Expanding Access to Family Planning
by Donna Clifton
(May 2010) Family planning empowers women and can save their lives. It can also help reduce poverty, slow population growth, and ease pressures on the environment. Yet family planning services often fail to reach those with the greatest need: the poor, those living in remote areas and urban slums, and people with little education. Other vulnerable groups lacking access include youth, indigenous populations, people living with HIV, and internally displaced people.
In many developing countries, governments and nongovernmental organizations are using some new approaches along with proven strategies to keep family planning services available in often challenging situations.
Bringing Services to People
Community-based distribution of contraceptives has been a successful program model in many countries for decades, reaching women and couples who would otherwise have to travel great distances. Community-based distribution can also allow women to access services away from public scrutiny, avoiding the stigma attached to family planning use in some communities.
In the Indian state of Uttar Pradesh, a joint project of the Indian government and the U.S. Agency for International Development (USAID) has been providing high-quality reproductive health and family planning services since 1992. Community-based distribution campaigns and social marketing efforts have led to an increase in the availability of birth-spacing methods. The project has also produced results: Approximately one-third of married women used a modern method of family planning in 2006, almost double the figure for 1993.1
A community-based family planning worker provides counseling to a village woman in India. Photo: Constella Futures, courtesy of USAID.
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Home delivery of contraceptives—modeled after Bangladesh's successful family planning program—has remained central to Pakistan's strategy to achieve universal access to modern contraceptives.2 Lady Health Workers visit women in their homes, providing family planning information and supplies and referrals for long-acting and permanent methods. While the rise in contraceptive use has leveled off in Pakistan in recent years, the Lady Health Worker program remains valuable and is seen as a way to reinvigorate national family planning efforts.
Training and Retraining to Help Meet Demand
A severe shortage of highly trained health workers, especially in sub-Saharan Africa, has led to the practice of task-shifting, or permitting less-specialized personnel to carry out certain functions. Other programs provide additional training to introduce new products or to orient health workers assigned to underserved areas.
In Uganda, where there is a scarcity of medical personnel, community health workers may soon be allowed to administer injectable contraceptives and help meet the growing demand for family planning. A pilot program in Nakasongola district demonstrated that trained community health workers, supervised by a more highly trained professional, can safely administer injectable contraceptives.3 The health workers already distribute condoms and oral contraceptive pills. If the practice is approved by policymakers, access to family planning will be greatly increased across the country.
Ethiopia is embracing a similar strategy to introduce a new long-acting contraceptive implant, Implanon, by using nurse supervisors to train health extension workers on proper insertion techniques. This approach will facilitate the government's comprehensive plan to make Implanon widely available throughout the country. It anticipates high demand for the method, which is effective for up to three years. The ministry of health ultimately plans to train 15,000 health extension workers to administer the implant.4
Reaching Vulnerable Populations
Marginalized populations often have few options when it comes to family planning. But in Latin America, programs that provide youth-friendly services and reach out to remote areas with indigenous or migrant populations are bringing family planning to many who would not otherwise have it.
To reach vulnerable young people, the International Planned Parenthood Federation/Western Hemisphere Region (IPPF/WHR) and its member association in Peru, INPPARES, provide clinical services specifically for youth. In Lima, youth are served by a separate center, Centro Juvenil Futuro, while in Chiclayo, youth services are provided in a separate space within the adult clinic. The centers seek input from young people in an ongoing effort to improve service. INPPARES has worked with youth living or working on the street since 1998 to improve their access to sexual and reproductive health services, and it was part of a recent three-country initiative, "Improving the Sexual and Reproductive Health and Rights of Street Youth in Bolivia, Guatemala, and Peru."5
IPPF/WHR and its member association in Bolivia, CIES, use mobile health units to bring high-quality services to remote and impoverished indigenous communities. Indigenous people make up 71 percent of Bolivia's population, yet they are largely neglected by medical and social services because of their geographic and cultural isolation. But their access to family planning is improving. According to one of the local health promoters, "The changes we've seen since the mobile health units started arriving four or five years ago is that now people don't have as many children as before. There's family planning."6
An IPPF/WHR mobile health unit project in the Dominican Republic, operated by member association PROFAMILIA, is increasing awareness and providing access to quality services to a socially and economically vulnerable population, Haitian Dominicans. Undocumented Haitians and their descendants are ineligible to receive public health services, even in cases of extreme emergency. The units provide basic health care and counseling, but their focus is on sexual and reproductive health services. In 2008, the mobile health unit distributed more than 3 million condoms and provided more than 1.5 million IUDs and hormonal contraceptives.7
Using the Media to Break Taboos
Another strategy for increasing access is the dissemination of information about family planning and available services. Public media can serve this function if the outreach is targeted toward marginalized and vulnerable populations.
The women's youth organization YWCA in Papua New Guinea has been a pioneer in using radio as a tool for advocacy and awareness on reproductive and sexual health. The Tokstret Radio Project, a call-in program begun in 1997, provided a forum for discussion of reproductive and sexual health issues. Women took the lead in talking about highly taboo issues related to sex and the use of male and female condoms, breaking down cultural barriers and paving the way for open discussions on reproductive health issues. The program also had a significant impact on men, who began calling in seeking advice on behalf of their wives. With 40 percent of the country's population under age 15, the program has now shifted its focus to adolescent reproductive and sexual health.8
On a broader level, increasing access to family planning services can help in achieving Millennium Development Goal 5, reducing maternal mortality by three-quarters between 1990 and 2015. A country's contraceptive prevalence rate is currently used as an indicator to monitor progress of this goal. In September 2010, a 10-year review of MDG progress will be carried out, providing donors and governments an opportunity to reaffirm the financial and political commitments necessary to increase access to family planning and move closer to achieving their goals.
Donna Clifton is senior program assistant in International Programs at the Population Reference Bureau.
References
- "Increasing Access to Family Planning,"Telling Our Story (Washington, DC: U.S. Agency for International Development, June 2007).
- Susheela Singh et al., Adding It Up: The Costs and Benefits of Investing in Family Planning and Maternal and Newborn Health (New York: UNFPA and Guttmacher Institute, 2009).
- Isaiah Esipisu, "Uganda: Improving Local Access to Family Planning" (Feb. 22, 2010), accessed at www.allafrica.com, on April 1, 2010.
- Abraham Gelaw, "Scaling Up Access to Family Planning in Southern Ethiopia" (Jan. 11, 2010), accessed at www.unfpa.org/public/news/pid/4675, on April 1, 2010.
- Carmen Barroso, International Planned Parenthood Federation/Western Hemisphere Region,"The Benefits of Investing in Family Planning: New Evidence and Regional Experiences," presentation to panel discussion sponsored by the Guttmacher Institute, New York, March 11, 2010.
- International Planned Parenthood Federation/Western Hemisphere Region, "Medicine on the Move," Reaching Out 31 (Fall 2009).
- Rachel Dowd, "Health on Wheels in the Dominican Republic," Annual Report 2008 (New York: International Planned Parenthood Federation/Western Hemisphere Region, 2009).
- Sarah Davies, World YWCA, "The Benefits of Investing in Family Planning: New Evidence and Regional Experiences," presentation to panel discussion sponsored by the Guttmacher Institute, New York, March 11, 2010.