CROSS-COUNTRY SYNTHESIS: FAMILY PLANNING

The Exemplars in Family Planning research examined successful strategies to increase voluntary modern contraceptive prevalence by studying positive outlier countries that sustained progress. This cross-country synthesis presents high-level insights from our research in six Exemplar countries:, Malawi,, , Lao PDR (People's Democratic Republic), and . It explores the common drivers, lessons, and insights that shaped their achievements and that can support decisionmakers across contexts to allocate resources more effectively, craft evidence-based policies, and identify critical gaps that require additional analysis.

KEY INSIGHTS

• We identified several drivers of exemplary progress that operated through at least one of three overlapping pathways: strengthening enabling environments, improving supply and service delivery, and raising awareness for family planning (FP).

• International commitments like FP2020 attracted donor funding and encouraged countries to take action through new laws, policies, and programs. For all six FP Exemplar countries, a period of accelerated growth in modern contraceptive prevalence (mCPR) coincided with their endorsement of at least one regional or international family planning declaration. Financing played a critical role in driving FP progress, and several governments demonstrated commitment by creating dedicated budget lines for FP.

• Introduction and scale-up of new contraceptive products, especially implants in Kenya, Malawi, Senegal, and Sierra Leone, led to broad health system investments, including strengthened FP communication, improved supply chains, and expanded availability of products and services.

• Community health programs also expanded service delivery, which helped close equity gaps for rural populations. Related policy changes corresponded with rapid mCPR growth in four of the six FP Exemplar countries. Several countries allowed community-based distribution of injectable contraception through national task-sharing policies.

• Media campaigns that aligned FP with national priorities, such as reducing infant and maternal mortality, were effective strategies for generating demand and aligned with rapid mCPR growth in four FP Exemplar countries. The media campaigns were often complemented by community-level campaigns that engaged men, religious leaders, and respected elders as FP champions.

Our findings from the Exemplars in Family Planning research reinforce the importance of political commitment, domestic ownership of health, supportive laws and policies, and effective coordination among donors, governments, and civil society stakeholders in advancing FP in low- and middle-income countries.