For 1.8 billion young people, family planning will be vital in shaping lives and livelihoods. As leaders prepare for the London Family Planning Summit, Lucy Lamble looks at the challenges ahead

LL Lucy Lamble

BS Beth Schlachter

JB Julia Bunting

LF Liz Ford

AK Ali Kaviri

AKM Annet Kyarimpa Mukabe

AN Annet Nabizzizzi

LL There are currently an estimated 1.8 billion young people in the world; the biggest cohort of young people ever, with nearly nine out of 10 of them living in developing countries. In 2012, London hosted a summit that set the agenda for family planning up to 2020. For a long time adolescents have not featured prominently on the development agenda, but increasingly there’s a realisation that their futures depend on being able to plan their families.



Preview clip from Uganda report So if we are not giving information to young boys and girls, then they don’t get the knowledge and empowerment they need to make great decisions. And of course, it affects the livelihood of the girl and the babies that they’re giving birth to.

LL In 2016 alone, 82m unintended pregnancies, 25m unsafe abortions and 124,000 maternal deaths were averted due to the use of modern effective methods of family planning. But despite this many people in the world still can’t count on access to contraception, and now many countries are about to face additional problems as the US cuts funding.

Rich countries pledge $2.6bn for family planning in global south Read more

I’m Lucy Lamble and this month on the Global development podcast ahead of the second London Family Planning Summit, we’re looking at how these challenges will affect the growing population of young people in the developing world and consequently the economy of their countries.

At the 2012 London summit, some of the world’s richer countries pledged $2.6bn over the next eight years and FP2020 was set up to monitor that promise. Beth Schlachter is their executive director.

BS In 2012, building on the excitement from the London summit, the global community set the goal of expanding access to contraception so that 120 million additional women and girls in the world’s 69 lowest income countries would be able to use contraception. And by that we mean that they would have access to a range of high quality products, that they would have healthcare services that consider their needs and are based on high quality information, on counselling sessions that really work with women to determine what their needs are and what would best suit their purposes.

LL Julia Bunting is from the Population Council.

JB When you give a woman or a young person the right to determine freely and for themselves whether, when and how many children to have, then their life chances are transformed. They don’t have unintended pregnancies, they’re not at much risk of unsafe abortions and maternal mortality. We see that they choose to have fewer children and to invest more in those children. So those children have greater life chances; they’re likely to be more healthy, they have more years of education and they’re more likely to be productive in the labour force.

And when we see this happen at an aggregate level – the choices of many individuals happening – then we see real benefits for countries in terms of their economic growth and development as well as things like security and stability.

LL That’s what’s known as the demographic dividend. How does that work?

JB The demographic dividend is a phenomenon that occurs when there is increased access to contraception that leads to reductions in fertility and that creates a change in the population age structure. So what we see is that there are fewer young people and more people of working age. And when we get that dependency ratio the number of young people to working age people when that reduces what we see is a real opportunity for economic growth because there are more people working.

Now for that to come to be, it’s not just that you need to increase access to contraception, you also need to increase human capital, improve people’s health and education, and you need to implement policies around labour and employment and trade.

And the demographic dividend is a very real phenomenon. We’ve seen it happening in countries around the world. So if you just take some of the examples, for example, the Asian tigers – the east Asian tigers countries like South Korea and Taiwan and Singapore – they experienced the demographic dividend between the late 1960s and the 1990s, and the economic miracle that we saw in those countries was in part a result of these investments. And they estimate that about a third of that economic growth was a result of harnessing the demographic dividend.

LL FP2020 publishes a report every year looking at the progress across the 69 countries they target.

BS Where we’ve seen considerable progress is in a lot of the difficult work that has to take place for governments to provide programmes to meet the needs of their citizens. So a lot of the work that we do as well is around social norms and around expanding the understanding within communities for why women should have access to products that give them control over the most intimate part of their lives. So we do a lot of work to help women understand what contraception is; to help communities support women having access to that, with the understanding that is women have more autonomy as they have healthier lives, as they have healthier children at birth and that they’re able to support them through early childhood, that we then have healthier families, stronger economics in local communities and potential for growth overall economically in countries.

'Global gag rule': stop playing politics with women's lives, MSF tells Trump Read more

So family planning is one of those interesting areas of work where both human rights and economics come together in a really interesting and challenging way. So we have to look at both sides of it, both the technical, the bureaucratic, the delivery side as well as the human side of healthcare and need for individual people.

LL Global development deputy editor Liz Ford travelled to Uganda where sex education is under great pressure.

AK So my name is Ali Kaviri. I’m a youth rights and women’s campaigner in Uganda. A Women Deliver young leader and I’m also the World Contraception Day ambassador for Uganda.

LF What about sex education in Uganda, is it taught in schools?

AK I will give you my experience. Like I only gotten about sex education maybe just a few phrases during biology lessons, where we draw the female reproductive organ. Where we would draw a female reproductive system, a male reproductive system and then have discussions and all that.

But in terms of sexuality education, or comprehensive sexuality education, right now they don’t even have this conversation, it’s banned. That means organisations cannot even take this message to young people. Young people now are just wondering on their own.

LL In Uganda, many believe that young people should not be educated about sex but instead be taught to abstain. Yet, adolescents are having sex. According to the country’s 2016 Demographic and Health survey, a quarter of girls aged 15 to 19 have had a baby or are pregnant. Annet Kyarimpa Mukabe is coordinator of safe motherhood with Reproductive Health Uganda.

AKM Uganda has one of the highest teenage pregnancies in the world, estimated at 25%. And one of the contributing factors is lack of access to family planning, cultural and traditional barriers that inhibit young girls from talking about sexuality issues. But also the environment in which young people access sexual and reproductive health services is not very conducive.

Uganda fails to target gay men and sex workers in fast-track HIV initiative Read more

LL Annet Nabizzizzi is a volunteer for Reproductive Health Uganda in Mbale.

AN I dropped from school because of unwanted pregnancy. I am a mother through very painful condition. I was 16 years, I gave birth at 17 years. I feel so bad for the young ones, the young girls. At least I counsel … I try to counsel them not to be like me.

LF So, Annet, if your 15-year-old daughter came up to you and wanted to talk to you or ask about taking contraception what would you say, or what would you do?

AN I first counsel her. But if she do insist I give the [contraceptives].

LF How would you feel about giving her something like that?

AN I feel very bad. I feel bad. I feel bad because early sex is not good.

LF But what would compel you to give her what she wanted?

AN Because she might get pregnant when she’s still in school.

AK What now this means for us as young people and especially with saying a lot in terms of increasing access to information so you can make informed choices in life, we’re going to see many young girls you know deferred. We’re going to have so many, let’s say, girls drop out of school due to pregnancy-related cases, due to child marriages, due to quite a number of things. And that means it has a bearing of course to the economy. That means you’re having child families that cannot be able to support and our people shall continue to live in poverty for many years to come.

LL In January this year, President Trump reinstated the Mexico City policy – also known as the “global gag rule”, which bars any overseas organisation receiving US aid from mentioning abortion in their work. In April, the US administration also cut funding to the United Nations Population Fund. Julia Bunting again.

JB We actually had decades of evidence around what works in family planning and decades of evidence that really shows the many and multiple benefits. It’s absolutely clear that the decision being put forward by the Trump administration to reduce their commitment to international family planning but to broader to health and development are going to be devastating. We know that when the Mexico City policy has been enacted in the past – under previous Republican administrations – that it’s led to reductions in services and to closures in clinics. And this version under President Trump is even bigger than that. We’re talking now about dramatic reductions in funding, not just in family planning but also across global health and development. And we expect that the results will be devastating for women and men and young people around the world.

LL Uganda may well be one of the countries affected.

AK I also happen to be a chair of the African Youth and Adolescent Network on Population Development, which is largely connected by UNFPA. And there’s a lot of support that we are receiving from UNFPA that is aimed at reaching out to youth groups ensuring that we have access to family planning information and services, to ensure that there is support for our comprehensive sexuality education, support aimed at saving mothers from dying, saving young mothers contracting fistula and so many other issues. So, that alone has a very big impact on women’s reproductive choices and it’s going to affect especially young people in Uganda that are heavily affected in this country.

LL The US announcement leaves a big funding gap, which means that national governments will now have to think hard about prioritising family planning in their budgets.

BS What we’re going to have to do is also see if our development partners in countries can do more as well to meet some of their need. UNFPA provides contraceptives in a number of countries but they also provide technical assistance and that’s where we really need to make sure that people on the ground to help developing countries to build their capacities, to expand their own programmes. So it’s those partnerships and efficiencies they’re in that are one of the areas that we’re going to have to look at in order to be able to maintain the programmes we have and to grow them for the future.

LL How are people on the ground going to get round this? Ali Kaviri again.

AK Through the Women Deliver programme and particularly through the World Contraception Day project that’s potentially between Women Deliver and Bayer, together with youth advocates, are being supported to launch a maiden, sort of, platform in this country. And that’s the Youth SRHR website. You can access it online. We are trying to ease information access to young people.

We have a broadcast radio, which is integrated with the website, and it’s purely broadcasting information around family planning. There’s a page where you can learn basically about family planning. You can even access some youth [information] that we have been able to release. You can have an interface with experts.

LL Annet Kyarimpa Mukabe.

AKM There are quite a number of non-government organisations that are providing youth friendly services. But this is limited in terms of numbers, geographical coverage and the reach for young people. So I think it’s important for governments to have youth friendly services in the public health facilities. That will address the stigma, but it will create space for young people. Space in terms of physical infrastructure, having trained staff in providing youth friendly services. But also at community level to be able to address the cultural and traditional barriers that stop young girls from demanding and using family and sexual reproductive services.

LL As stakeholders prepare to meet at the 2017 summit this summer, Beth Schlachter believes that now more than ever the global community must pull together.

BS So I think the summit comes at a perfect time because it allows us to plan together how we’re going to work together smarter and more effectively going forward, recognising that this a period of transition and uncertainty. So it’s a really positive moment for pulling the community together to say we’ve been working on family planning for 50 years; we’ve weathered different kinds of transitions before. We’re a strong sector, we know the work that we need to do, now let’s just get on with it. And let’s make sure we’re working the partnership in a way that keeps everybody together and making those decisions that are going to allow us to advance.

LL That’s all for this month’s episode of the Global development podcast. You can subscribe via iTunes, SoundCloud or your favourite podcasting app. And you can also listen to other episodes on theguardian.com/global-development. I’m Lucy Lamble and the producer is Kary Stewart. Thanks for listening. Goodbye.