Transitions in Family Planning


Many middle-income countries are seeing significant declines in donor financial and technical assistance across multiple health areas, including not only communicable diseases but also family planning. In many of these countries the family planning community—composed of national program officials, NGO and CSO staff, donor partners, and others—are less aware of these impending transition risks and are less prepared to advocate for more domestic resources, as compared to other programs such as HIV and immunization. To address these challenges, national and global family planning constituencies must act swiftly to plan strategically for donor withdrawal and critically address sustainability challenges. If not, there is a danger that past successes in expanding access to safe contraception for millions of women and girls worldwide will be eroded.


In collaboration with the Center for Global Development (CGD) and with funding from the Bill & Melinda Gates Foundation, Pharos conducted a global landscaping of countries receiving donor assistance for family planning and completed family planning transition risk assessments in three case study countries: Ghana, Kenya, and Bangladesh. Based on these analyses, Pharos is proposing recommended actions for national governments and donor partners to address key risks to family planning programs throughout transition and suggesting strategies to enhance advocacy efforts and secure more government funding and support in the face of simultaneous decreases in donor aid for other health areas, especially HIV, tuberculosis, malaria, and immunization.

This Pharos project was carried out in three phases:

Phase 1 (May 2019 – June 2019): Through an analysis of key metrics, Pharos identified 22 middle-income countries that are expected to see declines in family planning and other health aid over the coming years, but are not well prepared for the shocks of this transition. Drawing on relevant literature, Pharos also developed a framework to assess family planning transition risks in the areas of financing, procurement and supply chain, technical capacity, and legal & human rights. This framework was validated through interviews with global family planning and transition experts.

Phase 2 (July 2019 – September 2019): Pharos selected Ghana, Kenya, and Bangladesh for deeper analysis. The Pharos team completed a desk review of the family planning programs in these countries and conducted field visits in Ghana and Kenya, meeting with family planning, health financing, and other stakeholders and collecting data and documentation. A series of key informants from Bangladesh were interviewed remotely. From these conversations, Pharos refined its set of priority transition risks and recommendations for each country.

Phase 3 (October 2019 – March 2020): Pharos completed the write-ups for the three case study countries and developed cross-cutting recommendations for national governments and donor partners. Detailed recommendations are located in the report attached below.

The full Pharos report was revised and validated through discussions with country and global experts. In March 2020, the Pharos team presented key findings and recommendations at a CGD-hosted meeting for family planning and health transition experts around the world.


This report is one of the very few to date to examine the challenges of impending transitions in family planning in middle-income countries. It aims to encourage the family planning community to develop standardized tools for sustainability and transition assessments and to commit the financial resources and technical expertise to conduct these analyses in the 22 highest-risk middle-income transition countries. Pharos is actively engaged with key family planning donors such as UNFPA and USAID to increase awareness and advocate for stronger preparation for family planning transition.

Status: Complete

Team Members Involved: Devyn Rigsby, Gabrielle Appleford, and Robert Hecht.

For more information, contact Robert Hecht at [email protected].

LEARN MORE about Pharos Global Health Advisors response to the COVID-19 pandemic.