Organizations raise (false) alarm over “global contraceptive crisis”

By Rebecca Oas, Ph.D. | September 26, 2016

Today, the United Nations Population Fund (UNFPA) released an article calling attention to the “global contraceptive crisis” and calling for signatures on a petition asking the UN Secretary-General to “highlight the centrality of contraceptives to achieving the sustainable development goals.”

Of course, you would expect every service-providing agency and NGO to want world leaders to praise the “centrality” of their particular offerings. But there’s nothing like a looming crisis to make it seem even more important.

For months now, family planning groups have been ringing alarm bells about their funding deficits. Back in July, the Guardian ran an article warning that the FP2020 initiative was not on track to meet its targets unless donors ramped up the funding.

There are a few things that need to be mentioned here: first, in a video made for World Contraception Day (today!) and published on WHO’s website, the Population Council’s Professor John Townsend said, quite correctly, “awareness of contraception is now nearly universal.” Second, the concept of the “unmet need” for family planning is a very poor proxy for a measurement of actual demand for products or services.

So, back to the “crisis.” The first thing that should jump out at you is that these hand-wringing articles and petitions seem unduly focused on the threat to reaching new customers with contraceptives, but not terribly fussed about the prospect of being unable to provide their services to existing users.

To illustrate this point the Guardian article focuses on FP2020, whose goal is to “increase access to modern contraception for 120 million more women and girls in 69 target countries,” and where their measure of access is use, and their measure of presumptive demand is “unmet need.”

Similarly, the UNFPA’s news story today included this:

The funding shortfall could mean UNFPA Supplies is unable to provide the contraceptives and support required to prevent an estimated 80 million unintended pregnancies, 31 million abortions, 225,000 maternal deaths and 1.3 million newborn deaths.”

That looks very similar to something else UNFPA said in its recent “report on contributions by Member States and others to UNFPA and revenue projections for 2016 and future years”:

The funding shortfall could mean that UNFPA Supplies will be unable to meet the growing demand for voluntary family planning contraceptives, and that by 2020, there may be an additional 80 million unintended pregnancies, 31 million unsafe abortions, 225,000 maternal deaths and 1.3 million newborn deaths.”

For illustrative purposes, I’ve put the critical deleted line in bold. What UNFPA clipped out is the part where it becomes clear that it’s not existing users that are on the line, but hypothetical future users.

But what about this “growing demand for voluntary family planning contraceptives?” Funnily enough, when UNFPA’s family planning work came under review during its recent executive board meeting, the resulting hundred-page evaluation report mentions “demand” approximately once every two pages, but three quarters of those instances involve phrases like “demand generation,” “demand promotion,” or “demand creation.”

If family planning groups are having difficulty meeting their targets, it’s a lot easier to insist they are the secret ingredient to achieving international development goals than it is to admit that they’ve pretty much saturated the market and can no longer reasonably justify the kind of funding they want.

Given Professor Townsend’s point about near-universal awareness of contraceptives: to paraphrase the old saying, you can make a horse aware of water, but you can’t make it demand a drink.