Economic Policy and the Provision of Family Planning in Developing Countries

Published date01 September 2018
Date01 September 2018
DOIhttp://doi.org/10.1002/wmh3.279
Economic Policy and the Provision of Family Planning
in Developing Countries
Kelsey B. Harris
Despite some progress, wide gaps remain in the provision of family planning and reproductive
health services in developing countries. As governments debate how to provide such services, this
commentary considers general economic motivation, what principles are being implemented in
practice, and why government policy may not align with what economic analysis suggests. Case
studies from three developing countries—Uganda, Haiti, and the Philippines—are presented in an
attempt to bridge gaps between economic analysis, current policy, and implementation, and examine
whether economic concepts are being considered in current policy responses. Following this
preliminary review, all three countries appear to value economic concepts that reinforce the
government’s role in provision of family planning, but that does not necessarily correlate to effective
policy implementation or access to services. More broadly, this consideration of economic policy and
the provision of family planning in three developing countries suggests that economic policy can
complement rights-based policy arguments.
KEY WORDS: family planning, economic policy, developing countries
Introduction
As a result of global commitment to provision of family planning (FP) services
over the past several decades, developing countries have generally experienced
declining rates of fertility, unintended pregnancies, maternal and infant deaths,
and HIV prevalence. However, there are still wide gaps in the provision of
reproductive health services in developed and developing countries, with the
burden resting mostly on individuals residing in the least developed and poorest
regions of the world. Additionally, in developing countries, although provision of
FP services has increased overall, the use of contraception has been relatively
unchanged over the past 10 years (Singh, Darroch, & Ashford, 2014). As govern-
ments, international organizations, and other partners consider whether and how
to provide FP services, it is helpful to ref‌lect upon the general economic
motivations for providing these services and how such concepts are being
implemented in practice.
World Medical & Health Policy, Vol. 10, No. 3, 2018
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doi: 10.1002/wmh3.279
#2018 Policy Studies Organization
A discussion of provision of family planning and reproductive health (FP/
RH) is especially relevant today as, after a 10- to 15-year decline in support and
funding, the past several years have brought a renewed international political
focus in this arena. Bongaarts and Sinding (2011) explain that support waned in
the 1990s for many reasons, including resources being directed toward the HIV/
AIDS epidemic, the belief that the “population crisis” of the 1960s had come to an
end due to global decreases in fertility, and opposition from conservative
governments and international organizations. Yet, Bongaarts and Sinding (2011)
go on to explain that, over the last decade, the balance has shifted back toward
support of FP programs as the population has continued to grow exponentially in
poorer parts of the world and linkages are made between high birth rates and
large numbers of unintended pregnancies resulting in maternal and infant deaths,
scarcity of natural resources, and economic tensions and political instability in
heavily populated regions (Bongaarts & Sinding, 2011). Recent increases in
support can be partly attributed to the United Nations’ (UN’s) establishment of
improved maternal health and universal access to reproductive health as a
Millennium Development Goal (MDG) in 2005 and the inclusion of targets related
to FP/RH in the UN’s Sustainable Development Goals (SDGs) set forth in 2015.
This political revival o n FP has been more pronounce d in regions that have
a high fertility rate, such as sub-Saharan Africa (SSA). May (2017) provides a
political overview of FP pol icies in SSA and notes that, in the past, African
policymakers have been h esitant to embrace FP due t o traditional cultures an d
norms, concerns about aging po pulations, and skepticism surrounding Wester n
motivations for encourag ing reduced fertility. However, recently, there ha s
been greater acceptance in SSA of the pot ential health benef‌its tha t can be
gained from FP programs and the linkages betwe en lowered fertility ra tes and
socioeconomic growth ( May, 2017). In addition, in their evaluation o f the
evolution of FP in Latin Ame rica and the Caribbean, W ard, Santiso-G
alvez, and
Bertrand (2015b) point o ut that, due to the increase d availability of information,
the policy dialogue surrounding FP provision has become more evidence-b ased
and data-driven, which has resulted in more public debate about such issues
(Ward et al., 2015b). May (20 17) also notes that in the 2000 s, non-governmental
organization and donor priorities were able to shift to focus more on FP after
the threat of the HIV/AID S crisis receded, and new in ternational populatio n
development paradigms b egan to emerge. This was demo nstrated by the 2012
London Summit on Family Planning and subsequent launch of the Family
Planning 2020 (FP2020) Init iative, a global partnership focusing on closing the
gaps between the use of and need for contr aceptives in the 69 poorest
developing countries.
While the economic case for FP weakened in the 1980s, Bongaarts, Cleland,
Townsend, Bertrand, and Gupta (2012) note that new evidence has recently
surfaced that shows the positive economic impact of decreased fertility and
increased female workforce participation (Bongaarts et al., 2012). However,
Shiffman and Quissell (2012) offer the caveat that, despite this increase in funding
and support after the turn of the century, FP has both supporters and opponents,
302 World Medical & Health Policy, 10:3

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