The piece originally ran on New Security Beat
The sixth International Conference on Family Planning (ICFP) held in Pattaya, Thailand in November 2022 offered an important reason for celebration: tens of millions more people are using a modern method of family planning now than were doing so when the first ICFP was held in London ten years ago. How has this happened? One key reason is that governments, corporations, non-governmental organizations, and donors globally are taking steps to advance reproductive freedom through providing voluntary family planning.
Some 3,500 people from more than 125 countries gathered in Pattaya late last fall to push that work forward, sharing emerging research and innovations in family planning and to advocate for universal health coverage that centers both access to contraception and the freedom to choose one’s contraceptive method.
Discussions of abortion have historically been avoided at past ICFPs. Yet access to abortion was a central topic at ICFP 2022, largely due to growing global anti-abortion movements, as well as the U.S. Supreme Court’s decision to overturn Roe v. Wade just months prior to the conference. Presenters and participants alike brought abortion to the forefront of the discussion to prepare for how this landmark change in U.S. policy could impact countries that receive U.S. foreign assistance, as well as its potential impact on the role of the United States as a leader on issues of reproductive health and rights.
The conference also covered the growing impacts of climate change on sexual and reproductive health and rights (SRHR). This was a welcome inclusion during the conference, especially because other events occurring at the same moment as ICFP included the 2022 United Nations Climate Change Conference (COP27) in Egypt and the landmark announcement that global population had reached 8 billion people.
As some global experts raised the alarm on the potential ramifications of population growth, UNFPA Executive Director Dr. Natalia Kanem shared a different perspective at the conference on the day of that incredible milestone. “Eight billion is a global success story,” she said. “It’s a testament to decades of progress in public health, in reducing poverty. And it’s a story of people living longer, of more women and babies surviving childbirth. And it’s a story of more resilient and more effective health care systems. Eight billion is a story about the power of investment and it’s investment that’s made that progress possible.”
Family Planning Efforts in Thailand
ICFP is a research-focused conference, and given its location in Pattaya in 2022, this also allowed for interactive components to learn more about successful family planning strategies in the country. Thailand is globally recognized for its incredible success in uptake of voluntary family planning and strong supports for its diverse populations and their unique needs.
Due to its then high population growth, the Thai government implemented a National Population Policy in 1970 to support voluntary family planning. Contraceptive prevalence increased from 14.8 percent to 70.6 percent in the 20 years after the policy was implemented.
The objectives set for Thailand’s National Reproductive Health Development Policy and Strategy through 2026 are threefold, observed Dr. Suwannachai Wattanayingcharoenchai, Director-General of the Department of Health in the Thailand Ministry of Public Health. The first goal is to increase voluntary births (as opposed to unplanned and unwanted pregnancies); the second is to ensure that every birth is well prepared with sufficient antenatal care and birthing support; and, lastly, the strategy hopes to ensure that all newborns are born healthy and with high quality of life.
Implementing comprehensive family planning services throughout the country has required a great deal of innovation. Affectionately known in Thailand as “Mr. Condom,” Mechai Viravaidya, Founder and Chairman of Population and Community Development Association (PDA) shared some of the non-conventional strategies he has helped to implement since the adoption of the National Family Planning Program.
Viravaidya knew that winning the support of religious leaders was critical to the success of such programs, especially when considering setbacks to family planning uptake in other highly religious countries such as the Philippines. “We went to check with Buddhism,” he said. “We did not know what Buddhism would say about it.” Ultimately, Buddhist leaders fully supported family planning, and monks even blessed contraceptives with holy water to express their support.
Community involvement was also essential. Even after ensuring that doctors, nurses, and midwives could dispense contraceptives, only 20 percent of villages had access to services. Viravaidya pioneered a community-based contraceptive distribution network to train local shopkeepers to provide family planning options. As a result, all villages in Thailand had increased access to contraceptives. Eventually, many of these interventions to increase family planning uptake grew into programs to educate communities on how to curb the spread of HIV and AIDS throughout the country in the 1980’s and improve economic conditions for poor families.
Youth and adolescents are currently a major focus of Thailand’s family planning policies, which was evident on tours of Muang Pattaya Hospital and Nong Pang Kae Health Promotion Hospital in the Bang Lamung district offered during the conference.
At Muang Pattaya Hospital, Dr. Samut Satawichairut shared the successes of implementing family planning to adolescents in the district, including efforts to implement long-acting and reversible forms of contraceptives, such as the contraceptive implant, to reduce teen pregnancies in the district. Youth and adolescents are targeted for education about (and access to) family planning in hospitals across the Bang Lamung district in Pattaya through the use of youth “influencers,” local non-governmental organizations, and local nurses and midwives.
Adolescents also have access to a wide range of reproductive health services, such as safe sex education, HIV and AIDS prevention and treatment, and antenatal and postpartum care. In one primary care unit, nurses were trained to provide implants to adolescents in the absence of a doctor on site. Between 2019 to 2022, the number of implants administered in this care facility increased from 66 to 117, showing the successes of these efforts on a local level.
Though there has been great success in implementing family planning across the country, Thailand may now see the challenging side of this achievement. The country is now experiencing a plummeting birth rate, with the number of births dropping by a third since 2013.
Piyachart Phiromwsad, Head of the Research Unit in Finance and Sustainability in Disruption Era at the Sasin School of Management at Chulalongkorn University in Bangkok, Thailand, noted that Thailand now is navigating two major demographic challenges: declining fertility rates and a rapidly aging population. Dr. Wattanayingcharoenchai observed that efforts to counter the declining fertility rates have led the Thailand Ministry of Public Health to provide infertility treatment, an effort that includes reclassifying infertility as a disease and ensuring it is covered in benefit packages to promote universal health coverage. Additionally, the Thai government has made strides to provide increased parental leave, child care services, and tax relief to encourage voluntary births.
Challenging Foundational Approaches to Family Planning
Several panels and presentations throughout the conference encouraged attendees to adopt new thinking and new approaches to solving decades-old issues in family planning.
At a panel on the role of funders in reframing measurement in family planning, Jamaica Corker, a Program Officer for Data and Evaluation in the Family Planning Program at the Bill & Melinda Gates Foundation, noted that almost 30 years after the 1994 International Conference on Population and Development in Cairo, global health funders, researchers, and program implementers still rely on “foundational thinking” to promote family planning globally.
At the same panel, Janet Holt, Program Officer for Gender Equity and Governance at the William & Flora Hewlett Foundation, urged attendees to move beyond measures such as contraceptive prevalence, uptake, and unmet need, and begin to highlight reproductive autonomy and freedom. While measuring reproductive empowerment and satisfaction with contraceptive methods may be more elusive to capture, doing so can allow for increased nuance in the acceptance of different forms of contraceptives, as well as compel greater consideration of women’s voices and power in relationships.
ICFP 2022 also saw acknowledgement of pleasure as a driver of family planning uptake included on the conference agenda for the first time. “By ignoring pleasure, we’ve made our programs a lot less effective,” said Anne Philpott, Founder and Co-director of the Pleasure Project. Interventions aimed to increase safe sex behavior to reduce the risk of HIV, sexually transmitted infections, or pregnancy often fail to address sexual pleasure, thus ignoring a key driver of why people have sex.
Claire Rothschild, Senior Research Advisor for Sexual and Reproductive Health Strategic Evidence and Learning at PSI, noted that an intervention in Kenya found that incorporating information about pleasure increased adolescents’ agency. Through the use of a “chat bot” aimed towards adolescents, clients involved in this initiative had greater comfort talking to partners about sexual needs, accessing youth-friendly clinics in their communities, and receiving long-acting forms of contraception.
A focus on disease prevention that excludes pleasure as a driver of safe sex practices also prevents a more nuanced understanding of inconsistent contraceptive use. A recent systematic review and meta-analysis also found that interventions with pleasure components saw significantly improved condom use compared to interventions without a pleasure component, said Lianne Gonsalves, Scientist on Sexual Well-Being at the World Health Organization.
The dialogues at ICFP 2022 brought to light new and innovative ways to promote family planning globally, and made monumental strides towards the inclusion of often overlooked issues that impact family planning, such as abortion, climate change, humanitarian settings, and pleasure. However, there are still strides to be made going forward. More efforts must be made to include LGBTQ+, Indigenous people, people with disabilities, and other marginalized groups as key populations. This is paramount to achieving universal health coverage for all.
Sources: Bill & Melinda Gates Foundation, COP27, International Conference on Family Planning, ICMH Newsletter, PSI, Reuters, The Nation, William & Flora Hewlett Foundation, World Health Organization.
