Positive Disruptor

The population of Ethiopia’s capital city will suddenly surge on November 11. More than 3,000 researchers, government ministers, students and NGO leaders from 100 countries will gather in  Addis Ababa for the 2013 International Conference on Family Planning (ICFP). It’s yet another sign that family planning—once relegated to the global agenda’s hinterlands—is back. Two previous conferences led by the Bloomberg School’s Bill and Melinda Gates Institute for Population and Reproductive Health (Kampala in 2009 and Dakar in 2011) helped restore the field’s prominence. Then, at last year’s London Summit, governments and NGOs committed to delivering contraceptives to an additional 120 million women by 2020, and donors pledged $2.6 billion to do so.

Orchestrating the Addis conference’s 750 presentations in 150 panels, and  hundreds of parliamentarians and policy-makers, is Jose “Oying” Rimon II, MA,  Gates Institute deputy director. Rimon returned to the School in 2012 after five years at the Bill & Melinda Gates Foundation. Dubbed a “positive disruptor” by a former boss, Rimon is an exuberant, outspoken advocate with  a passion for evidence. He recently shared his vision for ICFP 2013 and his thoughts  on global family planning with Johns  Hopkins Public Health editor Brian W. Simpson, MPH ’13.

How do you plan a conference of this size?

You need vision and logistics. If it’s all vision without logistics, it’s going to fail. If it’s all logistics without the vision, it will just be another meeting.

Why does the field need another conference after the success of the London summit?

There’s some momentum after London, but that momentum needs to be substantive in terms of, is the money that the donors pledged actually flowing and how is that money going to be used. And on the  other side, are the developing countries owning this issue and allocating the right resources or implementing the right policies to their own situation. That’s still needed in a big way.

220 million women who do not want to become pregnant are not using contraception. What are the barriers to fulfilling this unmet need?

One is supply, the other one is demand. On the supply side, how do you make sure that the contraceptives that are needed for both spacing and limiting are actually available to the people who want them, when they want them? That means making sure that the stock-outs [when facilities run out of contraceptives] don’t occur as often as they do. In her field visits, Melinda [Gates] was surprised to observe that while there are no stock-outs for HIV/AIDS drugs or for vaccines, you have stock-outs for contraceptives. There’s something wrong with that picture, you know?

What’s the solution?

The tech experts call one solution the informed push model. That’s a complicated way of describing the Coca-Cola model: There is an established supply, and the suppliers just go and restock to the level determined for that area. If a store is supposed to have 1,000 bottles of Coke and there are only 400, they just stock it up to 1,000 and keep moving. It’s not rocket science.

And how do you address the demand side?

Especially in sub-Saharan Africa, there are still many countries where there is demand for high fertility among mothers and fathers. So Africans themselves have to work on educating people in terms of their options. And in virtually all of these countries, the desired number of children by mothers is almost always below the actual number of children in the family. Wouldn’t it be great if mothers could actually have the number of children they want? So behavior change, educational programs, outreach and counseling are key to addressing the issue of demand, the issue of misinformation and misconceptions, the fear of side effects, and oftentimes just the ignorance of where to go to get services.

How does a conference like the ICFP really effect change?

At many levels. When there is no sense of a community and there’s a feeling of abandonment, it’s like we can’t achieve anything. So this conference changes that perspective. It also brings in the exchange of best practices: What did Ethiopia do? Why are they successful? The reason we picked Addis is that we want to celebrate a little this time around. Ethiopia from 2005 to 2011 had an increase of almost 100 percent of their CPR [contraceptive prevalence rate]: Modern methods went from 14 percent to 27 percent.

How did Ethiopia achieve this?

They did this by political commitment at all levels, delivering services through a powerful health extension workers program and shifting tasks so a health extension worker can provide a contraceptive injection. It doesn’t have to be a nurse or a physician.

What do most people not understand about global family planning?

When I was at the Gates Foundation, we commissioned a series of surveys [of Americans] on international family planning. One of the major conclusions was that if you are advocating for family planning as an end to itself—that family planning is good—it doesn’t resonate as well with the American public because they think you have a hidden agenda like population control. But if family planning is positioned as reducing maternal mortality, infant mortality, unintended pregnancies and abortions, if you put it in that context, boom! Then all of a sudden you have overwhelming support.

So the field should be doing more to emphasize that family planning prevents maternal and child mortality?

Oh yeah. That’s the main argument now based on evidence. In The Lancet special issue on family planning last year, Saifuddin Ahmed [an associate professor in Population, Family and Reproductive Health] was the key author of a research paper that essentially said that satisfying the unmet need for contraception can prevent an additional 29 percent of maternal deaths per year. Other studies document a 19 percent reduction in infant deaths. It’s huge. I mean what other low-cost intervention could do that?