Beyond Access To Respectful Care and Informed Choice: Reflections from the International Conference on Family Planning

Guest post by Kelsey Holt, Harvard School of Public Health

The third biennial International Conference on Family Planning kicked off this week in Addis Ababa, Ethiopia, with almost 3,000 attendees from all over the world gathering in the remarkable African Union building. Delegates are seeking inspiration from leaders in the field, youth, and colleagues, and an opportunity to share research and best practices related to the vision of “Full Access, Full Choice” in family planning. The speeches given during the opening session of the conference Tuesday on sustained political commitment emphasized family planning as a tool to reduce maternal mortality and protect women’s rights. The successes of Ethiopia’s health care system in reducing “unmet need” for contraception in a short period of time— in part thanks to an impressive health extension worker program— and the country’s commitment to reproductive health and women’s equality were celebrated widely. John Kerry and other world leaders also urged renewal of the various commitments made to achieving universal reproductive health access for all beginning in the 1990’s as well as the recent FP2020 goal of reaching 120 million new contraceptive users by the year 2020.

Against this backdrop of political commitments and acknowledgement of the importance of family planning to women’s health and equality, the many subsequent conference sessions about quality of care hold much promise for real progress and action towards these goals. The importance of quality of care was described by Anrudh Jain on Wednesday in a session hosted by the David and Lucile Packard Foundation on quality of care as the “leaking bucket problem” whereby women who manage to make it to contraceptive services at least once do not always continue their relationship with the health care system after receiving sub-standard information, counseling, and method choice—or even disrespect or coercion. These women represent a substantial proportion of those with unmet need for contraception who are past users failed by existing methods and services.  The challenge of ensuring respect, dignity, and adequate choice for women receiving contraception counseling and services around the world persists.

Moving beyond access to quality and a focus on respectful care and informed choice seems particularly critical in the context of new approaches reported on at the conference to increase contraceptive uptake through financial incentives to women, health workers, and health facilities, or goals for uptake of a certain volume of long-acting methods. If not done carefully, these innovative programs threaten to create perverse incentives for systems and providers to coerce women into methods that are not right for them and must be carefully studied to ensure we do not sacrifice women’s rights for fertility and contraceptive prevalence targets. As emphasized by Ms. Theo Sowa, Chief Executive Officer of the African Women Development Fund, in Wednesday’s opening plenary, we need to challenge ourselves to do things differently: “If we are complacent, we do not achieve the things we need to achieve in the time we need to achieve them.” Quality of care is one area where we cannot afford to be complacent—and this includes tackling the hard issues of ensuring respectful treatment to ensure informed choice during contraceptive care. The centrality of the issue of quality at the ICFP is promising for our ability as a global community to acknowledge the skeletons of population control in our closet and proactively move towards a future where women of all ages and backgrounds have access to high quality counseling and services to meet their contraceptive needs and contribute toward the fulfillment of their rights and the goals originally conceived of during the Cairo conference in 1994.