Behavioral change communication is critical for the success of voluntary and choice-based family planning programs

Guest post by Banchiamlack Dessalegn, Ph.D., Senior Technical Advisor for Monitoring, Evaluation and Research, Family Health International 360 (FHI 360), Addis Ababa Ethiopia

Knowledge and awareness of available family planning (FP) methods, as well as of their benefits and side effects, is a prerequisite for informed decision making (Bongaarts et al., 2012). Behavior change communication (BCC) is a tool for increasing knowledge and awareness. In this way, BCC can be seen as critical to facilitating successful voluntary, choice-based FP.

FP options

The Government of Ethiopia aims to increase the modern contraceptive prevalence rate (mCPR) to 55% by 2020, as stated in Ethiopia’s new Health Sector Transformation Plan. To achieve this, the Federal Ministry of Health (FMOH) is putting emphasis on improving the FP method mix, including by increasing demand for and access to long-acting and permanent methods of FP (LA/PMs) without compromising informed and free choice. While target-setting at the national and subnational levels might lead to the erosion of choice-based FP services, the FMOH has given clear direction that services must be based on proper counseling and free choice. As a result of the concerted efforts and results-oriented policies of the FMOH, impressive achievements have been made in recent years, with the mCPR increasing from 28.6% in 2011 to 41.8% in 2014 and the total fertility rate dropping from 4.8 to 4.1 lifetime births per woman during the same period (CSA [Ethiopia] & ICF International, 2012; CSA [Ethiopia], 2014).

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A means to an end, or an end in itself? Rights, access, and comprehensive sexuality education

Guest post by Heather Barclay, International Planned Parenthood Federation

Comprehensive sexuality education (CSE) has been the focus of much discussion and political debate over the years. It has been lauded as the way for young people to be empowered and realize their rights, as well as a means through which to create demand for family planning and sexual health services. But as with many highly politicized debates, the truth lies somewhere in the middle.

A hallmark of CSE is its rights-based approach to education about sexuality, gender, sexual and reproductive health, and sexual behavior. It equips young people with life skills and empowers them to make autonomous, informed decisions about their bodies and futures. That means teaching young people comprehensively both about the biology of sex and about the personal, emotional, societal, and cultural forces that shape the way in which they choose to conduct their lives, including their sexual and reproductive lives. In particular, CSE imparts information, promotes responsibility, and equips youth to question why they act in certain ways, so that they can make informed and considered decisions that allow them to have healthy and empowered lives.

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Gender Norms and Power Inequities: Key Barriers to Realizing Sexual and Reproductive Rights

Guest post by Christina Wegs, Senior Advisor for Global Policy and Advocacy, CARE

December 10th was International Human Rights Day. This day commemorates the adoption of the Universal Declaration of Human Rights (UDHR) by the UN General Assembly in 1948, which affirmed the rights of all people, everywhere and all the time. The Declaration, as well as similar international treaties and agreements, confirm the centrality and importance of protecting and fulfilling sexual and reproductive rights (SRR). Embraced within the concept of SRR is the right to reproductive self-determination; the right to sexual and reproductive health (SRH) information, education, and services; the right to the highest attainable standard of health; and the right to equality and non-discrimination.

Despite international recognition of the importance of SRR, sixty years on and twenty years after the International Conference on Population and Development, women and girls in every part of the world continue to face considerable barriers to realizing their SRR. In many places, unmarried women and adolescents are denied access to reproductive health information and services, many women are not able to exercise full, free, and informed contraceptive choice, and women continue to die from preventable complications of pregnancy and childbirth. Pervasive gender inequality limits women’s decision-making autonomy and undermines their health and well-being throughout their lives. Finally, many women—especially poor and socially marginalized women—continue to experience systemic discrimination in health care, which not only results in poor quality of care and poor health outcomes, but also acts as a powerful disincentive to women seeking care.

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Health in hand: New contraceptive option expands access to family planning

Guest post by Sara Tifft, Project Director, PATH Sayana® Press Pilot Introduction project

Worldwide, women choose injectable contraceptives because they are safe, reliable, and discreet. In many rural or remote areas, however, travelling to a clinic to receive an injection is costly and burdensome. PATH, an international nonprofit health organization, is collaborating with global partners to address this challenge. We began with a basic question: What would it take to deliver more injectable options to women, particularly outside the clinic setting?

One answer is Sayana® Press: a small, easy-to-use injectable contraceptive that has the potential to increase access and choice for millions of women worldwide.

PATH is training community health workers in the Mubende district of Uganda to expand access to family planning, including the Sayana Press injectable contraceptive shown here. Photo credit: PATH/Will Boase

PATH is training community health workers in the Mubende district of Uganda to expand access to family planning, including the Sayana Press injectable contraceptive shown here. Photo credit: PATH/Will Boase

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Sexual and Reproductive Health and Rights and the Post-2015 Agenda: What’s Next?

Guest post by Françoise Girard, President of the International Women’s Health Coalition (IWHC)

Women's rights advocates at the 58th session of the Commission on the Status of Women on March 21, 2014. Photo credit: UN Women/Jeca Taudte

Women’s rights advocates at the 58th session of the Commission on the Status of Women on March 21, 2014. Photo credit: UN Women/Jeca Taudte

“You’ve done remarkably well!” Those were the admiring words of an incredulous high-level United Nations (UN) official, when a colleague and I met him a few weeks ago to discuss the outcome of the Open Working Group (OWG) of the General Assembly on the Sustainable Development Goals (SDGs). “We,” of course, are the women’s groups (organized as the Women’s Major Group) who’ve fought long and hard to ensure that a standalone goal on gender equality would feature in the SDGs proposed by the OWG. The inclusion of gender equity was not a given, but it was achieved.

We had also pressed governments to ensure that sexual and reproductive health and rights (SRHR) would be included as targets under both the gender goal (SDG 5) and the goal on health (SDG 3). We came away with a significant, if partial result: Under SDG 3, governments agreed, by 2030, to “ensure universal access to sexual and reproductive health care services, including for family planning, information and education, and the integration of reproductive health into national strategies and programmes” (target 3.7). Under SDG 5, they also agreed to “ensure universal access to sexual and reproductive health and reproductive rights as agreed in accordance with the Programme of Action of the ICPD and the Beijing Platform for Action and the outcome documents of their review conferences” (target 5.6).

Governments also agreed to “eliminate all harmful practices, such as child, early and forced marriage and female genital mutilations” (target 5.3). Other important targets included to eliminate all forms of violence against all women and girls (target 5.2), reduce the global maternal mortality ratio to less than 70 per 100,000 live births (3.1), end the epidemics of AIDS, tuberculosis, and malaria (3.3) and achieve universal health coverage, including financial risk protection, access to quality essential health care services, and access to safe, effective, quality, and affordable essential medicines and vaccines (3.8). Compared to the Millennium Development Goals, the proposed SDGs represent significant progress, addressing critical areas for action that, if implemented, will transform the lives of women and girls globally. They also put the lie to claims that “we could never get today the agreements we obtained in the 1990s.” We have in fact gone beyond them.

What now? The General Assembly will begin its final negotiations on the final post-2015 development agenda early next year, for adoption in September 2015. Governments from the global South have clearly indicated that they expect the outcome of the OWG to be the basis for negotiation, and would not tolerate attempts by the Secretary General’s staff to “streamline” its 17 goals and 169 targets. That is good news for SRHR, because these targets were the most thoroughly debated and negotiated in the OWG. What emerged on SRHR from the OWG certainly represents global consensus, despite objections from a handful of opponents led by the Holy See and Saudi Arabia.

The OWG document can and should be improved upon. Human rights, the rule of law, and access to justice were not sufficiently established as key aspects of development. As noted by several governments last month at the UN General Assembly’s first ever panel discussion on child marriage, preventing child, early, and forced marriage should be its own target since it has multiple, far-reaching causes and consequences. “Sexual rights” (i.e., the right of everyone to have control over matters related to their sexuality, free of coercion, discrimination, and violence) were omitted from the SDGs, despite having been agreed to by governments at Rio+20 and recent ICPD Beyond 2014 reviews in Africa, Asia-Pacific, and Latin America and the Caribbean. Non-discrimination on the basis of sexual orientation and gender identity, which the UN Human Rights Council has just again denounced, should be included. Finally, adolescents and their right to sexual and reproductive health services and information, including comprehensive sexuality education, must be addressed if the post-2015 agenda is to be relevant for the 2.4 billion children under the age of 19 alive today.

The freedom to determine what happens to our own bodies and to make decisions about sexuality, relationships, and childbearing are fundamental facets of our lives. By investing in and promoting these rights, governments can unleash the power of women and girls and transform societies.

Adolescent Sexual and Reproductive Health Key to Achieving Sustainable Development

By Suzanne Petroni, Senior Director for Gender, Population, and Development at the International Center for Research on Women (ICRW)

Last month, the global community celebrated the 20th anniversary of the International Conference on Population and Development (ICPD). The ICPD, which took place in Cairo in 1994, led to an historic agreement by 179 governments to place women—and importantly, their reproductive health—at the center of the sustainable development agenda. Five years later, while at the State Department, I served as the U.S. government’s “officer in charge” for the five-year review of the ICPD, where we exulted when the global community agreed to advance the ICPD agenda through promoting access to safe abortion, comprehensive sexuality education, and youth-friendly reproductive health services, among other critical areas.

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The Leaking Bucket Phenomenon in Family Planning

Guest post by Anrudh K. Jain, Ph.D., Distinguished Scholar, The Population Council

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.

Bucket
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Meeting the Family Planning Needs of Women and Couples Affected by HIV

Guest post by Tricia Petruney, Technical Advisor, FHI360

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.

Photo credit: FHI360
Photo credit: FHI360

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.

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

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?

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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