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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MCHIP and PSI Promote Postpartum IUD to Expand Access to Family Planning for More Women

Guest post by Holly Blanchard, Senior Reproductive Health/Family Planning Advisor, Maternal and Child Health Integrated Program (MCHIP)

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 gather for a demonstration of PPIUD insertion using anatomic models at a West Africa regional postpartum family planning workshop in Ouagadougou, Burkina Faso this past February. Photo credit: Jhpiego

Participants at the PPIUD meeting in Ouagadougou, Burkina Faso gather for a demonstration of method insertion using anatomic models. Photo credit: Anne Pfitzer

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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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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.

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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

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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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