Marie Stopes International and EngenderHealth lead endeavor to expand contraceptive choice

by Sara Malakoff, Senior Program Associate, EngenderHealth

Female sterilization is the world’s most popular contraceptive method with more than 220 million users. Sterilization is convenient for women who desire to limit childbearing, as it requires no further visits to a health care provider. In addition, it does not have the side effects that contribute to the discontinuation of user dependent methods, such as hormonal contraception. However, access to both male and female sterilization varies significantly geographically, is limited in many parts of the world (particularly in rural areas), and has not increased at a pace comparable to that of the unmet need to limit childbearing.

In an attempt to address issues of full contraceptive choice and to ensure the availability of and access to a wide range of contraceptives, including permanent methods, Marie Stopes International (MSI) and EngenderHealth under the auspices of the Support for International Family Planning Organizations (SIFPO) project funded by USAID, convened a two-day technical symposium in Nairobi in March 2014 entitled Provision of Permanent Methods of Contraception in Low-Resource Settings. A dynamic group of over 40 participants from 27 organizations and 13 countries attended the event.

Continue reading

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
Continue reading

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

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

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.

Continue reading

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

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)

Continue reading

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

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

Continue reading

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

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.

Continue reading

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

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.

Continue reading

Walking Together: Strengthening Health Facility and Community Links to Improve Access and Choice

Guest post by Molly Tumusiime, Program Associate (Community Engagement), EngenderHealth/Uganda

The Right to Health asserts that people are entitled to access reproductive health services, including family planning (FP), that are acceptable to them and of the highest possible quality. However, there are many barriers to individuals’ realizing this right at many levels. While policy change and provider training can support increased FP access and use and better ensure contraceptive choice, interventions at the policy and service delivery levels alone are insufficient. Community-level barriers also impede service utilization and should be addressed in participatory and cooperative ways.

In 2010, EngenderHealth began piloting site walk-throughs (SWTs) in Bangladesh, Ethiopia, Ghana, Tanzania, and Uganda. This promising approach—rooted in the core human rights principles of participation, empowerment, and accountability—catalyzes community participation in health and strengthens the accountability of service providers to communities. In addition, SWTs foster linkages and collaborative partnerships between health providers and community members in addressing barriers to informed choice and service access and in improving the quality and acceptability of services.

Photos by E. Brazier/EngenderHealth

Photos by E. Brazier/EngenderHealth

Continue reading

Hot Topic: Rights and Choice at the International Conference on Family Planning

From November 12–15, an estimated 4,000 government officials, policymakers, program managers, researchers, academics, and youth advocates will gather in Addis Ababa, Ethiopia for the 3rd Annual International Conference on Family Planning (ICFP).

The theme of this year’s conference—cohosted by The Bill and Melinda Gates Institute for Population and Reproductive Health and Ethiopia’s Ministry of Health—is “Full Access, Full Choice,” echoing the Family Planning 2020 (FP2020) initiative’s call to ensure that rights and contraceptive choice are central to meeting the commitment made at the London Summit on Family Planning to reach an additional 120 million women with access to contraception by 2020.

Continue reading