It Takes a Village: Getting Family Planning Where It’s Needed

See all our coverage of the 2012 Global Family Planning Summit here.

July 11th was definitely momentous, but I don’t think the hundreds of thousands of women and girls that are displaced by conflict living in South Sudan’s villages heard the news. The Bill and Melinda Gates Foundation, the British government and other donors committed $2.6 billion dollars to give a projected 120 million women in the world’s poorest countries access to lifesaving contraception. This unprecedented effort could be a major milestone in global health, development and women’s rights. But we need to make sure this new funding and political commitment is followed by swift action—and change felt on the ground.

In the humanitarian settings where we work, we have found that few aid agencies and governments focus on family planning—even though it is a critical public health intervention that saves lives and has impact far beyond health. In the immediate aftermath of a disaster, men and women fleeing their homes are not likely to be thinking about their contraceptives as a first priority, and neither is it a main concern of humanitarian aid agencies responding to these crises. Yet, experience has shown us that even in the earliest days and weeks of a humanitarian emergency, women and girls want to use contraception.

Providing family planning information and services should be a top concern from the very onset of a crisis. Many countries have protracted humanitarian situations; the average length of displacement for people living in refugee camps is now 18 years. Not having family planning services available can have far-reaching and long-term effects: keeping young girls out of school, increasing the chances they will marry early, and raising rates of maternal and infant deaths.

There have been some significant improvements in reproductive health care in crisis situations. The humanitarian community, governments and others are working to ensure that a set of basic measures are taken during humanitarian crises to meet women’s and girls’ reproductive health concerns. Yet, family planning often falls by the way side.

In a five-country study we conducted in 2011, we found that use of contraception is generally lower in refugee camps than in surrounding areas.  And awareness is low as well.

In recent years, several developing countries, like Bangladesh—which has successfully implemented a community-based approach—have seen improvements in family planning uptake. Now we need to make sure these programs and models are adapted and implemented in humanitarian settings on a wide scale—in the camps, villages, and urban areas where displaced persons live. Without this concerted effort, women and girls in regions hit by humanitarian crises will remain vulnerable to unplanned pregnancies and risk dying from complications.

Simple measures and methods that could protect them—like the pill or injectable contraceptives—are often neglected during crises. We have been working to develop educational materials that help local health providers and peer educators to explain the benefits of family planning and where and how to seek services. This outreach to communities is needed to really save lives and to ensure women and girls are informed and able to make choices about their futures.  

Community members are often best positioned and able to respond to the needs of their peers. We have seen this in South Sudan, where the Women’s Refugee Commission worked with the American Refugee Committee and local partners on an initiative to assess whether training community members and peer educators to provide information on family planning—and to provide methods like the pill and condoms—is a feasible approach.  Our project focused on the town of Malakal, which experiences heavy rain for half the year, decimating the few roads that exist. Needless to say, transportation is limited and health clinics are scarce. Prolonged conflict in the region further restricts access to whatever health care there is available.

We wanted to see if community workers making home visits and informing their peers about contraception, holding health education sessions in villages and doing radio shows would be effective. This approach did show potential: communities were open and enthusiastic about family planning. Adolescent girls, especially, were motivated to learn about and use contraception so they could stay in school and delay pregnancy.

Initiatives like these put family planning in the hands of those who would not be reached otherwise and are absolutely essential to improving reproductive health in the poorest parts of the world. Empowering communities, local leaders and health workers should be the next step in our global efforts. Without involving communities and engaging them from the start our plans will remain just that, no matter how good the intentions.

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  • steven-earl-salmony

    Dear Sandra Krause,


    Perhaps you would kindly devote one blog, just one, to sensibly “tracking” the extant scientific research on human population dynamics. A great deal of preternatural theory (eg, Demographic Transition Theory), politically convenient ideology (eg, Liberalism and Conservatism) and economically expedient theology (eg, Neoclassical Economics) falsely claim to have the sufficient support of science. Let us set aside these widely shared and generally accepted pseudoscientific branches of thought for a moment so that the best available scientific research of human population dynamics can be rigorously examined and meaningfully discussed.

    Thank you,

    Steve Salmony

  • colleen

     You can post your own commentary here, perhaps you should do the requested tracking and share the results with us in a Community post. She isn’t your secretary.

  • princess-jourdan

    Last Fall, an African woman came to my church as a guest speaker. She runs an orphanage in Kenya, and she showed us a video presentation of her orphanage and the 42 children she takes care of in it. She was a former street orphan who was rescued by a church and this became her calling. She talked about how some of the children she cares for are HIV positive, some were orphaned from their parents dying from AIDS or warfare, and some of them were abandoned by their families because they were no longer able to care for them. One little boy came to live at the orphanage because his family suddenly packed up and took off in the middle of the night…leaving him there in the hut while he slept. When he awoke the next morning, he was alone.

    I immediately went up to Victoria after her presentation and introduced myself and began asking her all kiifs of questions about the family-planning situation in Kenya. She said while contraceptives are becoming available in the cities, but are still unavailable to women in the rural villages. Then she began telling me about the dire situation in Kenya regarding pregnancy and child-birth. The people are poor and starving, and families have no way to control the number of children they bear. While the first few children a married couple have are regarded as a blessing, the 9th, 10th, and 11th child aren’t usually welcomed as a blessing…by that time the couple already have enough children to feed and simply don’t have the resources to add more children to the home. So in situations like this, she said it is common for the family to take the newborn to the river and throw it in for the alligators to eat…or leave the newborn lying on the savannah for the lions and other predators to find and kill. This is truly heartbreaking, but this is the reality of what happens when people aren’t given the means to humanely control their fertility. Humans will ALWAYS find a way to survive…even if it means killing their own offspring when they can no longer feed and care for them properly.

  • give-em-hell-mary

    Another more insidious RCC-approved means of unwanted offspring damage control is Munchausen by Proxy Syndrome abuse that is widely practiced by poor mothers in Brazil.  These mothers secretly starve or poison surplus kids to win pity from their neighbors and priests.

  • steven-earl-salmony

    Dear Colleen,

    Despite my inclination, I will not take time to characterize your reaction to my request of Sandra Krause.  Please note that human population dynamics is seldom discussed.  It seems to me that a “reality check” is in order.  Let me accept your invitation to remark on this subject with the hope that you and other thoughtful people will share your viewpoints.

    Regardless of what we believe because it is politically convenient, economically expedient, socially correct, religiously tolerated and culturally syntonic to do so, whatsoever is is, is it not? Please assist me by examining research of the population dynamics of the human species. The implications of this research appear to be potentially profound. If human population dynamics is essentially common to, not different from, the population dynamics of other species, then the unbridled growth of absolute global human population numbers in our time could be the proverbial “mother” of the human-induced global challenges looming before the family of humanity. If this global challenge continues to be ignored, the human family could end up winning some Pyrrhic victories over subordinate global challenges but losing the larger struggle for survival itself.

    Please note the following perspective from Sir Fred Hoyle that dates back to 1964, a time prior to the publication of Ehrlich’s “Population Bomb” and the Club of Rome’s seminal work, “Limits to Growth.”


    “It has often been said that, if the human species fails to make a go of it here on the Earth, some other species will take over the running. In the sense of developing intelligence this is not correct. We have or soon will have, exhausted the necessary physical prerequisites so far as this planet is concerned. With coal gone, oil gone, high-grade metallic ores gone, no species however competent can make the long climb from primitive conditions to high-level technology. This is a one-shot affair. If we fail, this planetary system fails so far as intelligence is concerned. The same will be true of other planetary systems. On each of them there will be one chance… and one chance only.”


    It appears to me that Sir Fred Hoyle was asking people years ago, when I was still a teenager, to carefully consider and rigorously examine a superordinate situation that was too dangerous to ignore… that dwarfed other already identified global challenges. Rather than seriously scrutinize population dynamics leading to the human overpopulation of the Earth, which would require experts to rivet their attention on the placement of the human species within the natural order of living things, the topic was avoided, just as it is being ignored now. At the beginning of my lifecycle in 1945 there were about 2.8+/- billion human beings on Earth. Only 65 years later 6.8+/- billion people are members of the human community.

    So much time has been wasted recently by the brighest and best of my generation. The implications of such an unfortunate failure of nerve appear to be far-reaching. We cannot address problems, the root cause of which we refuse to acknowledge.

    Representative democracies led by human beings with feet of clay could readily become a force too formidable to ignore with remarkable speed, I believe, but first humankind needs to be helped to see why a force too formidable to ignore is necessary as well as to understand more adequately the nature of the primary human-induced global challenge that presents itself to the family of humanity in our time; that takes its shape in the form of a colossal looming threat to future human wellbeing, environmental health and the integrity of Earth as a fit place for human habitation.

    Research by Russell Hopfenberg and David Pimentel appears to indicate with remarkable simplicity that human population dynamics is essentially similar to the population dynamics of other species.

    Since many too many population experts remain silent about this research and blogmeisters associated with the mass media refuse to discuss the peer-reviewed evidence, perhaps you could take a look at it Colleen, express your point of view, and encourage by your example others to do the same. You can find the article, Human Population Numbers as a Function of Food Supply, by Hopfenberg and Pimentel on the worldwide web or at the following link, . Other articles and a slideshow presentation on human population dynamics and human overpopulation can also be found at this link.


    Steve Salmony