Voluntary Family Planning: The Under-tapped Potential to Reduce Maternal Deaths by 30% in Africa
By Mark Akanko Achaw
There is compelling evidence highlighting the socio-economic and health benefits of expanding access to voluntary family planning services for women of reproductive age. Family planning plays a vital role in ensuring safe motherhood, averting nearly 30% of would-be maternal deaths, promoting healthy families, and yielding significant demographic dividend (i.e., rapid economic growth that can occur when the proportion of a country’s working-age population grows larger than its dependent population).
Since 2012, the use of modern contraceptives has prevented approximately 1.4 million maternal deaths (Figure 1). Despite this progress, over 218 million women in low- and middle-income countries (LMICs) still lack access to modern contraceptives. By 2035, the number of individuals in LMICs requiring modern contraceptive methods is projected to increase by 95.4 million.
Figure 1: Number of Maternal Deaths Averted as a Result of Modern Contraceptive Use (2012–2023)
What is the cost?
Globally, expanding and improving modern contraception services to meet the needs of all women and girls in developing countries is estimated to cost only US$1.93 per person annually. By including maternal and newborn care, the total estimated annual cost would increase to about US$8.56 per person. The cost analysis further indicates that investing in both contraception and maternal and newborn services could yield a net savings of US$6.9 billion.
However, despite the evidence, developing countries, especially in sub-Saharan Africa, are investing less in family planning and maternal and child health. In 2020, an estimated funding gap of US$322 million for contraceptives was recorded across 148 developing countries, and this gap continues to grow. By 2030, the world’s poorest countries are expected to face a contraceptive financing gap of approximately US$1.5 billion. In Ghana, the estimated financing gap is about US$7 million by 2023.
What is being done about the financing gap?
Despite ongoing efforts by national governments and the FP2020 and current FP2030 global partnerships to increase family planning funding, the financing of family planning services remains heavily reliant on external donors and individuals. Currently, donors account for nearly half (49%) of the total costs for reproductive, maternal, neonatal, and child health services.
At the recent UN General Assembly (September 2024), governments and philanthropies pledged approximately US$350 million to expand access to family planning and reproductive health services. While these contributions are crucial to advancing reproductive health globally, the current progress remains too slow to meet the growing needs, particularly for the rapidly increasing youth bulge (large youth population) in Africa. To harness the potential of the youth bulge, providing accessible education and voluntary family planning options for young people can drive rapid economic growth.
What is the role of domestic resources?
Adequate domestic resources provide sustainable financing for family planning (FP); however, this remains challenging as many African countries still struggle to meet their 15% Abuja targets. Currently, Africa’s domestic government health expenditure represents only 34% of total health expenditure (THE), compared to 47% in Southeast Asia and 67% in Europe. Between 2018 and 2020, the average health expenditure on contraceptive management (as a percentage of THE in Africa was just 2.5%, with Ghana recording one of the lowest rates at 0.1% (Figure 2).
Figure 2: Average Health Expenditures on Contraceptive Management as a Percentage of Current Health Expenditure (2018–2020)
To fully leverage the economic potential of Africa’s youth bulge, evidence-based advocacy with ministries of finance is essential to highlight the demographic dividend that could be achieved through increased investment in reproductive health.
What needs to be done to accelerate progress?
To harness the demographic dividend while ensuring healthy and productive lives for women and girls globally, the following steps are essential:
- Hold Governments Accountable for FP2030 Commitments. Governments must be held responsible for fulfilling their FP2030 pledges through deliberate advocacy efforts and direct technical support. For example, in Ghana, USAID, through PROPEL Health, provides technical assistance to implement innovative strategies towards expanding fiscal space for health via increased budget allocations and efficiency gains. This support has led to evidence-based, costed implementation plans for the national FP2030 commitments. PROPEL Health is providing similar assistance to other countries, including Burkina Faso, Cameroon, Côte d’Ivoire, Guatemala, Madagascar, Malawi, Mauritania, and Togo.
- Catalyze Private Investment. As development assistance for health declines, the private sector emerges as a sustainable source of funding to complement government allocations. Organizations, such as the International Planned Parenthood Federation and its local partners are already advancing the private family planning market. In Ghana, as part of domestic resource mobilization efforts, the USAID-funded PROPEL Health recently completed a philanthropic fundraising assessment for family planning. Based on this, plans are underway to launch a fundraising platform focused on family planning and reproductive health.
- Integrate Family Planning into National Basic Health Packages. To ensure better access and close the financing gap, family planning must be embedded in national primary health care service packages and fully funded through government budgets or domestic resources. While platforms like FP2030 and donor funding (the U.S. Government alone contributes 40% of total donor funded contraceptives to developing countries) are crucial for addressing short- to medium-term unmet needs, ensuring accessible, high-quality family planning services as part of routine primary health care is essential for long-term sustainability.
By taking these strategic steps, countries can ensure the well-being of women and girls, drive sustainable economic growth, enhance health outcomes, and empower future generations.
Mark Akanko Achaw is Senior Health Financing Advisor on the USAID-funded global PROPEL Health project and is currently supporting various activities in Kenya, Ghana, and Malawi.
