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Why Has Family Planning Become Almost Invisible as a Public Health Issue?

That's a good question, especially since the CDC named family planning one of the ten great public health achievements of the 20th century.

U.S. leadership in global funding of HIV/AIDS prevention and treatment programs has risen, while its support for contraceptive care programs has fallen. In the mid-1990s, the U.S. led the world in technical and financial support for contraceptive service delivery programs, but since 2002 White House requests for earmarked family planning/reproductive health (FP/RH) funding have either been flat or declined. While the president requested $30 billion for PEPFAR (upped to $50 billion by Congress), the FP/RH funding request in FY 2008 is only $302 million. U.S. foreign assistance averages only 65 cents per woman with contraceptive need.

So why should addressing contraceptive care for low-resource settings be more important than saving lives from the scourge of HIV/AIDS? Because family planning can help infected mothers who do not want more children to avoid transmitting the virus, protect couples from unplanned pregnancy and sexually transmitted infection, and provide young people with sexual health information and care that will serve them throughout their reproductive lives. Good public health focuses on prevention and equity, not just treatment. Today contraceptive use in one year in low-resource settings prevents 210.4 million unwanted births, which in turn prevents 34.2 million unsafe abortions, 10.5 million perinatal deaths and 687,000 maternal deaths. Are the lives of the 108 million women at risk of unwanted pregnancies each year less important than the 2.5 million people who may acquire HIV this year? If unwanted pregnancy was an infectious disease, do you think it would receive more attention?

Amy Tsui, PhD, is director of the Bill and Melinda Gates Institute for Population and Reproductive Health and a professor of Population, Family and Reproductive Health.

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