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Another Push for Reproductive Rights

Pam Johnson

WASHINGTON, Jun 17 2011 (IPS) - By 2015, women demanding family planning products and services in the developing world will likely reach 933 million, a terrific increase from the current 818 million women demanding access to these basic reproductive commodities.

In addition, according to the Reproductive Health Supplies Coalition (RHSC), the number of family planning users will soar from 603 million to 709 million – an increase of 64 million users across 66 developing countries, and 42 million spanning 89 middle-income countries – by the middle of the decade.

The increased cost associated with this skyrocketing demand is an estimated 5.7 billion dollars per annum for both low- and middle-income countries – including the expenses of procuring more contraceptive commodities, securing transportation for the products, expanding communication capabilities to educate the public, and stepping up training for health providers to distribute reproductive products and services.

“Today, there are over 200 million women in the developing world who want to prevent or delay pregnancy, but are not using any means of modern contraception,” John Skibiak, director of the RHSC, wrote earlier this month. “This is, without a doubt, a horrifying figure. But the greatest tragedy for us – those of us who have dedicated our professional lives to ensuring global access to family planning – is that this figure has not budged in nearly two decades… Each step forward is more than matched by comparable increases in demand in new users, [so] despite our best efforts, we are caught in a deadlock.”

According to Skibiak, 424 million dollars worth of commodities will be needed to satisfy demand for contraceptives by the year 2020, in donor-dependent countries alone.

If donor funding continues at its current rate, the world can expect a shortfall of nearly 200 million dollars annually, or a total deficit of 1.4 billion dollars between 2008 and 2020.

“What we need now is a reinvigorated effort to ensure [reproductive health and commodity security],” Skibiak said. “True contraceptive security exists when every person is able to choose, obtain and use quality contraceptives and condoms for family planning and for the prevention of HIV and AIDS and other sexually transmitted infections.”

Simple Technologies, Huge Results

Coming on the heels of the successful Global Alliance for Vaccines and Immunisation (GAVI) pledging conference earlier this week, which raised over 4 billion dollars to push the global health agenda forward, a congressional hearing on public-private partnerships in Washington D.C. Thursday raised the bar a little higher.

The Program for Appropriate Technology in Health (PATH), Research!America, the Global Health Technologies Coalition, and Bioventures for Global Health, in collaboration with Congressmen Albio Sires and Mario Diaz-Balart, presented ‘Partnerships for innovation: Simple solutions that save lives’, which outlined the use of fast solutions to immense global issues.

“The briefing on the Hill is meant to highlight the benefits of investment by the United States government and the U.S. Agency for International Development (USAID) in innovation, and to spotlight how we’ve been able to use this funding to produce technology that is greatly improving people’s lives,” Christopher Elias, president and CEO of PATH, told IPS.

With 32 field offices spanning 23 countries worldwide, PATH employs a user-driven design process, whereby its innovation efforts are fed directly from the grassroots.

PATH believes that it is only by monitoring and understanding local and community needs that the characteristics of a particular solution can be properly identified.

“One of the problems our field staff encountered was that the basic contraceptive diaphragm was not available in developing countries because it required gynaecology exams to determine which size should be used on the woman,” Elias told IPS. “As a result, scores of women in low-income countries were missing out on a simple method of birth control because of the absence of the necessary intermediary.”

So PATH worked to design a new silicone “one-size fits most” contraceptive diaphragm that eliminates the need for gynaecologists and that has been welcomed by women from Africa to Latin America and South Asia.

“We worked on this for ten years and went through over 20 different designs in a totally interactive design process, so that the end product was something the women would definitely use,” Elias told IPS. “One thing we were not expecting was that colour mattered a lot to the women – and in fact the final product is a very soft shade of purple, almost lilac, something that was universally popular. This is something we could not have anticipated without worldwide feedback!” he added.

In addition to creating new products, PATH believes that public-private partnerships are essential for deploying already-existing technologies to the women most in need.

Last year, the United Kingdom-based HIV/AIDS charity, AVERT, reported that in 2009, over 400,000 children under the age of 15 became infected with HIV – the large majority of them through mother-to- child transmission (MTCT).

In fact, the absence of proper treatment means that HIV-positive pregnant mothers face a one in four chance of passing the infection to their newborns. Given the current statistic of 18 million HIV-positive women in the world today, these numbers portend an almost-certain tragedy.

Nevirapine, an antiretroviral that has been made available free of charge by the German manufacturer Boehringer Ingelheim, reduces the risk of MTCT by 50 percent; however most women – especially those in remote rural areas – have been unable to access the required dose, delivered in syrup form, since their last visits to health workers often take place several weeks before birth.

“So PATH worked with USAID funding and Kenyan health workers to create the nevirapine pouch,” Elias told IPS.

“We developed a very simple system where nurses in antenatal clinics could fill a syringe with the right dose, cap it and seal it in a foil pouch with very simple, low-literacy instructions on it so that a mother could safely and easily give her baby the six drops of medicine to prevent MTCT, in her own home, minutes after delivery.”

“All it took was a simple packaging solution to enable millions of mothers to prevent unnecessary transmission to their children,” he added. “This is just one more example of the immense possibility of partnerships in reaching the most vulnerable populations.”

Luckily, PATH is not alone in its efforts. Next week, various members of the reproductive health community will converge in Addis Ababa, Ethiopia, to observe the tenth anniversary of the 2001 Istanbul conference ‘Meeting the Challenge’, which pioneered the global reproductive health supplies movement.

The RHSC’s two-day-long ‘Access for All: Supplying a new decade for reproductive health’ workshop series will form the nucleus of the conference, harnessing voices and strategies from the health community to meet the challenges of the coming decade.