Sumita Banerjee, Managing Director, FP2030 Asia & Pacific Hub and Rajat Khosla, Director United Nations University-International Institute for Global Health (UNU-IIGH)

The Asia Pacific region, home to 60% of the world’s population, has made remarkable progress over the last two decades. Many countries in the region have made significant strides across several health indicators such as maternal and child mortality, and infectious diseases, among others while also witnessing an economic boom. The region is also experiencing substantial shifts in its population dynamics with declining fertility in many countries, an aging population in some and a youth bulge in others.  

Yet this progress has not been equally realized, neither across countries as well as within them. The challenges of gender inequality, early marriage, and unequal and inequitable access to services especially among marginalized communities such as migrants, refugees, ethnic minorities, and adolescents continue to plague the region. More than one-third of the population in Asia and the Pacific is not effectively protected by a health-care scheme. This means that around 1.6 billion people are being left behind (ILO).  

Within these realities, countries continue to work towards attaining universal health coverage (UHC). UHC ensures that all people – no matter who they are or where they live – can receive quality health services, when and where they are needed, without incurring financial hardship. The Asia Pacific Region and the world is however unfortunately off track to make significant progress towards UHC by 2030 as improvements to health services coverage have stagnated. Important gains in service coverage since 2000 have stalled in recent years, threatening further progress toward UHC. While substantial gains in service coverage were observed globally over the past two decades, progress has stalled in recent years. Inequalities in service coverage persist within and between countries. 

The Imperative of Family Planning 

Many countries in the region are navigating their roadmaps towards achieving universal health coverage. This momentum provides a unique opportunity to integrate family planning within UHC as without meeting the sexual and reproductive needs of individuals UHC will remain a pipe dream.  

Over the last 20 years, the Asia and the Pacific region has seen impressive improvements in sexual and reproductive health, yet there are some stark realities related to family planning in this vast region with 140 million women of reproductive age still lacking access to a modern method of family planning (UNFPA). Disaggregated data shows deep seated inequalities in access to modern contraceptive methods across countries in Asia Pacific. Despite the transitions in fertility rates there lies a pressing urgency to provide information and access to contraception grounded in rights and choice and highlighting the essential role that family planning plays in empowering individuals, nurturing healthier families, and facilitating the social and economic well-being of communities. 

Embedding Family Planning into UHC 

Integrating family planning within the framework of UHC provides several opportunities for countries to address issues that they may be grappling with including but not limited to - 

Reduction in maternal and child mortality: Integrating family planning into UHC has the advantage of providing women of reproductive age with a range of contraceptive methods, counselling, and reproductive health services that are easily accessible. It allows women to decide on the timing, number, and spacing of their children, prevent unwanted pregnancies and unsafe abortions contributing to lowering of maternal and child mortality. Furthermore, there are economic benefits for investing in family planning. For every dollar invested in reproductive health services, $2.20 is saved in pregnancy-related health-care costs (Guttmacher Institute).  

Gender Equality: The fundamental role that contraception plays in empowering individuals to take control over their reproductive health, advancing bodily autonomy, and enabling decision making grounded in rights and choice cannot be underplayed. It also enables women to pursue their education, and careers and contribute as equal participants in the economy. Family planning is often classified as a best buy, with estimates from the studies in the region pointing to a 2:1 return on investment. (Galen Institute, Malaysia)  

Strengthening health systems: Integrating family planning into UHC provides an unparalleled opportunity to build robust and resilient health systems by addressing the current gaps in health systems that pose a barrier to scaling up and expanding the coverage of family planning services including human resources, financing options, data gaps, among others. Further, there are possibilities to create greater efficiency by leveraging existing infrastructure to expand services through capacity building programs, streamlining supply chains, and harnessing digital technology.  

The way forward 

Integration of family planning into UHC will require a multisectoral approach; first and foremost, it will require strong political commitment and leadership with policies that are grounded in human rights and are equitable and inclusive. It will also require adequate health financing across all levels national, provincial, and local, recognizing that the benefits of investing in family planning contribute to not just economic gains but also extend to social and human development. Further, engaging communities, and especially young people will go a long way in addressing norms and ensuring initiatives are impactful. 

In celebrating the Universal Health Coverage Day, we call upon all countries to work with other stakeholders and redouble their efforts, especially considering the General Assembly Resolution A/RES/74/2, of 2019. This contains the Political Declaration of the high-level meeting on universal health coverage in which countries have committed to achieving universal health coverage by 2030 for scaling up the global effort to build a healthier world for everyone. 

About the authors: 

Sumita Banerjee is Managing Director Asia-Pacific Regional Hub FP2030 & Rajat Khosla is Director United Nations University-International Institute for GlobalHealth (UNU-IIGH) 

About FP2030: FP2030 is the largest global community of practice focusing on family planning that brings together a wide range of partners by placing voluntary and rights-based family planning at the intersection of global health, development, and gender equality. It operates through five regional hubs that work closely with national governments and other stakeholders to facilitate FP2030 commitment making and its operationalization. 

About UNU-IIGH: The United Nations University-International Institute for Global Health (UNU-IIGH) is the designated UN think tank specializing in global health. With a mandate to facilitate the translation of research evidence into policies and tangible actions, UNU-IIGH serves as a hub connecting UN member states, academia, agencies, and programs.