Human rights–based family planning (FP) programming—what does it mean? Where do you start to translate it into practice? How comprehensive do you need to be? It is easy to become daunted by a long list of inputs and activities, such as those listed in the voluntary, rights-based family planning framework developed by a team led by Futures Group and EngenderHealth. The recent 2020 Vision newsletter refers to the overwhelming nature of existing guidance documents for ensuring that FP programs are rights-based and offers a simplified starting point. But will simplification of a complex set of challenges lead to the transformation in FP programming that our field needs?
We welcome the dialogue started by Population Action International (PAI) about how to move forward to protect and fulfill human rights within FP programs. This conversation is needed; multiple voices and views add richness to the discussion. PAI suggests starting with three priorities: voluntarism, informed choice, and achieving a diverse method mix. Certainly, we have to start somewhere, and these three elements are essential to rights-based FP— programs must be vigilant in preventing instances of coercion and in ensuring full, free, and informed contraceptive choice.
However, these program elements are not sufficient to ensure equitable access to services for all nor to ensure that the services are of high quality. They also do not address community factors that impede access to and use of FP. And they do not address the issue of accountability. These are critical considerations for reaching and fulfilling the human rights of the 220 million women with an unmet need for FP.
What value can be added by a seemingly complex model for a FP program that respects, protects, and fulfills human rights? First, a tool that provides a vision of a comprehensive, rights-based FP program can be useful to guide the design or assessment of programs in diverse settings. It can help local stakeholders identify the greatest needs and opportunities of their program to enable them to set their own priorities and starting point, which are likely to differ from program to program. Through the assessment process, decision makers may find that there is greater need to expand services to reach underserved groups than to invest more in existing service models. Or they might find that service quality negatively affects continuation rates or prevents people from accessing services in the first place and that improving the service delivery environment is what is needed. Focusing on a predetermined set of priorities may not suit local needs.
Second, such a model highlights the need to infuse rights into all dimensions of programming (from policies to service delivery to community settings)—where to start depends on where you are and where the greatest opportunities and challenges lie: developing contraceptive technologies that meet more people’s needs and making those technologies accessible; increasing service delivery capacity and service points to increase access; conducting policy review to identify rights barriers that warrant reform – all of these actions contribute to fulfilling rights. Essentially, rights apply to all aspects of programming, but not everyone does all aspects of programming—and that is okay. The logistics experts work on logistics, the service delivery experts work on service delivery, the advocacy experts support advocacy. However, all these different actors need to know what rights mean for their part of the program and how they can better incorporate rights into what they do. Of course, no one can do everything at once, but a cookie-cutter approach falls short because of the diversity of needs, interests, and expertise in FP. There is also a risk that the proposed starting point will become the end point, and we will continue to fail to address the full range of critical challenges to human rights in FP.
Finally, there is an unanswered question as to whether rights will increase service access and use. Although some might argue that the question is irrelevant, because rights are entitlements and legally enforceable, there is interest in learning whether integrating rights will improve outcomes. However, if a simplified version of a rights-based approach is used as the intervention and we don’t see a change, can we say that rights don’t work to increase the health and well-being of individuals and are therefore unworthy of investment? Designing programs that incorporate rights, test hypotheses, and measure impact requires a conscientious effort to include all that a human rights-based approach offers.
A comprehensive articulation of a human rights-based approach to FP helps to broaden the lens of inquiry and is likely to help policymakers, program managers, providers, advocates, donors, and clients prioritize and decide how programs can best meet the needs of the people they serve. It sets a vision toward which all of us can progressively work.