by Bill Frist, MD and Jenny Eaton Dyer, PhDWhen it comes to the health of children and mothers worldwide, there are immense challenges yet many signs of hope.
Over 6.9 million children die every year in the developing world from preventable, treatable causes. While the loss of these children is a tragedy of epic proportions, the good news is that over the last six years, this number has been lowered by 35%. We know we can combat newborn mortality and enhance child survival. Simple, low-cost measures are being taken to ensure better health for these children around the world. Measures like oral rehydration therapy, bed nets to prevent malaria, and access to immunizations have accelerated the rate of reducing child mortality in developing nations.
With an increased focus on maternal, newborn, and child health over the past few years, the global community has seen real progress against daunting challenges. An underappreciated part of that story is healthy birth spacing and timing, or family planning, which has a profound effect on the survival and quality of life of both mothers and children. As Michael Gerson, former speechwriter for President George W. Bush and Washington Post columnist, puts it, “family planning is a pro-life cause.”
When we talk about voluntary family planning in the international context, what do we mean? The definition I use is enabling women and couples to determine the number of pregnancies and their timing, and equipping women to use voluntary methods for preventing pregnancy, not including abortion, that are harmonious with their values and beliefs.
It shocks Americans to learn that one in every 39 child-bearing women in sub-Saharan Africa die in childbirth. However, when a woman delays her first pregnancy until she is at least 18, her chances of surviving childbirth increase dramatically. If she can space her pregnancies — through fertility-awareness methods (sometimes called natural family planning) or modern contraceptive tools — to at least three years between births, she is more likely to survive and her children are more than twice as likely to survive infancy.
The Center for Strategic and International Studies (CSIS) hosted a delegation in February for congressional staff, foundation, and nonprofit leaders, including Jenny Eaton Dyer, to see the emerging success of family planning in Ethiopia. With the infrastructure of their path-breaking Health Extension Worker (HEW) program, training 38,000 women as health workers in just a few years, women in the most rural communities now have access to antenatal care and family planning. With a Health Post designated for every 5,000 people, women have access to tools for healthy timing and spacing of pregnancies without having to walk for miles to a higher level health facility. In less than a decade, since 2005, Ethiopia’s contraceptive prevalence rate has nearly doubled, from 15% to 29%.
Healthy timing and spacing of pregnancies, alongside an increase in births taking place in Health Centers with skilled care during delivery and post-partum care, offers a strikingly successful model to reduce maternal mortality and improve child survival.
In addition to expanding access to voluntary family planning information and services, Melinda Gates, co-chair of the Bill & Melinda Gates Foundation, has also focused on healthy timing and spacing of pregnancies as a critical factor for global health and development. Hope Through Healing Hands, with support from the Gates Foundation, is promoting awareness and advocacy among Americans to support maternal, newborn, and child health. We are highlighting the crucial role that voluntary family planning is playing in nations such as Ethiopia.
Healthy timing and spacing of pregnancies does more than save lives from health risks: it also allows girls to stay in school. In Ethiopia, where the average age of marriage is just 16 (with many girls married as young as age 11), girls are often forced to drop out of secondary school to begin families. If girls can delay their first pregnancy and stay in school, ideally until the university level, they will be better equipped to partner with their husbands to meet their children’s needs, in a more stable family economic environment.
And as First Lady Roman Tesfaye of Ethiopia stated, “When a mother can contribute to her own life and family, she contributes to the nation as a whole.” Moving beyond the national level, healthy timing and spacing of pregnancies is also a key to other global health goals, like combating hunger and improving the status of women and girls. Family planning is a key, often hidden, engine for additional global health achievements.
Family Planning 2020 is a global partnership of more than 20 governments working with civil society, multilateral organizations, the private sector and others. Created at a 2012 London summit, it represents a commitment to meet the needs of an additional 120 million women who want to delay or prevent pregnancy but lack access to information and tools.
With a focus on healthy timing and spacing of pregnancies, we can make major strides in just a few years. That’s great news for mothers, children, and our entire world.
Bill Frist is a former U.S. Senator from Tennessee. Jenny Eaton Dyer, Ph.D., is the executive director of Hope Through Healing Hands.