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Voluntary, Rights-based Family Planning: Why, What and How? Voluntary, Rights-based Family Planning Framework Orientation.

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Presentation on theme: "Voluntary, Rights-based Family Planning: Why, What and How? Voluntary, Rights-based Family Planning Framework Orientation."— Presentation transcript:

1 Voluntary, Rights-based Family Planning: Why, What and How? Voluntary, Rights-based Family Planning Framework Orientation

2 Agenda  Opening Remarks – name, title  Ice breaker  Presentation: Introduce the VRBFP Framework  Discussion  Case Studies  Discussion Facilitator: name, title

3 Objectives 1.Explain why it is important for family planning programs to take a voluntary, rights-based approach 2.Introduce what a rights-based approach in FP is using the Voluntary, Rights-based FP framework 3.Describe how the framework and approach can be used in programs 4.(Optional) Provide a hands-on opportunity to apply the framework using case studies

4 WHY? The importance of taking a voluntary, rights-based approach to family planning

5 History of Rights and Family Planning  History of associating human rights with FP and SRHR  Tehran 1968 – Human Rights Conference – voluntarism in FP  Cairo 1994 – ICPD – reproductive health and rights  Issues in FP/population programs  Examples of coercion and forced sterilization (India, China, Peru, etc)  Civil society participation  Attention to accountability mechanisms  Effective use of human rights treaty bodies to address issues of coercion and human rights violations 5

6 Coercion in Family Planning: past and present examples  Enforced policies limiting the number of births (e.g. China but more recently contemplated in Africa)  Involuntary Contraceptive Use (e.g. China, India/Emergency, Peru, US often targeted at poor and marginalized)  Excessive Social Pressure (e.g. China, Indonesia, but potentially Rwanda and Ethiopia - fine line between efforts to change social norms and coercion)  Targets and Performance Management Indicators linked to numbers of acceptors (e.g. China, Indonesia, Rwanda, Performance-based Financing focused on numbers)  Incentives and disincentives (e.g. Bangladesh, India, payments to providers)

7 Provider bias for specific methods Misinterpretation of eligibility criteria Incentives (e.g. performance-based financing) Targets and quotas Involuntary sterilization of ethnic minorities (Peru, Roma, U.S.) and HIV + women (Namibia, Ukraine, Kenya) PPIUD insertion w/out consent (Mexico, India) Withholding benefits Lack of : accurate information community or spousal support for FP or specific methods access to new/innovative contraceptive technologies Poor quality of services Gender norms and status of women Negative attitudes towards marginalized populations Limited choice of method available (not offered); out of stock Lack of equitable distribution of FP outlets Lack of trained providers Cost unaffordable Denial of family planning to unmarried youth Subtle Overt Coercion Barriers Challenges to Rights: it’s not just about coercion

8 Provider bias for specific methods Misinterpretation of eligibility criteria Incentives (e.g. performance-based financing) Targets and quotas Involuntary sterilization of ethnic minorities (Peru, Roma, U.S.) and HIV + women (Namibia, Ukraine, Kenya) PPIUD insertion w/out consent (Mexico, India) Withholding benefits Lack of : accurate information community or spousal support for FP or specific methods access to new/innovative contraceptive technologies Poor quality of services Gender norms and status of women Attitudes towards marginalized populations Limited choice of method available (not offered) Lack of equitable distribution of FP outlets Lack of trained providers Cost Denial of family planning to unmarried youth Subtle Overt Coercion Barriers Challenges to Voluntarism: it’s not just about coercion A rights-based approach can address each of these challenges

9 WHAT IS A RIGHTS- BASED APPROACH?

10 What is a Human Rights Approach? 10 PrincipleAction P articipation/ Empowerment Communities and individuals are empowered to know and demand fulfillment of their rights Recognize people as key actors in their own development, rather than passive recipients of commodities and services. A ccountability Governments that have signed human rights treaties have obligations to 1)Put monitoring mechanisms in place, and 2)Demonstrate efforts towards progressive realization of rights. M&E of both processes and outcomes of programs N on- discrimination & E quity Increases focus on structural barriers that lead to inequities in access and quality of FP services. L inked to treaty bodies Align programs with governments’ legal obligations to uphold rights Human rights-based approaches hold the dignity of individuals at the center

11 Additional Principles Public Health Programming: Beneficence Equity Autonomy/Agency Voluntary Family Planning (USAID) : The opportunity to choose voluntarily whether to use FP or a specific FP method Access to information on a wide variety of FP choices Clients are offered, either directly or through referral, a broad range of methods and services Verify client’s voluntary and informed consent for sterilization in a written consent document signed by the client 11

12 Legally Defined Human Rights Related to Reproductive health Summarized from Global Treaties and Conventions

13 3 Broad Categories of Reproductive Rights  Rights to reproductive self-determination Right to bodily integrity and security of person Rights of couples and individuals to decide freely and responsibly the number and spacing of their children Right to make decisions concerning reproduction free of discrimination, coercion and violence  Rights to sexual and reproductive health services, information, and supplies Including right to the highest attainable standard of health  Rights to equality and nondiscrimination Erdman and Cook (2008)

14 Right to Health : Governments have an obligation to provide health services that are: General Comment 14, Article 12 from the UN Committee on Economic, Social and Cultural Rights Rights elements Program implications Available Broad choice of methods offered Sufficient number and needs-based distribution of functioning service delivery points Accessible Information available in language/terms people can understand; geographic access, financial access, policy access Continuous contraceptive security; convenient service hours; service integration increases access Acceptable Cultural acceptability of FP and specific methods; community/family supports women’s right to choose; tolerance of side effects; client satisfaction with services Quality Clinical quality/technical competence good client-provider interactions and counseling privacy, dignity, respect demonstrated in service delivery Continuity of care

15 November 12, 2013 © 2013 Bill & Melinda Gates Foundation | 15 CREATE A WORD CLOUD:  Rights-based approach  Voluntary FP  Full, free and informed choice  Contraceptive choice  Quality of Care  Quality assurance/ improvement Other related concepts

16 A Rights-based Approach… Improves the availability, accessibility, acceptability and quality of family planning information, services and supplies Ensures voluntarism by protecting the right of the individual to decide freely and responsibly, whether and/or when to have children and promotes programmatic attention to full, free and informed choice +Expands access to family planning without discrimination or coercion +Demands that accountability systems are in place to effectively expose vulnerabilities, and requires that alleged or confirmed rights violations and issues are dealt with in a significant, timely, and respectful manner +Considers how programs are designed to respect dignity and promote individual agency

17 HOW TO OPERATIONALIZE RIGHTS IN FAMILY PLANNING

18 Operationalizing Human Rights in Family Planning How can we ensure public health programs oriented toward increasing voluntary family planning access and use respect, protect and fulfill human rights in the way they are designed, implemented and evaluated?

19 INPUTS/ACTIVITIES COUNTRY CONTEXT OUTPUTS OUTCOMES IMPACT August 2013 Framework for Voluntary Family Planning Programs that Respect, Protect, and Fulfill Human Rights Citation: Hardee, K., et al Voluntary Family Planning Programs that Respect, Protect, and Fulfill Human Rights: A Conceptual Framework. Washington, DC: Futures Group. Policy Level Service Level Community Level Individual Level

20 POLICY LEVEL OUTCOMESINPUTS & ACTIVITIES COUNTRY CONTEXT Assess to inform interventions OUTPUTS Illustrative Family planning services are Available (adequate number of service delivery points, equitably distributed) Accessible (affordable and equitable; free from discrimination; no missed opportunities for service provision) Acceptable (respectful of medical ethics, culturally appropriate, and clients’ views are valued) Highest quality (scientifically and medically appropriate and of good quality (e.g., full, free, and informed decisions; a broad choice of methods continuously available; accurate, unbiased, and comprehensive information; technical competence; high- quality client-provider interactions; follow-up and continuity mechanisms; and appropriate constellation of services) Accountability systems are in place, which effectively expose any vulnerabilities, and alleged or confirmed rights violations and issues are dealt with in a significant, timely, and respectful manner Communities actively participate in program design, monitoring, accountability, and quality improvement Community norms support the health and rights of married and unmarried women, men, and young people and their use of family planning Agency of individuals is increased to enable them to make and act on reproductive health decisions * Reproductive rights: R1: reproductive self- determination R2: access to sexual and reproductive health services, commodities, information, and education R3: equality and non- discrimination (“All Rs” indicates that all rights are encompassed) Illustrative Women, men, and young people decide for themselves— free from discrimination, coercion, and violence— whether, when, and how many children to have and have access to the means to do so Trust in FP programs is increased Universal access to FP is achieved Equity in service provision and use is increased Availability of a broad range of contraceptive methods is sustainable Women get methods they want without barriers or coercion FP needs are met; demand is satisfied IMPACT Decreased Unintended pregnancies Maternal/infant deaths Unsafe abortions Adolescent fertility rate Total fertility rate Increased Agency to achieve reproductive intentions throughout the lifecycle Well-being of individuals, families, communities, and countries August 2013 Framework for Voluntary Family Planning Programs that Respect, Protect, and Fulfill Human Rights SERVICE LEVEL COMMUNITY LEVEL INDIVIDUAL LEVEL Citation: Hardee, K., et al Voluntary Family Planning Programs that Respect, Protect, and Fulfill Human Rights: A Conceptual Framework. Washington, DC: Futures Group. A.Develop/revise/implement policies to respect/protect/fulfill rights and eliminate policies that create unnecessary barriers to access (All Rs)* B.Develop/revise/implement policies to ensure contraceptive security, including access to a range of methods and service modalities, including public, private, and NGO (R2) C.Create processes and an environment that supports the participation of diverse stakeholders (e.g. policymakers, advocacy groups, community members) (R2/R3) D.Support and actively participate in monitoring and accountability processes, including commitments to international treaties (All Rs) E.Guarantee financing options to maximize access, equity, nondiscrimination, and quality in all settings (R2/R3) A.Inform and counsel all clients in high-quality interactions that ensure accurate, unbiased, and comprehensible information and protect clients’ dignity, confidentiality, and privacy and refer to other SRH services (All Rs) B.Ensure high-quality care through effective training and supervision and performance improvement and recognize providers for respecting clients and their rights (All Rs) C.Ensure equitable service access for all, including disadvantaged, marginalized, discriminated against, and hard-to-reach populations, through various service models (including integrated, mobile, and/or youth-friendly services) and effective referral to other SRH services (All Rs) D.Routinely provide a wide choice of methods and ensure proper removal services, supported by sufficient supply, necessary equipment, and infrastructure (R2) E.Establish and maintain effective monitoring and accountability systems with community input; strengthen HMIS and QA/QI processes (All Rs) A.Engage diverse groups in participatory program development and implementation processes (R2/R3) B.Build/strengthen community capacity in monitoring and accountability and ensure robust means of redress for violations of rights (R2/R3) C.Empower and mobilize the community to advocate for reproductive health funding and an improved country context and enabling environment for FP access and use (All Rs) D.Transform gender norms and power imbalances and reduce community-, family-, and partner-level barriers that prevent access to and use of FP (R3) E.Support healthy transitions from adolescence to adulthood (All Rs) A.Increase access to information on reproductive rights, contraceptive choices (All Rs) B.Empower, through education and training about reproductive health, self-esteem, rights, life-skills, and interpersonal communication (R1/R2) C.Foster demand for high-quality services and supplies through IEC/BCC and empower individuals to demand their rights be respected, protected, and fulfilled (R2)

21 21  Country Governance  Health Governance  Funding/Resources  Health Policy Environment  Sociocultural context and gender norms  Diverse stakeholder participation  Adherence to global human rights agreements  Global accountability of actors  National accountability mechanisms Country Context Assess the overall country and global context—within which voluntary, human rights-based family planning is situated—and use the findings to inform interventions at all levels, including interventions related to marginalized and vulnerable populations:

22 Policy Level 22 A.Develop/revise/implement policies to respect/protect/fulfill rights and eliminate policies that create unnecessary barriers to access (All Rs) B.Develop/revise/implement policies to ensure contraceptive security, including access to a range of methods and service modalities, including public, private, and NGO (R2) C.Create processes and an environment that supports the participation of diverse stakeholders (e.g. policymakers, advocacy groups, community members) (R2/R3) D.Support and actively participate in monitoring and accountability processes, including commitments to international treaties (All Rs) E.Guarantee financing options to maximize access, equity, nondiscrimination, and quality in all settings (R2/R3)

23 POLICY LEVEL 23 A.Develop/revise/implement policies to respect/protect/fulfill rights and eliminate policies that create unnecessary barriers to access (All Rs) Develop laws and policies that ensure that family planning services are sufficiently available; physically and economically accessible to all people without discrimination; acceptable—respectful of culture and confidentiality; and of the highest possible quality Support the promotion of gender equity and women’s autonomy in realizing their reproductive rights Support prevention of harmful practices (e.g., child marriage, gender-based violence, female genital cutting) and knowledge of the rights violations and harms caused by such practices Ensure equitable access to services for all groups (e.g., without discrimination in respect of ethnicity, age, income level) Eliminate unjustifiable access barriers (e.g., client eligibility criteria) or policies that contain method-specific or performance-based targets or incentives that have the effect of being coercive in practice Set service standards and enable task shifting and task sharing and facilitate access to a wide range of safe and effective contraceptive methods Protect privacy in service delivery settings

24 24 A. Inform and counsel all clients in high-quality interactions that ensure accurate, unbiased, and comprehensible information and protect clients’ dignity, confidentiality, and privacy and refer to other SRH services (All Rs) B. Ensure high-quality care through effective training and supervision and performance improvement and recognize providers for respecting clients and their rights (All Rs) C. Ensure equitable service access for all, including disadvantaged, marginalized, discriminated against, and hard-to-reach populations, through various service models (including integrated, mobile, and/or youth- friendly services) and effective referral to other SRH services (All Rs) D. Routinely provide a wide choice of methods and ensure proper removal services, supported by sufficient supply, necessary equipment, and infrastructure (R2) E. Establish and maintain effective monitoring and accountability systems with community input; strengthen HMIS and QA/QI processes (All Rs) Service Level

25 25 A. Engage diverse groups in participatory program development and implementation processes (R2/R3) B. Build/strengthen community capacity in monitoring and accountability and ensure robust means of redress for violations of rights (R2/R3) C. Empower and mobilize the community to advocate for reproductive health funding and an improved country context and enabling environment for FP access and use (All Rs) D. Transform gender norms and power imbalances and reduce community- family-, and partner-level barriers that prevent access to and use of FP (R3) E. Support healthy transitions from adolescence to adulthood (All Rs) Community Level

26 Individual Level 26 A.Increase access to information on reproductive rights, contraceptive choices (All Rs) B.Empower, through education and training about reproductive health, self-esteem, rights, life-skills, and interpersonal communication (R1/R2) C.Foster demand for high-quality services and supplies through IEC/BCC and empower individuals to demand their rights be respected, protected, and fulfilled (R2)

27 Using the framework in FP programming Phase of the Program Cycle Illustrative Actions that Incorporate Rights Principles Assess needsAsk new questions i.e. who are we not reaching and why? DesignEngage stakeholders more deliberately Systematically think through interventions impact on rights ImplementMake rights and responsibilities explicit (clients’ rights, providers’ needs) Offer a full, free & informed contraceptive choice Expand concept of demand Monitor and Evaluate Promote accountability throughout the system Do facilities have mechanisms to protect privacy? Collect and use client feedback/means of redress Do service data indicate equitable service delivery SustainEngage communities to improve outcomes and achieve lasting behavior change

28 Discussion  Questions?  Observations?  Does the framework help you see your work differently? If so, in what ways?  What activities are you already involved in that you could build on to take a rights-based approach? What might you do differently?  What challenges to this approach do you envision ?

29 Applying the Framework to Case Studies

30 CASE STUDIES (45 minutes)  1) In your small group, discuss what factors supported or challenged contraceptive choice and human rights in this case study. Write each individual factor on a note card or Post-It and determine the level in the health system at which it exists.  2) For each challenge identified, consider what should be done to promote respect for, protection and fulfillment of human rights in the program described. Use one note card or Post-It for each suggested intervention or change.  3) Select someone at your table to post and explain your cards during the report back 30

31 Discussion Did anything surprise you? If so, what and why? Is there anything familiar about the circumstances described in the case studies? Which of the suggested interventions or changes would be relatively easy to implement? Which might be harder? How might you be able to begin? What more would it take? 31

32 Next steps **Tailor this slide to the context of the presentation** 32


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