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

February 26, 2014

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

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

January 9, 2014

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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Strengthening the Links Between Human Rights and Family Planning: An Update from Addis

December 23, 2013

Guest Post by Shannon Harris

There is greater interest and investment in family planning (FP) programs now than in the last 20 years. With this increased attention and funding, programs are also benefiting from an increased commitment to ensuring that vulnerable and hard-to-reach populations are being better served and that women are receiving high-quality services and expanded contraceptive choice. As FP reemerges as a global priority, there is more attention to the human rights that underlie providing contraceptive services to all individuals. The recently published Family Planning 2020 (FP2020) first annual progress report highlights the new Conceptual Framework for Voluntary, Rights-Based Family Planning, a tool designed to ensure that public health programs oriented toward increasing voluntary FP access and use respect, protect, and fulfill human rights in the way they are designed, implemented, and evaluated.

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

December 10, 2013

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

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Expanding Choice through the Introduction and Scale-Up of the Standard Days Method® in India

November 25, 2013

Guest post by Lauren VanEnk, Program Officer, Institute for Reproductive Health at Georgetown University (IRH)

Photo credit: Institute for Reproductive Health (IRH) at Georgetown University

For decades, India’s national family planning (FP) program has emphasized female sterilization, resulting in limited contraceptive method options for those with an unmet need for FP, especially for spacing pregnancies. However, following the 1994 International Conference on Population and Development (ICPD), which recommended high-quality services and a range of methods, the Government of India adopted a national population policy in 2000 that shifted its FP program’s focus from achieving target-driven demographic goals to ensuring reproductive health and rights, including voluntary and informed choice.

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

November 8, 2013

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 3^rd 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.

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Developing Country Leaders and Advocates Urge Improved Commodity Security to Ensure Rights

October 18, 2013

Ms. Anuradha Gupta, Additional Secretary of India’s Ministry of Health and Family Welfare and Mission Director of the National Rural Health Mission (NRHM) / Photo credit: RHSC

Last week, the Reproductive Health Supplies Coalition (RHSC) held their 14th annual meeting in Delhi, India. The meeting, cohosted by India’s Ministry of Health and Family Welfare, convened more than 200 participants from civil society, the private sector, and governments to work collaboratively toward strengthening the core principles of commodity security—method choice, quality, and equity—to increase access to affordable, high-quality family planning (FP). Continue reading →

Respect, Protect, and Fulfill Human Rights: A New Conceptual Framework for Voluntary Family Planning Programs

August 19, 2013

How can public health programs oriented toward increasing family planning access and use ensure they reach as many people as possible with lifesaving contraception in a way that respects, protects, and fulfills human rights?

Today, the Futures Group and EngenderHealth launched a joint publication, Voluntary Family Planning Programs that Respect, Protect, and Fulfill Human Rights: A Conceptual Framework that presents a new framework for holistic, quality family planning (FP) programs with clients and their rights at the core. This practical framework integrates human rights law and principles with FP program and quality of care frameworks, and depicts how key concepts translate into concrete interventions, outputs, and outcomes into programming. It offers a pathway for governments and other implementing partners to fulfill their commitments to the provision of voluntary FP services that respect, protect, and fulfill individuals’ human rights as programs pursue health and development goals.

A mother and child in Mwea Village, Kenya. Photo credit: The Bill & Melinda Gates Foundation

“In the wake of the London Summit on Family Planning, we have seen a reenergized commitment among governments and donors to expand access to FP, especially under the FP2020 initiative,” said Jan Kumar, Senior Technical Advisor at EngenderHealth and one of the framework’s authors. “As this framework highlights, however, it is critical that any efforts to scale up family planning over the next decade must be met by equal attention to ensuring that programs respect, protect, and fulfill human rights and put clients’ needs and preferences at their core.”

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Contraceptive Choice and Human Rights in Malawi: Q&A with UNFPA’s Dorothy Nyasulu

Over the past decade, Malawi’s family planning (FP) program has made remarkable strides in expanding access to FP to help women and couples better meet their desired family size. As a direct result of advocacy efforts and renewed government commitment to FP, a broader mix of contraceptive options are becoming more widely and equitably available, including long-acting and permanent methods (LA/PMs) such as implants and female sterilization. However, despite impressive gains [1], high unmet need and barriers to FP information and services persist. To learn more, EngenderHealth’s Holly Connor sat down with Dorothy Nyasulu, Assistant Representative for UNFPA/Malawi and a leading champion on human rights and gender equality for over 20 years, to discuss the intersection of FP, contraceptive choice, and human rights in her home country.

[1] The modern contraceptive prevalence rate (CPR) increased from 22.4 in 2004 to 32.6 by 2010 (Malawi Demographic and Health Surveys)

Dorothy Nyasulu and Holly Connor of EngenderHealth/The RESPOND Project at a regional family planning stakeholders meeting in Malawi in February 2013.

Dorothy Nyasulu, Assistant Representative of UNFPA/Malawi and Holly Connor, Senior Program Associate, EngenderHealth/The RESPOND Project at a regional family planning stakeholders meeting in Mzuzu, Malawi in February 2013.

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Championing Contraceptive Choice: Promoting and Protecting Rights beyond FP2020

Artwork by Sita Magnuson, The Value Web ®

The London Summit on Family Planning, which took place a year ago this month, kicked off a potentially new era for international family planning (FP). By focusing renewed attention, rallying political commitment, and garnering a substantial increase in pledged funding to support services, it raised FP on the global health and development agenda. The London Summit also reinvigorated the focus on human rights in FP programs, which coalesced in part around the concern that human rights could be sacrificed in the pursuit of the numerical goal of reaching 120 million new women and girls in the world’s poorest countries with FP information, services, and supplies by 2020 (known as FP2020). Attention to these issues has also been fueled by preparations to formulate the post-2015 development agenda that will follow the expiration of the Millennium Development Goals (MDGs). Continue reading →