Family planning (FP) programs in developing countries have been experiencing a phenomenon that I like to call “the leaking bucket.” Let’s say that you place a bucket under an open tap and watch the water level rise, until you discover a hole in the bottom of the bucket. Water is now leaking out of the bucket. Filling the bucket will be easier once the hole is plugged. In the same way, meeting women’s desire to reduce unwanted fertility will become easier once FP programs pay more attention to contraceptive discontinuation.
Like all women and men, people living with or at risk of acquiring HIV have the right to determine the number and timing of their children and to safely achieve their reproductive intentions. Yet many women and couples affected by HIV lack access to family planning (FP) services and experience disproportionately high rates of unintended pregnancy and abortion. Why is this so? One major challenge is that myths, misinformation, and stigma with regard to the sexual and reproductive health (SRH) rights of people affected by HIV continue to persist among healthcare workers.
Research has shown that healthcare providers often have poor knowledge, attitudes, and behavior with regard to providing contraception to clients affected by HIV. For example, they often (incorrectly) emphasize condoms as the sole FP option appropriate for these women and couples. Moreover, most do not routinely discuss the importance of dual method use, offer other more reliable contraceptive method options, or provide emergency contraception.
On July 17, Katja Iversen, CEO of Women Deliver, published “Working Hard to Get the World We Want: Sexual and Reproductive Health and Rights After 2015” on The Huffington Post’s Global Motherhood blog. In this post, Iversen reports on the work of the Open Working Group (OWG) for Sustainable Development Goals, which is comprised of representatives from 70 countries and tasked with the creation of a new global framework for development that they are set to present to the United Nations Secretary-General Ban Ki-moon by the end of July. The influence of this report on the future of international development, sustainability, and human rights cannot be overstated.
The goals and targets it proposes—and the issues explicitly addressed—will be of utmost importance in the shaping of the post-2015 development agenda. Due to conservative push-back, Iversen decries, the current report language fails to include sexual and reproductive health and rights (SRHR), as well as the health of young people despite the fact that “the majority of governments have identified [SRHR] as a priority to get the world on a sustainable path.”
The blog post discusses the vital role that voluntary family planning and ensuring rights and contraceptive choices for women and girls play in ensuring equal opportunity, economic growth, and the development and maintenance of healthy populations. Iversen urges readers to take action and suggests ways to become involved in supporting the push for inclusion of SRHR in the forthcoming global development framework. Read this important post and join EngenderHealth, Women Deliver, and other organizations and individuals in the effort to make SRHR a priority in the post-2015 global development agenda and a reality for all.
Guest post by Lynn Bakamjian
Today, as family planning (FP) programs are receiving renewed attention and resources as a result of FP2020, several important issues have risen to the top of the investment agenda. These include increasing access to quality long-acting reversible contraceptive (LARC) methods; task-shifting FP information and services to lower level health workers to address provider shortages; and scaling- up approaches that extend services, such as postpartum FP , mobile services, and increased engagement of the private sector. As programs strive to make more contraceptive choices available to reach more than 200 million women with an unmet need for FP, there is one topic that receives little attention—how to expand access, availability, acceptability and quality of permanent methods (PMs) (voluntary female sterilization and vasectomy). (more…)
Human rights. Contraceptive choice. Access. Information. Empowerment. What do all of these things mean? How do they relate to family planning (FP)? Since the 2012 London Summit on Family Planning and the movement it initiated, FP2020, the topic of human rights and empowerment in FP has risen on the international development agenda. We know that the Summit “underscored the importance of access to contraceptives as both a right and a transformational health and development priority.”[i] But what does this mean in practice? How can FP programs turn rhetoric about rights into a reality?
The newly published Voluntary Family Planning Programs that Respect, Protect and Fulfill Human Rights: a Conceptual Framework Users’ Guide (beta version) is intended for use in conjunction with the Voluntary Family Planning Programs that Respect, Protect, and Fulfill Human Rights: A Conceptual Framework, published in 2013 by Futures Group and EngenderHealth with funding from the Bill and Melinda Gates Foundation.[ii] The User's Guide is intended for use by a wide audience spanning policymakers, program managers, health providers, rights advocates, civil society organizations, donors, technical assistance agencies, implementing organizations, and researchers. The document contains three modules to orient stakeholders to the framework and to guide the processes for using it to assess, plan or strengthen, monitor, and evaluate FP programs through a human rights lens.
Guest post by Holly Blanchard, Senior Reproductive Health/Family Planning Advisor, Maternal and Child Health Integrated Program (MCHIP)
Access to a wide range of safe and effective contraceptive options is every woman’s human right, including those who have just given birth. Access to family planning (FP) not only enables a woman to achieve her and her partner’s desired family size, but also contributes to improved health outcomes for both women and children. However, in many low resource settings, postpartum women are offered a limited range of FP methods, if they are counseled on postpartum FP (PPFP) at all. With increasing numbers of women delivering in health facilities, the opportunity to offer the option of immediate postpartum intrauterine device (PPIUD) services should be maximized.
The task of translating the International Conference on Population and Development’s (ICPD) Programme of Action (PoA) into meaningful change for women and girls globally includes some important detail work. Several years ago, my organization – the Center for Health and Gender Equity (CHANGE) – set out to better define the meaning of key PoA terms. Our guiding question was: “What constitutes comprehensive, rights-based sexual and reproductive health (SRH) care?” We found some useful literature and human rights documents to point us in the right direction, but most importantly, we wanted to make sure our answer was grounded in the lived experiences of women and girls.
Guest post by Shannon Harris
Given the many challenges that countries face in providing family planning (FP) services, how can a client-centered, rights-based approach to programming help governments meet their obligations to respect, protect, and fulfill clients’ rights to meet their reproductive needs and desires? This question framed two recent country consultations in India and Kenya to explore the feasibility and desirability of applying the voluntary, rights-based FP (VRBFP) conceptual framework. Were country-level FP stakeholders—program managers, policymakers, and providers—even interested in such an approach?
With funding from the Bill & Melinda Gates Foundation, the Futures Group and EngenderHealth partnered with the Population Foundation of India and the National Council for Population and Development in Kenya to host national and regional stakeholder consultations, as well as conduct FP site visits to explore these questions. Despite diverse cultural, policy and program environments, stakeholders in both countries expressed tremendous interest in using a rights-based approach. Stakeholders found the program vision described in the VRBFP framework appealing and relevant to their programs because of its emphasis on the individuals and communities served by the FP program, while simultaneously acknowledging the importance of the policy environment and supply-side factors.
People often assume that women who’ve undergone an obstetric fistula repair are not interested in using family planning (FP). After all, most lost a baby during the obstructed labor that led to their injury. However, recent studies (see here and here) indicate that fistula clients are often interested in using FP if they learn about available methods and services during their post-repair recovery period. When fistula surgeons and counselors make assumptions about women’s desires, they miss the opportunity to provide needed services and to offer reproductive choices to women who may have been disadvantaged and marginalized as a result of their injury.