Monday July 2: In the UK family planning is a lifestyle choice but in many of the countries where global health charity Merlin works, this lack of choice can prove fatal.

As we approach the London Summit on Family Planning, it is estimated that every year 287,000 women and girls die from complications in pregnancy and/or childbirth. The vast majority of these deaths occur where poverty, conflict and natural disaster make everyday life a challenge.

This is why Merlin is determined to make it possible for more women to choose when to have children and how many.

Merlin is already helping hundreds of thousands of women in 16 countries make this choice which could literally save their lives. Merlin’s firm pledge is to give 1.5m additional women access to family planning by 2015.

Merlin’s chief executive, Carolyn Miller said:

“A pregnancy should be a cause for joy, not a potential death sentence. We will save lives by putting family planning at the forefront of our health programmes.

“When the public see us saving lives wrecked by disaster and disease they understand what we are doing. But we want people to realise that lives lost through pregnancy are a disaster too and one that we can prevent.

“Merlin is making great progress in giving women choice about having children. For instance, in Pakistan we are ahead of targets with more women taking up family planning than we expected. It is clear that they want to take control of their health, their incomes and their way they live their lives.”

Girls who have frequent pregnancies from being married in their early teens and women whose bodies are weakened through continuous childbearing are most at risk from dying as a result of becoming pregnant.

The simplest way to prevent these deaths is to prevent the pregnancy. There are 80m unintended pregnancies globally every year with many of these occurring where there is little or no access to family planning.

Merlin is striving to save the lives of women in some of the worlds’ toughest countries by helping them have the choice about having children that we take for granted.

The right to decide when and if she becomes pregnant with an informed choice of modern methods of contraception empowers women and underpins their right to health. But it is a right that has long been neglected and under-resourced. The London Summit on Family Planning is welcome if it results in lasting commitments to transform the lives of women and girls worldwide.

Family planning case studies

Philippines

Elvira lives in Tondo, a district of Manila known for its slum areas that is home to an estimated 283,000 people. The 39-year-old mother of four moved to the capital with her husband in the hope of a better life and a brighter future for their children. But today the family of six is struggling to survive on Elvira’s husband’s daily wage of 135 pesos (£1.91).

The latest national Family Health Survey revealed that the estimated maternal mortality rate (MMR) had increased by 36 per cent to 221 per 100,000 live births in 2011 (from 162/100,000 live births in 2009). This represents a serious concern for the country which is already struggling to reach its 2015 Millennium Development Goal target of reducing MMR to 52/100,000.

With two of her children already underweight, Elvira knew the risk to her family of conceiving again. On visiting a clinic, however, she was told that a contraceptive injection would cost 200 pesos a time in addition to the cost of travelling to the clinic.

Like in many other places in the Philippines, modern family planning is unavailable in the public health facilities of Manila and people have no choice but to turn to the private sector. Then a neighbour told Elvira about Merlin’s clinics in the three main slums areas of Manila, which provide information, counselling and free contraception to around 2,000 people a month.

Elvira is now a regular user of family planning services and just needs to come to the clinics every three months for follow up and further free services as needed.

Access to quality family planning services is one of the key components of Merlin work in Manila. The project, which is supported by the European Union and run in partnership with a national NGO called Likhaan, advocates for a sustainable response to the unmet family planning needs of the poorest and expects to provide more than 75,000 consultations over the next three years.

Pakistan

Mariyam Samar, 30 visits the Merlin supported health clinic in the village of Sheer Ali Shah, Thatta, Sindh. She has eight children, the youngest just 12 days old.

“I have eight children. My body feels exhausted and I’m weak. My children are gifts from Allah but I am tired of being pregnant and giving birth. We are very poor. I have too many children to think about and feed. I worry about how I will feed my children. I wait until they have eaten and if there is food left over I eat it and if not I drink a glass of water and go to sleep.”

Here, preventing pregnancy is not a lifestyle choice but a means of ensuring a mother's survival. In this part of Pakistan, women have on average eight children, and in some cases girls get married as young as 14, having a major impact on their bodies and on their health.