When Everything Must Go Right So Nothing Goes Wrong

By Pamela Barnes, President & CEO, EngenderHealth

In global health, nobody has an easy job, but ensuring voluntary and safe permanent contraception is among the toughest. Everything has to go right so that nothing goes wrong.

The latest disturbing news coming from Chhattisgarh, India, reminds us that despite being 20 years post-ICPD, we global health professionals have more to do to ensure reproductive rights, choice, and quality of care. And as the story goes—as it has too many times before—the devastating consequences are borne by mostly poor, rural women. It’s unconscionable.

Although the Chhattisgarh situation is under investigation by the Government of India, we know that quality of care was compromised at all levels. This includes the conditions under which the surgical sterilizations were performed, the high number of surgeries in a given period, the questionable quality of the medications, the implicit targets set by local authorities, and financial incentives. In many ways, there isn’t a simple answer to what happened–there were a series of systemic, programmatic and clinical failures. Many organizations, including EngenderHealth, have called for a greater need to ensure and protect human rights, reproductive rights and clients’ rights; and to address informed and voluntary decision making, counseling, client safety and service quality.

But how does this translate into action? What must go right so that nothing goes wrong?

EngenderHealth’s commitment to getting everything right, beginning with our work in voluntary permanent methods decades ago, has led to the development of standards used throughout the field for informed consent, clinical safety, infection prevention, and other aspects of quality service delivery. These have also been applied to broader family planning and reproductive health issues. What we’ve learned is that investments must take place at all levels – beginning with a fundamental recognition that individuals have a basic right to full and appropriate information about their reproductive health choices and that they are able to make decisions without coercion, pressure, or inducements. For EngenderHealth, it’s about achieving a vision of client-centered care and all that is meant by this term.

For example, in India it would mean expanding the contraceptive method mix in the public sector, ensuring quality, and working to advocate for a focus to be on client’s choices rather than achieving targets. Right now, it’s mostly sterilization services, intrauterine devices (IUDs), condoms and pills—a situation which limits choice for women and others, including unmarried adolescents. We also see a greater need for training so that service providers are equipped with skills to provide voluntary, safe and quality services and can monitor quality, rights and choice for continuous quality improvement. These are examples of the kinds of concrete actions that must be undertaken as part of a broader comprehensive strategy rooted in a rights-based approach.

The incident in Chhattisgarh is a sobering reminder of what can happen when family planning services are not designed, implemented, or monitored in a way that protects and fulfills individual’s human rights. We urge the Ministry of Health and state governments to take decisive action to develop practical approaches for infusing a rights-based approach, with quality of care as one of the top priorities and with women’s needs, desires, and preferences at the center. To do otherwise would simply maintain the status quo.

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EngenderHealth and its partners have developed two new publications to assist diverse audiences, including donors, policymakers, program planners and managers, service providers, rights advocates, and community members, in their efforts to achieve rights-based family planning programs.

The first publication is the Voluntary Rights-based Family Planning Conceptual Framework User’s Guide, a practical resource to help stakeholders design, implement, and monitor family planning programs that respect, protect, and fulfill human rights. Coauthored with the Futures Group, with support from the Bill & Melinda Gates Foundation, the guide is a companion to the recent publication of Voluntary Family Planning Programs that Respect, Protect, and Fulfill Human Rights: A Conceptual Framework, which took long-standing family planning concepts, such as quality of care, voluntarism, and service access and linked them with human rights principles, such as empowerment, equity, nondiscrimination, and accountability. The Framework provides a holistic vision of what a rights-based family planning program looks like; the User’s Guide provides a pathway to applying the framework in actual practice.

EngenderHealth also developed Checkpoints for Choice: An Orientation and Resource Package, which takes a closer look at the concept of voluntarism—one component of a rights-based approach—and helps stakeholders understand the clients’ experience and their ability to make full, free, and informed choices about family planning. The tool, developed with support from the William and Flora Hewlett Foundation and the United States Agency for International Development, consists of a detailed plan with all support materials for a one-day workshop to enable family planning program planners and managers to strengthen the focus of family planning programs on clients’ ability to make full, free, and informed contraceptive choices in the context of a rights-based program. In addition to the workshop guidance and materials, the package includes links to recommended references, tools, and additional reading.

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

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

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

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

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

IRH Georgetown picture

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

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.

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

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

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

World Contraception Day and the UN General Assembly Millennium Development Goal Review

Celebrating World Contraception Day

Today, the international community celebrates World Contraception Day. This global campaign strives to increase awareness of contraception and encourage its use to enable people to make informed decisions about their sexual and reproductive health and to prevent unplanned pregnancy and sexually transmitted infection. This year’s motto, “Your Future, Your Choice, Your Contraception,” targets young people.

Bwaila Hospital, Lilongwe, Malawi (Photo by Holly Connor/EngenderHealth

A woman enjoys her new granddaughter at Bwaila Hospital in Lilongwe, Malawi. She is there in support of her daughter, who has requested counseling from a family planning nurse on obtaining a female sterilization. (Photo by Holly Connor/EngenderHealth)

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Human Rights and the ICPD Beyond 2014

This past July, more than 300 participants representing governments, civil society organizations, youth networks, United Nations (UN) agencies, and human rights experts and defenders converged in the Netherlands for the International Conference on Human Rights: ICPD Beyond 2014. Hosted by the Government of The Netherlands, in partnership with the United Nations Population Fund (UNFPA) and the Office of the UN High Commissioner for Human Rights, attendees addressed the links between human rights, equality, accountability, and population and development.

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