Building on Experience: Lessons about Family Planning from Four Former Directors of USAID’s Office of Population and Reproductive Health

Access to voluntary family planning has far-reaching implications for the economic empowerment and the health of women and their families. And never has the demand for family planning services been so large or grown so quickly in low- and middle-income countries. Yet, even as demand continues to grow, international support for family planning has fallen for the second year in a row. Compounding this problem is that country commitments are hard to measure and often undermined by currency fluctuations. Support from the US government—the largest bilateral donor to family planning—is increasingly uncertain. Although, this is not the first time that uncertainties have been experienced.

Last month, CGD hosted four former directors of USAID’s Office of Population and Reproductive Health to reflect on their experiences, which spanned US administrations from Ronald Reagan to Barack Obama. (You can watch the event here). Below, we highlight three main takeaways— the critical role of technical leadership, the importance of data, and the need to start with the end in mind when planning for successful transitions.  

1. More than Money: USG Technical Leadership

“What characteristics does USAID have that other sources of funds don’t have? … Knowledge generation. Many of the examples we’ve talked about are knowledge generating activities that USAID has been involved in and if we were to lose that, it would be a loss, not just for our programs, but for the field, in general.” – Duff Gillespie

“The single most important feature of AID assistance has really been the technical leadership and innovation—and people have to keep pushing the boundaries, keep innovating, keep providing that technical leadership, keep showing the way, make sure it’s well-documented, there’s good evidence, make sure evidence is turned into action, and make sure that there’s an opportunity to scale up.” – Liz Maguire

Much of the US government’s impact on international family planning stems from its deep technical expertise and support for innovation. Panelists reflected on the office’s crucial role in strengthening organizations that work in partnership with host countries, which allowed new donors in family planning to build rapidly on the capacities USAID had in place. As the donor landscape expanded, USAID’s deep understanding contributed to the creation of FP2020 and the Ouagadougou Partnership. Attention to the quality of care and voluntarism in family planning programs has long been a hallmark of USAID support. Underlying the field-based expansion of quality family planning services, the US government remains one of the very few institutions with a strong history of support investment in R&D for new and newly adapted contraceptives that are used by women both in the US and around the world.

2. Leading the Movement: Data to Drive Program and Policy Decisions

“The DHS has been a very useful tool to show that these programs are actually having an impact. . . I think that having the data to show that it [family planning] does work and to help inform program and policies about what is it that is working is a critical investment.” – Scott Radloff

“[Developing a budgeting model] allowed us to identify the highest-priority countries—at the time we had 13 countries we identified as high-priority, mostly in Africa and some in South Asia as well. Even though the budget was more or less stable, stagnant over that period of time, we were able to double, and then I think triple, the resources going to those thirteen countries.” – Scott Radloff

From the creation of the World Fertility Surveys—the basis for the Demographic and Health Surveys—the office has a longstanding history in gathering and using data. Early data modelling tools that clearly demonstrated the role family planning contributes across many development sectors set the standard for data-based policy dialogue with host country governments as they determined how to set and reach their larger development goals. And in the early 2000s, the office established a set of indicators to identify priority countries for USAID family planning investments and decentralized decision-making to local USAID mission staff. Many of the lessons of using data-based decisions to strategically program resources have been adopted and expanded upon by FP2020 and other global platforms.

3. Start with the End in Mind: Planning for Successful and Sustainable Country Transitions

Recognizing that phase-out of external funding should be systematic to be successful, in 2006 USAID defined a family planning graduation strategy. The strategy relied on a set of indicators to identify countries that were good candidates. As the process unfolded, USAID concentrated on partnering with each government to increase country ownership and transition away from assistance. 

“We felt we needed to have criteria and data that would allow us to say, no [this country is] not ready. Or, let’s have some real analysis out in the field to really make sure that what we’re doing won’t leave that country going backwards as opposed to continuing to go forwards.” – Margaret Neuse

“[Following] the criteria really helped make for a more robust transition.” – Liz Maguire

“There are places where, in fact, consumers already pay a great deal out of pocket…and one area where AID has done fabulous work in is looking at private sector options, be it social marketing, be it doctors adding family planning to their practices, etc. and. . . other types of creative funding mechanisms” – Margaret Neuse

Historically, once a country was identified, there was an intensive multiyear process that brought together host country governments, USAID’s Washington and mission staff, and local partner organizations to ensure the continued procurement of contraceptives, quality service delivery, and a supportive policy environment. Sustainable financing was often central to the process, at times including unique models, such as impact bonds, endowments, and enterprise funds. The strategy allowed for effective and sustainable transitions of many countries in Latin America, as well as others like Morocco and Turkey.

The shared experience of these four former directors highlights three unique strengths of USAID’s Office of Population and Reproductive Health and provide overarching lessons for US and international family planning practitioners during a time of funding and policy uncertainty. Concern was noted about the impacts of the Mexico City Policy, including the well-documented role of family planning in decreasing abortion.

Independent of administrations or the congressional environment, USAID family planning programs have played a leading role in supporting expanded access to high-quality voluntary family planning through technical leadership, diplomatic and policy engagement, and financial support. Their history reinforces the importance of using data to ensure the most impactful use of scarce resources while focusing on the long-term goal of building more resilient and sustainable programs, and exploring creative approaches to design alternative financing mechanisms. Laying the groundwork for the investment case for family planning is more important than ever, and critical in enabling the community to harmonize efforts for short- and long-term planning and results.

Thanks to Jessie Lu for contributions to this post.