Critical support for improving access to reproductive health services

This paper makes an objective assessment of the planned family planning efforts in India organised under the National Family Welfare (Planning) Programme during the period 1970-71 through 2010-11. The assessment covers the conceptual foundations of official family planning efforts, administrative capacity and organisational efficiency of the National Family Welfare (Planning) Programme, outputs of official family planning efforts in terms of needs effectiveness, capacity efficiency, goals effectiveness and realised efficiency of the National Family Welfare (Planning) programme, and impact of official family planning efforts in terms of realisation of demographic targets and goals. The analysis, based primarily on the services statistics of the National Family Welfare Programme, suggests that, at the policy level, there has been considerable dilution in the official family planning efforts which has implications for organising family planning activities at the grassroots level and the impact of these efforts in terms of reduction in the birth rate and population stabilisation. The paper argues for reinvigorating the official family planning efforts and proposes a framework for the purpose.

Although the international family planning program at USAID had enjoyed priority attention and funding from its inception in the 1960s until the time of the Cairo Conference in 1994, by 2001, its funding had stagnated at low levels for five years; the Mexico City Policy had been imposed; HIV/AIDS was gaining ascendancy in funding within the Agency; and both fertility levels and modern contraceptive prevalence rates (MCPR) in several sub-Saharan African (SSA) countries were stagnating. Some scholars even suggested that the international family planning movement was at the stage of fragmentation and decline. Consequently, USAID in collaboration with the World Health Organization and other partners began an initiative to reposition family planning in SSA. Within ten years, the initiative had achieved numerous impressive results: the annual funding for family planning at USAID increased by over 50%; MCPR saw unprecedented increases in several SSA countries; increased funding commitments were coming in from host country governments and international donors; and family planning now enjoys greater visibility and is recognized as a key variable for economic development. This paper’s goal is to explain the strategies adopted by USAID to reposition family planning, discuss the key achievements, and highlight the challenges that remain

The Katanga Province in the south-east of DRC covers an area of 496,877 square kms with an estimated population over 11.462.290 inhabitants out of 68% are under age of 25 ; maternal mortality rate is high 612 per 100.000 live births; the modern CPR is low 2,3%; one in four adolescent girls aged 15-19 has already given birth or been pregnant. HIV prevalence rate is 5,6%. However, local authorities’ financial commitment to advance ICPD agenda is strong. Thus, UNFPA decided to support provincial government’s initiatives where financial commitment is expressed.Three types of programs were identified: i) Maternal and newborn health; ii) Integrating Youth Friendly Services and HIV prevention; iii) Availability of data for development. The key challenge faced was the limited resources of UNFPA and youth community as well. Advocacy and BCC activities, building alliances with media professionals, partnerships, resources mobilization and auto financing were implemented. From 2009 to date, the local government has invested 15,000,000USD for renovation/ construction of over 15 maternity wards and health facilities, 383,000USD for construction of the multifunctional youth center including promotion HIV VCT and 262,901USD for the setting up of a population statistics center to avail accurate data in prevision of the census.

The London FP Summit on July 11, 2012 galvanized high level support to reach 120 million new family planning users by 2020. Such growth in FPusers would be unprecedented. The theme of rights was emphasized at the FP Summit. Despite this firm global commitment to voluntary, rights-based family planning programming, instances of coercion have occurred in FP programs. These experiences have made some wary of the potential for coercion to reemerge in FP policies and programs. A recent court ruling in Namibia has highlighted the pressures faced by HIV-positive women to stop childbearing, reminiscent of experiences in the West of targeting disabled women with contraception. It is important to fully understand each situation and how it occurred to develop approaches to ensure that these experiences are not repeated.

The paper examines instances of coercion in FP to understand the context, the type of coercion, how it was uncovered and how it was addressed. Using these examples, the paper offers recommendations for policy and program steps to ensure voluntarism in family planning and adherence to a rights-based approach as countries scale up programs to reach the ambitious goal of FP2020.