Bill & Melinda Gates foundation

We work to keep family planning on the global agenda in a number of ways. We advocate for increased funding from governments, donors, and the private sector, as well as better policies at every level that support greater access to and availability of contraceptives. We also work to improve coordination among donors and governments and build a sustainable movement for expanded and improved contraception.

In addition, we conduct economic analyses in priority countries to determine the return on investment of family planning expenditures, and we promote transparency and government accountability by working to increase the availability of national and local budget and policy information.

Most global population growth is expected to occur in towns and cities in developing countries. In Sub-Saharan Africa and South Asia—the fastest-growing regions in the world—urban populations are projected to double between 2000 and 2030.

A mother and newborn in Uttar Pradesh, India

Currently, the highest birth rates are concentrated among the poorest populations, and a significant number of pregnancies are unintended. We focus on stimulating demand for and providing high-quality, affordable, and voluntary family planning information, services, and supplies in these communities, primarily through the Urban Reproductive Health Initiative in Uttar Pradesh, India, and in Nigeria, Kenya, and Senegal. We focus on birth spacing and family planning counseling and providing supplies and services for post-partum mothers, post-abortion clients, HIV-positive women, and vulnerable adolescent girls.

We work with the private sector and civil society organizations to identify effective approaches, and we help build country-level implementation teams into networks that share practices and strategies. We also support measurement efforts to ensure data-driven implementation, rigorous evaluation, a focus on the poorest and most vulnerable people, and widespread sharing of evidence.

Women forgo the use of contraceptives for a variety of reasons, even when they want to avoid pregnancy. Some women have misconceptions about their risk of becoming pregnant, while others have concerns about the side effects of modern contraceptive methods. In some cases, opposition from family members and a limited choice of methods are key factors.

We support the discovery, development, and distribution of new technologies that address reasons for non-use, with a focus on implants and injectable contraceptives. Implants and 3-month injectables are the most popular reversible contraceptive methods in Sub-Saharan Africa, and new versions of these methods show great potential for increasing access to and use of contraception. We are currently investing in quality assurance, regulatory approval, and introduction of two products in selected countries in Sub-Saharan Africa and South Asia.

Less than 20 percent of women in Sub-Saharan Africa and barely one-third of women in South Asia use modern contraceptives.

The first product is Sino-implant (II), which is produced by Shanghai Dahua Pharmaceuticals in China. Sino-implant (II) is a long-acting, effective, and low-cost implant that is approved for use in more than 20 developing countries. Efforts are under way to ensure prequalification approval by the World Health Organization.

The second product is Sayana Press, a new subcutaneous version of the popular three-month injectable from Pfizer called Depo-Provera. Depo-Provera is delivered through intramuscular injection, which must be administered by a health worker in most countries. Sayana Press can potentially be delivered by nonmedical providers, such as trained community health workers, or even self-administered by women. Efforts are under way to assess the acceptability of the product by women and to implement the training, systems, policies, and infrastructure needed to sustainably deliver it.

Additional contraceptive methods are needed to address the diverse needs of communities around the world. For example, we are investing in the development of an on-demand oral contraceptive pill, contraceptive vaginal rings, a six-month injectable, long-term implants, non-hormonal contraceptive methods, and nonsurgical female sterilization. We also support development of multipurpose solutions, such as those that prevent both pregnancy and HIV infection.

Improving access to family planning resources requires filling critical gaps in knowledge to inform policy and program implementation. We support research to test ways to integrate family planning services with other health services, including HIV prevention and care, maternal and child healthcare (including postpartum care), and post-abortion services. We also seek better data on the potential interactions between HIV acquisition and the use of hormonal contraceptives.