The Gates Institute: 20 Years of Positive Disruptions in Family Planning
The ROI on More Accessible and Informed Family Planning
Increasing access to family planning resources has substantive impact on the health and well-being of women and families—especially in developing countries.
Family planning can mean birth spacing for healthier mothers and children. Better reproductive health care—specifically access to contraceptives—can help women finish school or learn skills so they can contribute to household income. On a broader scale, sustainable human populations can help mitigate environmental health impacts like hunger. When nations invest in family planning and reproductive health, they are investing in healthier families and communities and in their own economic growth.
The Bill & Melinda Gates Institute for Population and Reproductive Health launched in 1999 in response to this global need for investments in effective family planning and reproductive health programs and research efforts. Building on the Bloomberg School’s global public health leadership, the Institute’s work translates science into action with projects in 22 countries.
Twenty years later, the Institute celebrates progress to date and forges new commitments to increase access to family planning and to improve reproductive health for women and men, communities and countries across the world.
Global Snapshots of Success
The Challenge Initiative is the Gates Institute’s “business unusual” approach to rapidly and sustainably scaling up proven reproductive family planning solutions for women and girls living in urban slums. This demand-driven model lets local governments lead and implement TCI’s evidence-based approaches to achieve sustainable impact.
In Nigeria, many clinics are dilapidated and lack trained providers for family planning services. TCI has been perfecting an evidence-based approach—the 72-Hour Facility Makeover—to improve the physical environment of facilities over a three-day period.
So far, 70 such makeovers have been completed across 10 Nigerian states. During the makeover—which occurs over a long weekend to minimize service disruptions—facilities are renovated, refurbished, and equipped for optimal family planning service provision. By engaging the community and local artisans and vendors throughout the makeover process, the physical makeover also becomes a mental makeover in restoring the community’s confidence in the facility and its services and gaining local buy-in to advocate for and contribute to continuous maintenance.
While this approach has been done previously in Nigeria, TCI simplified and reduced the time to implement the entire makeover process—including a four- to five-week planning period—to be more efficient and ensure local government counterparts maintain momentum to complete the intervention while preserving quality. This will help rapidly scale up the proven approach.
In Uganda, there are only 14 nurses and one physician for every 10,000 people. This means a critical shortage of health services, and nearly a third of married women are unable to obtain contraceptives.
Ugandan women’s contraceptive of choice is a long-acting injectable that must be administered every three months. The Gates Institute’s Advance Family Planning initiative advocated for policy changes that enable community health workers to fill gaps in health services. Trained community health workers can visit homes or meet with women to administer the contraceptive.
In eight sub-Saharan African countries, women are gaining access to and using modern contraception at a faster rate than previously projected, according to a 2019 study using data from the Gates Institute Performance Monitoring for Action (formerly PMA2020) survey project.
These are compelling examples of positive social and political disruptions. But family planning work entails more than expanding access to contraceptives, and its benefits extend beyond developing countries.
Research is key to informing policies and solutions
Researchers from the Gates Institute in 2007 studied 41 countries and found that higher fertility rates and lower contraceptive use among poorer populations can be considered an inequity when compared with those of wealthier populations.
Several of the same authors published research in 2012 estimating that contraceptive use contributed to a 44% reduction in maternal deaths across 172 countries. An explanation for the high growth rates is that countries—especially across Africa—are now committing more resources to family planning:
“This study provides further evidence that with the countries’ own commitment and resources and with support from international donors, family planning services are becoming more accessible and used more by women in Africa to make informed reproductive decisions,” says Scott Radloff, director and scientist for PMA.
The “Demographic Dividend” concept illustrates the economic boost that countries can experience when fertility reduction creates changes in a country’s age structure. The concept, promoted and revitalized on the international agenda by the Gates Institute, shows that countries thrive when there are more people contributing to the economy than are dependent on it. This powerful, measurable return on investment of family planning dollars makes the case for additional funding for reproductive and women’s health.
This and other groundbreaking research helps to inform policy conversations and interventions that consider equity and ethics.
20 Years of Positive Disruptions & Investing in Tomorrow
The Gates Institute offers a visionary model for global change sustained by a number of formidable roots:
• Groundbreaking research
• Global cutting-edge policy and advocacy
• Innovations in performance monitoring and urban reproductive health
• Ability to translate evidence into policies, programs and practice
The Institute has two other muscles to flex: convening power and a focus on youth.
The International Conference on Family Planning, held every two years, convenes thousands of political leaders, scientists, researchers, policymakers, advocates and youth to disseminate knowledge, celebrate successes, and identify next steps toward the goal of enabling 120 million more women and girls to access voluntary, quality contraception by 2020. The 2018 ICFP took place in Kigali, Rwanda, with more than 4,000 people from 119 countries in attendance. A record number of more than 600 youths attended the youth pre-conference.
In 2015, The Gates Institute’s focus on youth clicked into even sharper focus with the introduction of 120 Under 40: The New Generation of Family Planning Leaders. The project recognizes up-and-coming young leaders who are driving the field forward.
Among the 120 Under 40 are youth advocates working in medical settings, newsrooms, universities, and research organizations who understand that educating youths about family planning is an investment in their well-being—and the well-being of the larger community. For many of these advocates, family planning is as much about personal safety and education to make good choices as it is about access to contraceptives.
“Policymakers tend to be blind, to live in denial that youth have sex,” says Richard Mugenyi, advocacy and communications manager of Reproductive Health Uganda, a local NGO affiliated with the International Planned Parenthood Federation, which means that, globally, family planning dollars may be shunted towards ineffective abstinence-only education—what Mugenyi calls a “one-sided intervention.”
“Reproductive rights are human rights” assert 120 Under 40 family planning champions, “critical to young people’s health and well-being and essential to sustainable global development.”
Year 21 and Beyond
There’s still work to be done to shift entrenched cultural beliefs and political practices. The global family planning community recognizes and celebrates thoughtful family planning for stronger, healthier families. It is the Gates Institute’s vision—but not yet the global reality—that reproductive health services and access to contraception will be available to all women.
The Gates Institute, 20 years into its charge, is a global leader in bringing family planning to national and international policy and research agendas. Going forward, the Institute will continue to make “positive disruptions” in family planning and reproductive health for individuals, communities, and countries worldwide.
“We know that investments in family planning reap tremendous rewards in terms of education and empowerment, economic growth, family welfare and environmental health. We look toward a future when people around the world will see family planning’s great benefits realized in their communities and countries. Even in these challenging times, I still believe we can change the world with family planning.”—Jose “Oying” Rimon II, Gates Institute Director
Join public health leaders Al Sommer, Jose "Oying" Rimon II, Leana Wen, Josh Sharfstein, Tlaleng Mofokeng, and Susan Krenn for a lunchtime series beginning Tuesday, September 17.