Yearly Archives: 2014

Can 223 million women be wrong? A reflection on the status of voluntary sterilization programs

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Guest post by Lynn Bakamjian

Tanzanian couple receiving family planning counselling (Photo credit: Sala Lewis)

Tanzanian couple receiving family planning counselling (Photo credit: Sala Lewis)

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). Continue reading →

Public Sector Social Franchising: The Key to Contraceptive Choice?

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Guest post by Dr. Boubacar Cissé, Social Franchise Director of Marie Stopes International Mali (MSI/Mali)

A lot needs to change if we are to make contraceptive choice a reality for every woman. Public sector social franchising has the potential to unlock real change in Mali and in low income countries around the world. The term sounds complicated, but the principle is simple: leverage the country’s existing network of health facilities to maximize the contraceptive choices available to women. Mali currently has a contraceptive prevalence of nearly 10%, with long-acting and reversible and permanent methods of contraception accounting for just 0.2% of the method mix. When more family planning (FP) options are available, more individuals can meet their reproductive intention to delay, space, or limit future births.[1]

Photo Credit: Marie Stopes International (MSI)

Photo Credit: Marie Stopes International (MSI)

To expand access to a broader range of FP methods for women and couples, MSI/Mali and the Ministry of Health brought together 102 health clinics under the social franchise BlueStar brand. Many of these clinics already offer short-acting contraceptive options. However, when health clinics join the BlueStar social franchise network, MSI provides support to increase the range of FP methods available to include intrauterine devices (IUDs) and implants. MSI trains doctors, nurses, and midwives to provide these additional options. We also support the management of supply chains to prevent commodity stock-outs, as well as assist health facilities to raise awareness of available FP choices.

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The Road to Implementation: A User’s Guide for Applying a Rights-Based Approach to Family Planning Programs

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Guest post by Mariela Rodriguez, Research Associate, Futures Group

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 recently published Voluntary Family Planning Programs that Respect, Protect and Fulfill Human Rights: a Conceptual Framework Users’ Guide 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.

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MCHIP and PSI Promote Postpartum IUD to Expand Access to Family Planning for More Women

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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.

Participants gather for a demonstration of PPIUD insertion using anatomic models at a West Africa regional postpartum family planning workshop in Ouagadougou, Burkina Faso this past February. Photo credit: Jhpiego

Participants at the PPIUD meeting in Ouagadougou, Burkina Faso gather for a demonstration of method insertion using anatomic models. Photo credit: Anne Pfitzer

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Meeting the Reproductive Needs and Rights of Women and Girls: The Legacy of ICPD is in the Details

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Guest post by Mary Beth Hastings, Vice President of Center for Health and Gender Equity (CHANGE)

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.

Field research in Bahir Dar, Ethiopia. Photo by M.B. Hastings/CHANGE

Community-based health workers in Bahir Dar, Ethiopia met with CHANGE to share their comprehensive approach to sexual and reproductive health and rights. Photo by S. Sippel/CHANGE

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Getting Real on Rights: Experience from Two Country Consultations on Applying a Rights-Based Approach to Family Planning Programming

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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.

Photo by H. Connor/EngenderHealth

Members of the Futures Group/EngenderHealth rights framework team visit a community motivator in India’s Bihar State to identify the realities and challenges related to protecting and fulfilling human rights in FP at the community level—specifically to identify the conditions and practices that either uphold or violate human rights. (Photo by H. Connor/EngenderHealth)

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Family Planning for All: The Importance of Contraceptive Access and Choice following Fistula Repair

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Guest Post by Carrie Ngongo (Project Manager, Fistula Care Plus)

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.

Photo by R. Raj Kumar/EngenderHealth

Photo by R. Raj Kumar/EngenderHealth

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Ensuring Human Rights–Based Goals in the Post-2015 Development Agenda

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PictyureThis week, the Center for Reproductive Rights (CRR) published Substantive Equality and Reproductive Rights: A Briefing Paper on Aligning Development Goals with Human Rights Obligations, a new resource offering guidance on how governments can ensure that principles of substantive equality, including human rights principles and obligations, are reflected in the post-2015 development agenda.

Substantive equality calls for states to respect, protect, and fulfill human rights, ensure equality for all, and promote accountability for rights violations. The paper contends that violations of reproductive rights are primarily manifestations of discrimination, poverty, and violence. Therefore, where women’s rights to equality and nondiscrimination are not fulfilled, their ability to access reproductive health services and make meaningful choices about their reproductive lives is limited.

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Keeping Complexity in a Human Rights–Based Approach to Family Planning: Is It Worth It?

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Submitted by Shannon Harris, on behalf of the team led by Futures Group and EngenderHealth that developed the Voluntary, Rights-Based Family Planning Framework

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.

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