Prime Minister Stephen Harper Office of the Prime Minister 80 Wellington Street Ottawa, ON K1A 0A2 29th May, 2014 Dear Prime Minister Stephen Harper, IPPF are delighted to share with you this letter from the undersigned civil society organizations; We applaud you for bringing the chronic challenge of maternal, newborn and child health to global attention at the High-Level Summit from May 28-30 in Toronto. Canada's Muskoka investments have focused on countries with high child and maternal morbidity and mortality rates, demonstrating that countries with challenges can make progress on maternal, newborn and child health. As members of civil society within countries that have made significant progress, we would like to draw your attention to the role that rights-based family planning has played in this success, thanks in part to the investment by Canada. Delaying and spacing births enables women to bear children in their healthiest years, reducing the risk of maternal mortality, and enables them to have their desired number of children. Babies born less than two years after the next oldest sibling are more than twice as likely to die in the first year as those born after an interval of three years1. By preventing closely spaced births, improved access to family planning choices could save the lives of over a million infants and children annually2. In recognition of the integral link between family planning and maternal and child health, many of our governments recently committed to enable 120 million more women and girls to use contraceptives by 2020. Please find annexed below details of the commitments made by our governments. We therefore call on you in your conference and policies to recognise the vital role that access to life-saving family planning plays within the continuum of care along the spectrum of reproductive, maternal and newborn and child health (RMNCH)3 and of the integration of family planning into MNCH. We further urge you to remember that reducing maternal mortality is a key part of the Muskoka commitments and that achieving these targets will not be possible without increasing access to family planning. We hope that the High-Level Summit will further promote greater global investment and political commitment to this critical aspect of women and children’s health.
1
Family planning saves lives (fourth edition), Rhonda Smith, Lori Ashford, Jay Gribble & Donna Clifto, Population Reference Bureau, 1999. 2 Adding It Up: The Costs and Benefits of Investing in Family Planning and Maternal and Newborn Health, S. Singh et al., Guttmacher Institute and United Nations Population Fund, 2009. 3 http://www.who.int/pmnch/about/continuum_of_care/en/
Family planning is not “in addition to” health programming for women and children; it is central to achieving a healthy life for all. Only when universal access to family planning is achieved, will women and their newborn infants have the best chance at a full and healthy life. Yours faithfully, Signed by the following civil society groups:
The Family Guidance Association of Ethiopia (FGAE) Partners for Health, Ethiopia The Family Planning Association of Malawi (FPAM) The Associação Moçambicana para Desenvolvimento da Família (AMODEFA), Mozambique Noble Missions for ChangeIinitiative (NMI), Nigeria International Centre for Women Empowerment and Child Development (ICWECD), Nigeria Better Society for Child, Adolescents and Maternal Care (formerly. Association for Child Health, Nigeria Niger Delta Women's movement for Peace and Development, Nigeria Chama cha Uzazi na Malezi Bora Tanzania (UMATI) bdnews24.com, Bangladesh
Appendix: Relevant commitments made by our governments to family planning (including FP2020) Bangladesh The government has committed to increase access and use for poor people in urban and rural areas, improving choice and availability of Long Acting and Permanent Methods (LaPMs), including for men, and post-partum and post-abortion services. Ethiopia In the early 2000’s the Ethiopian Government and in particular the Ministry of Health recognised the vital role that family planning can play in saving women’s lives and improving the health and wealth of families4. Collective activities by the government and other stakeholders contributed to the increase in CPR from 13.9% in 2005 to 27.4% in 2011. The Ministry has thus undertaken a massive campaign for sub-dermal insertion of Implanon by Health Extension Workers along with misoprostol for prevention of postpartum hemorrhage. Significant investments and promotion are also being made on system strengthening and human resource development to increase access to and utilization of long acting FP methods through Implants and IUCD scale up. The government has pledged to further increase funding to uphold the rights of all people to access and choose voluntary family planning through the strong network of primary health care providers. The current Health Sector Development Program (HSDP IV) prioritises expansion of family planning services as a key strategy. Reducing maternal mortality ratio to 267/100,000 and increasing skilled birth attendant to 60% and the CPR to 65% by 2015 are bold targets set by HSDP IV. Malawi With the goal of "no parenthood before adulthood," Malawi has committed to raising the country's contraceptive prevalence rate to 60% by 2020 with a focused increase in those aged 15 to 24. Malawi has also pledged to create a family planning budget line in the main drug budget by 2013/2014 and to raise the age of marriage to 18 by 2014. In addition, Malawi plans to develop a comprehensive sexual and reproductive health program to meet the needs of its young people and will work to strengthen effective policy leadership for family planning and improve financial allocation for health systems supporting family planning. Malawi is aiming to increase coverage of services through the expansion of public/private partnerships, increase community access to family planning methods and strengthen forecasting and data management for effective supply chain operation. Mozambique The government of Mozambique is committed to continuing to provide free integrated sexual reproductive health services and commodities in all health facilities, and to cover 5 percent (2012), 10 percent (2015) and 15 percent (2020) of contraceptives needs. Family planning information and services for the youth will be revitalized. Access to long acting and permanent methods will be
4
http://www.mariestopes.org/news/ethiopia-family-planning-success-story
increased from about 1 percent to 5 percent of women by 2015. Post-partum and post-abortion counselling on family planning and contraception will be expanded by training at least 500 health providers throughout the country by 2015. A public-private partnership to strengthen the distribution of contraceptives will increase the number of health facilities with at least three contraceptive methods from one-third to 50 percent by 2015. Nigeria “Nigeria commits to increase CPR by 2% every year to achieve 36% by 2018. This will avert 31,000 maternal deaths and 1.5 million child deaths, and save more than 700,000 mothers from injuries or permanent illness due to childbirth.� Nigeria has committed to achieving the goal of a contraceptive prevalence rate of 36% by 2018. This will enhance maternal and child survival, thereby contributing to the government of Nigeria's initiative to save one million lives by 2015. In addition to Nigeria's current annual commitment of US $3 million for the procurement of reproductive health commodities, Nigeria commits to provide an additional US $8.35 million annually over the next four years. This increases Nigeria's total commitment for the next four years from US $12 million to US $45.4 million, an increase of almost 300%. The federal government will work with the state and local governments to secure complementary budgets for family planning and reproductive health service delivery. Nigeria's commitments include training frontline health workers to deliver a range of contraceptives and action to improve equity and access to family planning for the poorest. The government of Nigeria will partner with the private sector, civil society, traditional and religious institutions and development partners. Tanzania The Tanzanian government has committed to doubling the number of family planning users to 4.2 million by 2015 to reach a national contraceptive prevalence rate of 60 percent. The government will increase its financial allocation for family planning, while strengthening partnerships to continue implementing the National Family Planning Costed Implementation Program. The government of Tanzania through the Ministry of Health and Social Welfare has developed a Sharpened One Plan (2014-2015) to accelerate reduction of maternal newborn and child deaths in the countdown period to 2015. The Ministry of Health has also developed a Reproductive, Maternal, Newborn and Child Health (RMNCH) Score Card as an advocacy tool to draw attention of policy makers, influential leaders and key decision makers. The Sharpened One Plan and RMNHC Score Card were launched on May 15th 2014 by his excellency, the President of the United Republic of Tanzania, Hon. Jakaya Mrisho Kikwete. The Ministry of Health and Social Welfare has planned to Institutionalize Community Health Care Workers, by training over 2000 Community Workers in 2014, a curriculum and work plan has already been developed.