May 2008: HIV & AIDS Monthly Newsletter

Family planning integration: A proven, but highly under-utilised prevention strategy

By JONATHAN MUNDELL (1)

According to an Issue Brief, released by USAID in 2006 (2), family planning in the era of HIV & AIDS is more important than ever. The brief discusses why family planning is so essential in the context of HIV & AIDS, especially in the developing world. Half a million women and 11 million children die each year from pregnancy-related complications, and family planning integration could potentially prevent 25% of these deaths. Family planning programmes, if implemented effectively, can play an important role in assisting HIV prevention goals, and in the same vein, HIV programmes can assist in broadening access to family planning services.

Another briefing paper, released by USAID last year (2), documents “Family planning choices for women with HIV”, and states that family planning is also the key strategy to prevent or reduce mother-to-child transmission (PMTCT) of the HI-virus. Family planning integration also provides an important entry point for a wide range of other services, and allows more contact opportunities with a client, because more services are offered. In addition, service providers are cross-trained in a variety of issues, which greatly assists in efficient information dissemination. Family planning can also often encourage the involvement of men, and so such integration can potentially increase the number of men who have contact with HIV & AIDS services. From a more sociological viewpoint, family planning can also play a “pivotal role in population growth, poverty reduction and human development” (3).

However, despite the numerous, widely researched benefits of integrating family planning services into HIV & AIDS service delivery, many funders, governments and policy makers around the African continent, and globally, have under-utilised this strategy.

PEPFAR CRITISISED FOR NEGLECTING FAMILY PLANNING INTEGRATION

Following the very recent re-authorisation of the US President’s Emergency Plan for AIDS Relief (PEPFAR), which will see US$ 50 billion spent on curbing the epidemic over the next five years, Washington lawmakers have come under fire, for failing to adequately address family planning integration. According to Jamila Taylor, policy analyst for the Centre for Health and Gender Equity (CHANGE), the new Bill continues “the legacy of the extremely harmful abstinence-until-marriage funding directive by imposing a confusing reporting requirement on countries that spend less than fifty percent of sexual transmission funds on abstinence and faithfulness prevention programs” (4). Taylor goes on to question the fact that the new Bill only provides family planning related funding to programmes that are compliant with President Bush’s “Mexico City Policy” (5), and the fact that they fail “to mention family planning in the context of HIV and AIDS all together”.

PEPFAR has received further criticism in a recent article, published in the Guardian (6), entitled “George Bush's Aids relief plan is undermined by morality clauses”. In this article, Nina O'Farrell applauds the US Government for their increase in funding, but states that “the effectiveness of this money is undermined by clauses that are based on American conservative moral considerations rather than hard facts about how to prevent HIV infections”. The article discusses how abstinence and faithfulness approaches to HIV prevention have been shown to be ineffective, even in the USA, while programmes that have incorporated “comprehensive sexuality and life-skills education alongside the provision of condoms and family planning services” have been found to be far more successful.

It is therefore valid to ask why such conservative stipulations have been made, but at the same time, it should be kept in mind that despite the criticism, PEPFAR has made an enormous impact in the global fight against the HIV & AIDS epidemic, and is confident about meeting its goals of backing treatment for 2 million, preventing 7 million new infections and providing care for 10 million. It should therefore also be noted that issues such as these, where family planning integration continues to be neglected as an effective prevention strategy, are not limited to US funding policy alone.

AFRICAN LEADERS PERPETUATE THE ISSUE

Recently, a number of African leaders have made controversial moves in the area of family planning and HIV & AIDS. In March, for example, Ugandan President Yoweri Museveni stated, during a Parliamentary commemoration of 25 years of HIV & AIDS in Uganda, that the promotion of condom use pushes the youth into having sex, and that “Condom use is not good”. He went on to say that he “would not advise children to use them. Those were meant for prostitutes”. Coincidentally, these comments were shortly followed by a statement by World Bank social demographer John May, who revealed that Africa’s current population growth rate of 2.5 percent means that it will double by 2036. Africa’s population is growing twice as fast as those of other regions. This disturbing statistic seems to demand family planning intervention.

A month later, the State Commissioner of Health, Amobi Ilika, in the Southeast Nigerian state of Anambra, stated that “the use of condoms has greatly encouraged immorality”, and that children should not be taught “how to use condoms to enjoy sex, they should be taught total abstinence”. The encouragement of condom use and other forms of birth control has now been made illegal in the state, prompting concern from a number of sociologists, family planning specialists and AIDS support groups around the continent. This move has slightly contradicted the good family planning initiatives that have been implemented around the rest of the country.

As was discussed in last month’s newsletter, good leadership is essential in the fight against HIV & AIDS, as the youth, and in fact the entire country, look to their leaders for guidance and example. Messages such as these can have a severe negative effect on the various prevention efforts around the continent, and the fight against the epidemic as a whole.

A NEGLECTED NEED

It needs to be remembered that HIV-infected individuals have similar reasons to have children or to prevent unwanted pregnancies as anyone else. However, there are a variety of additional issues that they must consider during these decision making processes, and therefore it is imperative that HIV & AIDS services be integrated with family planning. In addition, it is critical that HIV-infected individuals are treated without discrimination or prejudice. The past few months have also seen the interesting development of at least 10 cases of forced sterilisation of HIV-infected women in Namibia. These women were allegedly sterilised without their consent, or without their knowledge, and a number of them then apparently enquired about family planning services, emphasising the fact that they were not aware of the implications of the procedure.

Despite the obviously huge need for the integration of family planning and HIV & AIDS services, the number of services currently available to people living with HIV & AIDS is inadequate, and the number of HIV & AIDS services that integrate family planning is minimal. Couples interested in building a family, whether HIV-infected or not, deserve to be given the information required for them to make informed decisions. Government policies, as well as international funding stipulations, need to take these points into account, and recognise that family planning is an important, tried and tested strategy in HIV prevention.

(1) Jonathan Mundell is Director: HIV & AIDS Unit at Consultancy Africa Intelligence (jonathan.mundell@consultancyafrica.com).

(2) These issue briefings can be found at http://www.usaid.gov

(3) Allen, R.H. (2007). The role of family planning in poverty reduction. Obstetrics and Gynecology. 110 (5), p.999-1002.

(4) Jamila Taylor’s article can be found at http://www.rhrealitycheck.org

(5) http://www.globalgagrule.org

(6) http://www.guardian.co.uk/commentisfree/2008/apr/16/aids.usa

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