Making Rights a Reality

WASHINGTON, DC (January 16, 2016) – The 2012 London Family Planning Summit set the stage for increased attention by governments and other global health institutions to family planning however some of the numeric goals raised concern among advocates worried that the rights of women and men could be neglected, or abused, in the quest to reach 120 million new family planning (FP) users by 2020.  Three years into FP2020 programming, how is rights-based FP faring?  While taking a rights-based approach is contested in some countries that consider rights a “Western” notion not suited for them, overall there are promising signs that rights are not being ignored as countries and organizations move forward with programming to achieve the FP2020 goal.  But to take rights from the realm of declarations and conventions to practical application, the field needs guidance on rights and family planning, integration into national policies and programs, indicators and measurement tools, and evidence of how to implement rights-based FP programming and its effect on reproductive health outcomes.

We are making some encouraging progress on each of these.  The global organizing mechanism to adhere to the goals of the 2012 Summit is called FP2020. An important part of FP 2020 is a focus on ensuring that programming would not only focus on numbers and in that regard FP2020 has articulated for countries rights and empowerment principles that need to be addressed in FP programming. WHO put its weight behind developing guidance and recommendations on ensuring human rights in the provision of contraceptive information and services.

Translating these 13 rights and empowerment principles into actual programming is a challenge that calls for practical tools.  One such tool is a conceptual framework, developed with input from a range of stakeholders in nearly 40 countries.  The framework shows what voluntary family planning programs that respect, protect and fulfill human rights should look like at the policy, service delivery, community, and individual levels.

Rights language is beginning to be featured in FP costed implementation plans (CIP) that are being developed to guide implementation of programming to reach FP2020 goals, including Uganda’s FP CIP (2015-2020), which explicitly pledges to protect and fulfill human rights in the provision of FP services.  When I asked stakeholders in Uganda why the FP CIP had such strong rights language, I was told that rights issues came up repeatedly in broad stakeholder consultations, supported by the Advance Family Planning project, among others that were part of the process. This highlights the important role of rights champions in the CIP development process.

But a rights framework and rights language in FP CIPs are not enough: countries need to take further steps to operationalize their rights rhetoric.  The USAID-funded Evidence Project, which I direct, together with IPPF’s Sustainable Networks Project (SIFPO2/IPPF), are taking part in a process spearheaded by the Ministry of Health and Reproductive Health Uganda (RHU) to develop an action plan for a rights-based approach in support of the FP CIP. Using the guidance and tools described above, Uganda is moving from words to rights-based services for women, men and young people.  Stakeholders engaged in the process identified key priorities related to rights and a coordination task team that includes representatives of the MOH, UNFPA, Human Rights Commission, and Uganda Family Planning Consortium with RHU serving as the Secretariat are finalizing the action plan, concentrating on mainstreaming the plan into existing MOH structures and procedures and the CIP’s performance monitoring plan.

To augment the scant evidence on rights-based family planning, as part of our work in Uganda, the Evidence Project, with SIFPO II/IPPF and RHU, is testing a rights-based (RB) FP Index to measure adherence to Rights-based family planning at the service delivery level (in later iterations, the index will be extended to the policy, community and individual levels).  The study is measuring individual facilities’ readiness to implement rights-based family planning, including identifying areas where there are potential rights vulnerabilities that can be addressed through small-scale rights-based service delivery modifications, which will later be evaluated. Such rights-based modifications could include, for example, increasing the range of methods available to clients, strengthening logistics systems to ensure availability of the methods, and training staff on the rights of clients, all of which could improve full, free and informed decision-making. A sister study is being conducted by the Palladium Group in two states in Nigeria.  The Rights-based Family Planning Index has been informed by collaborative work by FP2020, WHO, Guttmacher Institute and others to define indicators to measure adherence to rights in family planning.

While these developments to promote rights-based family planning over the first three years of FP2020 are encouraging, there is continued need for international organizations and countries to coordinate on defining, operationalizing, studying, documenting and monitoring rights-based family planning.  The importance of ensuring rights-based family planning was reinforced by the tragedy of deaths in a sterilization camp in Chhattisgarh, India in 2014, which showed extreme neglect of rights.  There are also many more subtle ways clients of family planning programs are denied choice of contraceptive methods, autonomy in decision-making, access to quality services, equity and respectful treatment. Taking a human rights lens to family planning can also help programs identify groups that are not being served by family planning programming.

At the 2016 International Conference on Family Planning, I, together with other colleagues, will be taking stock of what we have accomplished and pushing the field on ways to move forward to ensure that human rights are respected, protected, and fulfilled in family planning programming.

Karen Hardee is the Senior Associate and Project Director for the Evidence Project, Population Council