Implementing family planning programs in developing countries: lessons and reflections from four decades of Population Council experience.

Over the last three decades, contraceptive prevalence has risen from about 10% to nearly 60% in developing countries, but still about 1 in 4 births in developing countries (outside China) is unwanted. More than 120 million women in these countries who do not want to become pregnant do not use contraceptives. Nearly 600,000 women die each year from pregnancy-related causes, between 67,000 and 204,000 of them from unsafe abortions. At the 1994 International Conference on Population and Development in Cairo, delegates endorsed the view long advocated by the Population Council: the primary purpose of family planning programs should be to help women avoid unwanted pregnancy and achieve their fertility goals safely. That means, at the very least, that programs should address those reproductive health issues that are directly related to fertility regulation. To meet the Cairo challenge, progress is needed simultaneously on several levels. We need more and better contraceptive technologies that meet the needs of different groups; higher-quality family planning services; more outreach to underserved groups (such as men and adolescents); programs tailored to local cultures; and measures to address all the factors that prevent women who do not want to become pregnant from using contraceptives. The call for a client-centered, reproductive health approach to family planning constitutes a critique of programs driven by demographic goals. The new family planning paradigm puts a premium on 'quality of care'. Unfortunately, many family planning programs still fall substantially short of offering clients reproductive choice and supporting their reproductive health. The Population Council takes the view that contraceptive research and development is an essential component of a multilevel strategy to reduce unwanted fertility safely. New products, used ethically and provided with quality, would be of tremendous benefit to women and men throughout the world. The Population Council has developed, registered, and licensed seven products, including some of the most widely used contraceptives in the world. The Council is also one of the world centers for research on male reproductive physiology and male contraception. New contraceptive methods are only as good as the context in which they are offered. To accelerate the pace of overall fertility decline, governments must adopt policies that reduce the economic and social risks associated with having smaller families, and policies that promote later and planned childbearing.