Building a Sustainable Family Planning Program in a Pronatalist Environment

Ukraine is shifting from abortion to contraception. To support Government efforts, the USAID-funded Together for Health (TfH) project has worked since 2005 with the Ministry of Health (MOH) to (1) build a national family planning (FP)/reproductive health (RH) Program, (2) secure Government investment in the Program, and (3) support effective Program management. TfH helped MOH design the Program consistent with the World Health Organization's RH Strategy. To build political support in the face of strong pronatalist policies, it developed advocacy papers outlining the rationale for FP in low-fertility countries. The Cabinet of Ministers adopted the State Program “RH of the Nation up to 2015” (SPRHN) in 2006, authorizing $100 million over 10 years for safe motherhood, FP/RH, youth RH and related topics, including $12.5mill. for contraceptive procurement and other FP investments. Designated priority populations were people living with HIV, youth, low income groups and women at medical risk. Regions drafted their own RH Programs, using a simple planning and budgeting tool developed with TfH support. By 2009, two-thirds of Ukrainian regions had adopted RH Programs, allocating over $100mill., including $18mill. for FP investments. More accountable Program management was fostered by coordinating committees at all levels and by setting up a monitoring system to track program expenditures and results. Although the economic crisis has constrained Ukrainian Government investment in the Program, the SPRHN continues to attract support from regional authorities and some donors, and Program management is improving. It serves as a regional example of sustainable Government commitment to FP/RH.