If I won lotto, a decent amount of money, I would use that money to distribute free long term contraceptive implants.
Of course just going around handing them out would be ineffective to say the least. I would set up teams in developing countries with doctors and nurses – women who are locals and also some foreigners already over there – and a few volunteers and medical researchers perhaps, and then I would purchase crazy large amounts of these contraceptive implants, the ones that are effective for three years and five years. Then the team would go from town to town first educating the local health authorities and medical practitioners about the implants and how to safely insert and remove them, then educating the local women on what they are and on general sexual health, then offering for them to be implanted for free. The team will go around and then circle back to return to the towns every two years and do the same, so that the education is enforced and to monitor the women and how effective the program is, and of course to implant more.
The teams will also visit refugee camps and camps of displaced people, as the women there will be especially keen to control the amount of children they have while living in those conditions (although, this may need more planning as follow up maybe difficult as the displaced people move around). As these women are in isolated or temporary places there will have to be studies to ensure that there is no harm in the implant remaining in place for longer than it is effective ie 20 years or longer, if the woman is unable to get it safely removed.
The teams would set up in conjunction with local hospitals and clinics, but may also venture out to set up mobile clinics and education centers in camps without clinics and to areas that are in particular need, for example areas with a high concentration of sex workers. They may not feel that they are able to attend the clinic and hospitals, due to the stigmatism enforced by local culture for example, but they may be the most in need of safe effective long term contraception. Of course implants will not stop the spread of HIV or other STIs, so condoms will also be distributed, but at least they can control their ability to get pregnant while continuing to work. It will also decrease the number of unsafe abortions which happen every year.
The implant also has the advantage of being a long term mostly invisible form of contraception. The husband or sexual partner need never know about it, it does not require a daily dose which must be picked up and stored somewhere and remembered every day. It does not require refrigeration or need to be given every three months like the contraceptive injection. It is 99% effective and it is effective for longer than other methods, it is also safe to use while breastfeeding and it works seven days after being implanted. Only one clinic visit every three years or five years is required. All this is essential for women who live in isolated towns and camps.
Obviously such an idea is ambitious, maybe it will have to start small, in particular areas where contraception is needed and wanted by the population, where perhaps there are not cultural or religious barriers to contraception. It could start in towns in India, towns in sub-Saharan Africa, camps in Haiti for example; all places where access to contraception is low and fertility rates are high.
Why long term contraception? Why of all things do I see it as so important? It was triggered mostly by this particular article, but it is something I have been a proponent of for a long time: http://www.ipsnews.net/2012/06/will-the-world-listen-to-women/. The first line tells you everything:
“What does birth control have anything to do with reducing global emissions? Everything, women around the world would say, because they know how closely linked reproductive health is to issues ranging from poverty and food security to climate change and beyond.”
It goes on to say that 215Million (at least!) women are not using effective methods of or are unable to have access to contraption, even though they do not want to get pregnant. As a woman myself, I know that avoiding pregnancy – when for what ever reason you do not want to be pregnant – is a huge stress on your life when you are unable to secure effective contraception. It is not just about single women having sex; married women want to have sex, and certainly their partner will want to still have sex, but women may want to use the three year implant to space out the number of children they have. This will lighten the financial and health burden of too many children. She can also decide how many to have, perhaps three or four and then no more. Less women will die from pregnancy related complications, according to the article 287,000 currently die every year. This will therefore contribute to Millennium Development Goal 5; to reduce maternal mortality, as well as other Millennium Development Goals of eradicating extreme poverty and hungry, promoting gender equality and empower women, and also ensuring environmental sustainability.
If women can choose to have children later in life, they can continue their education, their career and be more financially stable when they do decide to have children. The more educated and financially stable they are when they have children, the more educated and healthy the children are likely to be.
Population growth is now alarming as we reach 7 billion people in the world today. Slowing population growth will slow carbon emissions, slow deforestation, slow the rate at which we consume our environment. When some people say that two out of five pregnancies are unplanned, if women are given access to safe and effective contraception you can imagine how much the population growth will decrease.
Less unwanted pregnancies means less children, means less human consumption, that scarce resources will go further, and sustainable development is more achievable. If women have fewer children it increases their ability to participate in the economy (easier when you don’t have ten children attached to you). Women farmers make up 43% of the agricultural labor force in developing countries, if women can put more time and attention into farming, fewer families will be hungry, and with smaller families, the women can sell the extra. Women will have more time to participate in local politics and decision making.
Despite all this, most funders are reluctant to spend money on contraception, especially American funders, as part of any sort of development agenda. In many African countries, funding and promotion of “family planning programs” have declined in the past decade so in tandem the decline of fertility rates has now stalled. With the recent Rio summit many people were also disappointed, as one comment in the above article mentions; “references to women’s reproductive rights and gender equality were being scrapped” from the summits outcome text. The blame can be laid on the fact that reproductive rights are still contentious in many countries (I could say a lot more on this, but that may have to be another day).
When women are free to be more than a mother, when women are free to choose when to be a mother, then not just the women, but the community and the environment will benefit. This is why I have this dream to distribute free contraceptive implants in developing countries.