On the eve of London’s family planning summit, global contraception efforts are faltering – and Trump’s reinstated ‘gag rule’ makes matters worse, say experts

Global efforts to help millions of women plan their families – and address unsustainable population growth – are falling woefully short, with looming cuts in funding threatening to hamper progress further, campaigners warn.

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On the eve of a landmark summit in London called to accelerate family planning progress in 69 of the world’s poorest countries, latest figures show that an eight-year programme to get contraception to more than 100 million women is way off target.

Concerns are mounting, too, that policies introduced by Donald Trump slashing funds for family planning programmes will exacerbate the problem. The US is the largest donor for family planning, allocating $607.5m (£470.4m) this year.

The summit, coinciding with world population day on Tuesday, brings together top officials from more than 50 countries to discuss how to step up flagging family planning efforts.

The target to get modern contraception to 120 million women and girls by 2020 was set five years ago. So far barely 30 million have been reached – nearly 20 million fewer than the plan required at this stage.

The goal was established to bring international attention to an issue that reduces deaths in childbirth, improves women’s economic chances, and also addresses concerns over the growth in the world’s population – forecast to hit 8 billion in 2023 and almost 10 billion by 2050.

The countries predicted to see the largest growth in population by the mid-century are those with some of the highest rates of unmet need for family planning.

Recent UN predictions show that half the projected growth in population between now and 2050 will occur in Africa – a continent with the world’s highest fertility rates and the lowest use of modern contraception. The population of 26 African countries is predicted to at least double by 2050.

Some experts worry that rampant population growth in Africa will not just aggravate the current migration crisis but could play into the hands of terror groups across the Sahel who seek recruits among large, poor families with few options.



At the same time, the international will to address this has taken a heavy blow from some of Trump’s earliest decisions in office. Since January, Trump has announced a cut in all funding for international family planning in his proposed budget, has stopped funding the UN population fund (UNFPA), and has reintroduced the Mexico City policy, or global gag rule, which prevents money from going to overseas organisations whose work touches on abortion.

What is the 'global gag rule'? The rule, otherwise known as the Mexico City policy, requires NGOs to certify that they will not perform or promote abortions anywhere in the world as a condition for receiving US family planning funds. Every Republican president since 1985 has implemented it. But Donald Trump has adopted a stringent version of the rule, under which NGOs that refuse to sign will be refused all health assistance, including for HIV, primary care, nutrition, tuberculosis and malaria programs. As much as $8bn in US funding could be affected – money that developing world health budgets can ill afford to do without.









Trump’s policies have left some of the largest providers of reproductive healthcare services in poorer countries struggling for money. The International Planned Parenthood Federation (IPPF) and Marie Stopes International are already reporting the closure of family planning programmes in Africa, Asia and Latin America.

The UNFPA, the agency charged with ending maternal deaths and promoting family planning services, is facing a $700m funding gap for contraceptives over the next three years.

“It’s looking dire,” said Katja Iversen, chief executive of Women Deliver. “We see great people stepping up, but in no way in the magnitude that is needed. We’re seeing the largest cohort of adolescents ever … and the needs for contraception will be key for the whole world, not just for them.

“It’s a very important moment for the world to rally around women’s ability to decide their own fertility. In that sense, the family planning summit comes at a very good time.”

Erica Belanger, senior family planning adviser at IPPF, added: “There is a particular crisis in the funding of contraceptive supplies. The actual product is not being funded to meet the growing demand that women and girls have for contraception.”

Beth Schlachter, executive director of FP2020, established after a previous family planning summit in 2012 to work with governments to meet their commitments, said it was very unlikely the US Congress would approve a budget with no money for family planning. But she added: “We remain in a period of incredible uncertainty.

“Funding issues are critical and an ongoing challenge for all of us to confront together. Countries and donors each have a role to play. At the same time, we don’t want to lose momentum in supporting countries to achieve their own goals. We can’t let that uncertainty draw focus from the growing number of country and partner commitments that are driving progress.”

Finance and health ministers and senior officials from the European commission are scheduled to attend Tuesday’s summit, which is hosted by the UK government, the UNFPA and the Bill and Melinda Gates Foundation.

Discussions of the Mexico City policy are not on the agenda, but it is likely to cast a shadow over the meeting. The US is expected to send representatives.

Although not billed as a pledging conference, some new funding commitments are expected to be announced. The UK, the second largest bilateral donor for family planning, is expected to pledge extra money, as is the Gates Foundation. Canadian delegates are likely to use the conference to outline how their country plans to spend the $650m it has earmarked for reproductive health over the next three years.

Melinda Gates said the summit was coming at the right time. “Funding is being squeezed when we need it the most, because the biggest-ever generation of girls is entering adolescence,” she said. “If they are empowered to decide if and when to get pregnant, they can invest in themselves and their families. If they are not empowered, they may well be trapped in the same cycle of poverty as their parents.”

A number of companies are also expected to make announcements, which could include plans to fund family planning services to workers.

According to the Guttmacher Institute, the cost of meeting all women’s needs for modern contraception in poorer countries would cost $1.75 per person, per year, and would result in a 75% decline in unintended pregnancies, unplanned births and abortion annually.

Universal access to family planning is included in the sustainable development goals, adopted by 193 countries in 2015.