Contraception: best for women, babies and the planet

Why is philanthropist Melinda Gates dedicating the rest of her life to improving women’s access to contraception? DFID UK Department for International Development

Melinda Gates’ vow to put the availability of contraception back on the global health agenda – even if it means going against the Pope – has provided a welcome voice for logic and compassion.

Speaking to The Guardian during last week’s London Summit on Family Planning, Gates explained: “In my country where it’s considered highly controversial… 82% of Catholics believe contraception is morally acceptable. So: let the women in Africa decide. The choice is up to them.”

The summit was co-hosted by the British Government and the Bill and Melinda Gates Foundation, with strong support from Prime Minister David Cameron. It represents a historic global breakthrough, since discussion of contraception – and the role it can play in maintaining the sustainability of our planet – has been largely overridden by views of minorities and political correctness.

This is in spite of World Health Organization figures showing that by 2020, 1.2 billion people, or 16% of the world’s population, will be entering their child bearing years, with the developing world accounting for 90% of this figure. Important discussion articles from this meeting were published in The Economist, in a series in The Lancet, and in a report from the Guttmacher Institute, a New York think tank.

Conference speakers pointed out that in 2012 alone, full access to family planning could prevent 200 million unintended pregnancies, 50 million abortions, 25 million miscarriages and 100,000 maternal deaths. This is in addition to the millions of children who, if they survive their first year of life, face a future of poverty and ill health. There is a strong unmet need for voluntary family planning, with 40% of pregnancies in the developing world unplanned and approximately 215 million women unable to access much wanted family planning support.

The outcomes from the summit go a long way towards Melinda Gates’ aims. Developing and developed countries contributed US$4.6bn to support family planning initiatives over the next eight years. This transformational funding will reverse years of neglect; with initiatives including the provision of contraception (along with education about contraceptive options) to 84 million women annually across 42 countries. Overall, women in 69 of the poorest countries with low rates of contraception will have their lives revolutionised.

As Melinda Gates has enunciated so strongly, contraception is the key to so much, even beyond saving lives of women and children. As well as reducing the number of unsafe abortions and the high mortality at childbirth, it results in healthier mothers and children and increased investment in each child.

Melinda Gates meets with mothers in India. Gates Foundation

Thanks to the recent global vaccination programs supported by the Gates Foundation, children now have a greater chance of survival, providing good reason for the social ambition to focus on the health of children, rather than number of children. Fewer mouths to feed means increased input into the health and education of children. It’s also clear that voluntary family planning results in more peaceful and more prosperous communities.

Freedom from the likelihood of pregnancy is also essential to the liberation of women and to ensuring they can access educational and employment opportunities. Indeed, the surge in the contribution of women to western societies during the past 50 years has been largely attributable to the availability and uptake of the contraceptive pill. Women are half of our human resource and yet many in the developing world are disabled by repetitive pregnancies and lack of appropriate care. Thus fewer pregnancies mean a healthier mother who is more likely to survive to see her children reach adulthood.

Ready access to contraception will also increase the overall health of communities living close to the poverty line. There is now an entire discipline, The Developmental Origins of Health and Disease (DOHaD) based on the knowledge that the nutritional status of the mother, before conception and throughout pregnancy, has a significant impact on the long-term health of the child. Not only does near starvation during pregnancy increase prematurity and low infant birth weight, but those infants will grow to be adults with increased propensity for serious disorders including diabetes, hypertension and obesity.

Apart from improving the health of women and children, population growth damages the environment, particularly with human beings competing with most other species for space and resources. While population size is now either stable or reducing (excluding growth by migration) in most developed countries, in many places land degradation is reducing the capacity to grow food, and the availability of clean water is a continuing major issue.

Freedom from pregnancy is essential in ensuring women and girls can access education. ILRI

Previous contraception campaigns have courted controversy. Most notably, India’s sterilisation campaign in the 1970s raised issues of coercion and discrimination. Concerns have been highlighted in the media and social media that the new initiative will follow these lines, since success will be measured quantitatively. However, lessons have been learnt and the statements from London affirm that the outreach will be non-coercive and non-discriminatory.

The Gates Foundation is also funding the development of new contraceptive options, with a particular focus on contraception provided by a six-monthly or annual injection and the development of dual action contraception that may assist in reducing sexually transmitted disease. In an environment where research on contraception has been poorly sustained, this support is most welcome.

It’s easy to see why Melinda Gates has pledged to dedicate the rest of her life to this issue: contraception saves lives and remains central to the rights of women to access education and jobs. As Gates says, “There are 200 million women who want to have access to contraception, and if we’re not serving them, that’s not right.”