Parents have a basic human right to determine freely and responsibly the number and spacing of their children. As outlined in the Tehran Proclamation of 1968, and as the theme of this year’s World Population Day emphasizes, family planning is a human right, and one central to the rights-based framework that protects and promotes the health and wellbeing of all people everywhere. Since the Tehran proclamation, and particularly during the Millennium Development Goal (MDG) and now Sustainable Development Goal (SDG) eras, countries across the WHO South-East Asia Region have affirmed the right to family planning in both letter and spirit.
Access to contraceptives, for example, has increased significantly. In 2015 74% of women of reproductive age who were married or in-union had their family planning needs met with the use of a modern contraceptive method. Between 1990 and 2015 the Region’s contraceptive prevalence rate meanwhile increased from 37% to 60%. Crucially, by allowing women and their partners to better determine the number and spacing of their children, maternal and newborn mortality has declined substantially. During the MDG era, for instance, maternal mortality across the Region was reduced from 525 per 100 000 live births to 164 – a decrease of 69% compared to a global decline of 44%. The Region meanwhile slashed newborn mortality by 54% as compared to 47% globally.
Nevertheless, there is progress to be made and opportunities to seize. As evidence-based modelling shows, meeting the right of every adolescent and woman to access modern contraception and of pregnant women and their newborns to access essential care would result in dramatic progress across the developing world, including in the South-East Asia Region. Based on 2017 data, unintended pregnancies would drop by an estimated 67 million (a 75% decline). Unplanned births would be reduced by 23 million (a 76% decline). Induced abortions would decrease by 36 million (a 74% decline). Newborn deaths would meanwhile shrink by 2.2 million (an 80% decline). And there would be 224 000 fewer maternal deaths (a 73% decline).
WHO South-East Asia is committed to championing the right to quality family planning services, achieving these outcomes and supporting Member States fully implement WHO’s recently updated technical guidelines for improving family planning services. To this end, a number of key interventions will accelerate Region-wide progress and increase access to safe, good quality family planning services.
First, access to adolescent sexual and reproductive health services should be increased to ensure young women and girls have greater power over their sexual and reproductive lives. Doing so means enhancing the services facilities offer, including a wider range of modern contraceptive methods. It also means ensuring health workers – especially at the primary level – are able to convey accurate information in a way that creates Adolescent Friendly Health Services, a longstanding WHO commitment. As part of this, adolescents should be able to access these services without parental or guardian authorization or notification, and without facing prohibitive financial barriers.
Second, women of all ages should have access to a continuum of family planning care. That includes access to high-quality contraceptive services, including a range of methods; the active prevention of stock-outs of supplies; the provision of adequate counseling and follow-up; and the facilitation of women’s switching of contraceptive methods if desired. Investing in the development of new, highly effective and easy-to-use methods should also be a priority. Notably, the contraceptive needs of single, sexually active women are more likely to be unmet than those of in-union women, largely due to the fear of stigma. It is therefore imperative that family planning services are provided free of judgement or prejudice, and that health workers are sensitized accordingly.
And third, the Region-wide practice of early marriage should be ended. Every year an estimated 6 million adolescents aged 15-19 years across the Region give birth, while in four of the Region’s countries birth rates within that age bracket remain a troubling 5%. Apart from the significant health risks teenage pregnancy and childbirth pose, the fact that nearly half of these pregnancies are unintended indicates a lack of agency when it comes to making the life-changing choice of becoming pregnant. That should be of immense concern to us all, and a catalyst for Region-wide social and legal change, including the implementation of legislation that bars early marriage.
Among other measures highlighted in WHO’s updated technical guidelines for improving family planning services, each one of these interventions will help ensure the right of all parents across the Region to determine freely and responsibly the number and spacing of their children, and to do so via family planning services that are readily accessible and of good quality. Until that right is enjoyed by all, WHO South-East Asia will continue to prioritize and promote family planning services, as well as the sexual and reproductive health of all women, adolescents and girls Region-wide. Need it be said: Their right is our obligation.