In this article, Amy Tsui, PhD, reviews some of the most striking highlights from the International Conference on Family Planning 2013 in Addis Ababa, Ethiopia. Tsui is director of the Bill and Melinda Gates Institute for Population and Reproductive Health at the Johns Hopkins Bloomberg School of Public Health.
In November 2009 I walked from the hotel compound with a young woman recruited to help support our first international conference on family planning held in Kampala, Uganda. “How do I get involved in family planning?” she asked. “I want to learn more about this field. It is so positive. Not like HIV.” Uganda then had been weathering an HIV epidemic, which saw more than 120,000 new infections each year, more than half being women and children. They were the same groups who stood to benefit from family planning. Indeed a third of married women in Uganda were assessed in 2011 as seeking to delay or stop childbearing but not contracepting—a staggering 1.11 million women. Women reported that on average 1.5 of all their births were not wanted at the time.
An astounding 1,200 conferees made it to the Kampala meeting, when we were expecting 300. In 2011, when our second international conference was being held in Dakar, Senegal, 2200 conferees appeared; and last week, more than 3,300 from more than 120 countries made it to Addis Ababa, the “mother” of all such family planning conferences. The atmosphere in the stunning African Union Conference Center was palpably uplifting—sessions were full and lively with productive exchanges. Many notable events took place—high level meetings of ministers, with new pledges to commit resources to family planning from Benin, the Democratic Republic of Congo, Guinea, Mauritania, and Myanmar, countries whose support a year ago would never have been anticipated.
Journal supplements and books were launched showcasing the scientific issues linking contraceptive practice with reproductive, child health, and sexual health. The best scientific presentations assessed:
• the effectiveness of “vocal local” procedures used during sterilizations
• the absence of spillover effects from HIV therapy investments on family planning visits
• the acceptability of a new one-year contraceptive vaginal ring
• and the selective differences between users of DMPA (injectable) and other methods that can affect clinical trials when the former serve as controls.
Finally, a 2013 assessment 4 to 8 years after completion of a long-running intervention in northern India showed that its impact on contraceptive awareness and practice could still be observed, after adjusting for confounding factors.
These were just a few highlights from among more than 700 peer-reviewed presentations. A testament to the stamina and absorptive capacity of conferees was the large number leaving the halls at 8 p.m., after nearly 12 hours of sessions.
More than 130 young people from around the world competed with YouTube videos for the chance to participate in person, and 350-plus made their mark and presence felt, as well they should. The sonorous beats and songs of enthusiastic musicians filled inside and reverberated outside the conference halls. Queens of royal families in Ghana and Uganda presided over and absorbed the potency of plenary discussions. Awards for excellence in leadership were conferred to a young population-environment group, Blue Ventures, to the government of Malawi, to Banja La Mtsogolo a Marie Stopes International affiliate in Malawi, and to the Director General for Reproductive Health in Senegal, Dr. Bocar Daff, who was our 2011 conference co-chair. There modern use of family planning has doubled since 2005 from 8 to 16 percent. We also recognized leadership roles in Ethiopia, by individuals, such as Dr. Mengistu Asnake, and organizations, such as the Federal Ministry of Health, ably led by Dr. Kesetebirhan Admasu. In Ethiopia, as in Senegal, increases in contraceptive use are being observed, rising from 15 to 29% in 6 years and child mortality has been reduced by two thirds.
It was also exciting to hear Melinda French Gates spur the conferees to be accountable and achieve full contraceptive access and choice, humbling to hear how Ethiopian health extension workers and couples served their communities as providers and role models, and sobering to be reminded at the closing plenary that the security of more than 10,000 Ethiopians living and working in Saudi Arabia had been compromised, news brought compassionately by the former Minister of Health, Dr. Tedros Adhanom, now Minister of Foreign Affairs.
Many leaders, in person or in video, from the Prime Minister of Ethiopia to the US Secretary of State, spoke of their appreciation for those working to ensure contraceptive access and choice in benefitting the lives of their daughters. The Prime Minister of Thailand offered her government’s assistance based on their longstanding experience in family planning care. How did something as personal as a couple’s birth control decision become an international theme of declaration?
For a year, Gates Institute staff has labored to organize a conference around a platform of shared values and evidence-driven solutions. Oying Rimon, our Institute’s deputy director, and his team, carried forth well into the evenings to build inspiring plenary programs across partnerships and handle the millions of logistical tasks. How do you arrange for 3000-plus people to be transported between hotels and the conference center, obtain photo badges, queue and pass through many security screenings, and find their way to their sessions of choice? How do you feed them at lunch? By trial and error with rain mixed in. How do you build a spirit of excitement for family planning? With the family planning fan, of course.
For me, most gratifying was the active participation by the Johns Hopkins University President, Ronald Daniels, and Dean of the Bloomberg School of Public Health, Michael Klag, which showed that not only had the Gates Institute come to walk to the talk but so had our university leaders. We were family planning personified and collectively prepared to assure the world Full Access and Full Choice.
My hope is the young Ugandan woman I met in 2009 did find her way into our field—like us, she would indeed have found it positively uplifting and all about life. —Amy Tsui