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
Blog post by Jan Kumar, EngenderHealth/RESPOND Project
The planets have aligned in Uganda over the past few weeks for a significant shift in the country’s national family planning (FP) program that sets it on a new and ground-breaking course. From July 28-30, 2014, the Ugandan Ministry of Health (MOH)—with support from the United Nations Population Fund (UNFPA)—hosted an event titled “Accelerating social and economic transformation through universal access to voluntary family planning.” President Museveni used this opportunity to accelerate the government’s commitment to FP2020 and to voice his endorsement for FP as a means to improve maternal health, reduce poverty, and support social and economic development. The meeting paved the way for the promotion of equitable access to a wide range of quality FP services that ensure full, free, and informed choice, as well as the protection and fulfillment of human rights for all Ugandan women and couples who wish to space or limit their childbearing.
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.
The goals and targets it proposes—and the issues explicitly addressed—will be of utmost importance in the shaping of the post-2015 development agenda. Due to conservative push-back, Iversen decries, the current report language fails to include sexual and reproductive health and rights (SRHR), as well as the health of young people despite the fact that “the majority of governments have identified [SRHR] as a priority to get the world on a sustainable path.”
The blog post discusses the vital role that voluntary family planning and ensuring rights and contraceptive choices for women and girls play in ensuring equal opportunity, economic growth, and the development and maintenance of healthy populations. Iversen urges readers to take action and suggests ways to become involved in supporting the push for inclusion of SRHR in the forthcoming global development framework. Read this important post and join EngenderHealth, Women Deliver, and other organizations and individuals in the effort to make SRHR a priority in the post-2015 global development agenda and a reality for all.
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 →
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 at the PPIUD meeting in Ouagadougou, Burkina Faso gather for a demonstration of method insertion using anatomic models. Photo credit: Anne Pfitzer
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.
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)
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.
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.
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.