Women's Rights and Funding for Family Planning Scholarly Articles
Plain Linguistic communication Summary
The numeric goal announced at the 2012 London Peak on Family Planning (FP) sparked piece of work to ensure that achieving the goal was undertaken through programming that respects, protects and fulfills man rights enshrined in human rights conventions and in the 1994 International Conference on Population and Development. This paper draws on 23 interviews in 2019 with key informants working on FP and engaged with the FP2020 partnership, along with documentation of FP2020 and the FP2030 partnership.
Respondents noted progress, particularly tools and guidelines identifying and explaining rights in relation to FP, promotion of rights-based approaches to programing, strengthened accountability, and measurement of rights-focused outcomes. Moving forwards, they recommended: Focusing on country-level rights literacy and implementation, with accountability and continued work on metrics and bear witness generation and dissemination. Institutionalizing rights-based FP will crave enhanced commitment and funding over the long term.
Review of initial planning under FP2030 related to each of the recommendations suggests that the new partnership is seeking to addressing each of them. This paper helps provide a roadmap for not only building on the gains fabricated over the by decade and to effectively tackle the challenges remaining to ensure rights-based programming to achieve the vision of FP2030.
Background
A press release from the 2012 London Acme on Family Planning, organized by the Nib & Melinda Gates Foundation and the United kingdom of great britain and northern ireland Department for International Development, pronounced that the superlative
Will mobilize commitments to back up the rights of an boosted 120 million women and girls in the world'south poorest countries to apply contraceptive information, services and supplies, without coercion or discrimination, past 2020 (https://www.familyplanning2020.org/sites/default/files/About_the_London_Summit_on_FP_-_Summary_Document.pdf)
The emphasis on rights responded to concerns by civil guild that having a numeric goal for the initiative represented a retreat from the human rights-centered approach that emerged from the 1994 International Conference on Population and Development (ICPD) framework for sexual and reproductive health.1–4
The Family Planning 2020 (FP2020) Partnership constituted to achieve the goal of the 2012 London Summit, equanimous of governments, civil society, multilateral organizations, donors, the individual sector, and non-governmental organizations (NGOs), with back up from a secretariat, was challenged to ensure that human rights grounded in the ICPD framework were at the heart of programming. A 2019 assessment of the measures FP2020 and partners took to ensure the rights of women and girls to contraception after 2012 highlighted, amongst other actions, efforts undertaken to develop tools and guidelines that identify and explain rights in relation to family unit planning, to promote programming implemented through rights-based approaches, to strengthen accountability, and to measure outcomes from a rights lens.five
At the close of 2020, the vision for moving family planning frontwards to 2030 was announced every bit the new iteration of the initiative was launched. FP2030'due south vision is not numeric; instead envisions
A future where women and girls everywhere have the freedom and ability to lead good for you lives, make their own informed decisions about using contraception and having children, and participate as equals in social club and its development. (http://world wide web.familyplanning2020.org/Building2030)
FP2030's vision is underpinned past principles of voluntarism, rights, disinterestedness, and accountability. Edifice on the momentum on rights-based family planning over the past decade, what is needed to ensure rights under moving to 2030?
The 2019 assessment of progress on rights-based family planning was also frontwards-looking, with recommendations on strengthening rights-based family planning offered by respondents from the family planning customs. This paper focuses on key recommendations and how they can guide programming over the next decade. The paper also reviews initial planning under FP2030 related to each of the recommendations to appraise if and how the new partnership is seeking to address them.
Methods
This newspaper draws on interviews with 23 cardinal informants working on family unit planning and engaged in various roles with the FP2020 partnership at global and national levels, along with documentation of FP2030 partnership plans. The interviews were conducted as part of an assessment of contributions made by FP2020 in advancing rights-based family planning, conducted in 2019 rather than under a research protocol.5 The assessment did not go through ethics review, although the authors asked respondents to provide written informed consent to participate in the fundamental informant interviews and for their quotes to exist used. All participants agreed. The key informants represented governments (2), civil society and youth focused organizations (9), implementing partners (four), and bi-lateral/multilateral organizations and foundations (viii). Cardinal informants were based in Africa, Asia and the Pacific, Europe, and the U.s.. The key informants were selected purposively both to provide geographic perspective and to include stakeholders who were involved in service provision, oversight or evolution of family planning programs, in their country and/or organization, and who had familiarity with FP2020. Time and resource considerations associated with the overall cess in which the interviews were conducted determined the sample size. The authors developed an interview guide, including two forwards-looking questions that are the focus of this paper: ane) what more needs to be done, in your opinion, to promote right-based FP? (Prompt: Recall of the global, country and customs levels); and 2) If you could give advice to those developing the vision for FP at 2030 related to rights-based family planning, what advice would that be?
The central informants, nigh interviewed by the authors but with some responding electronically. The interviews lasted betwixt 30 minutes to one hr. The authors reviewed the written responses to the questions, from which emergent themes formed the recommendations. For purposes of reflecting comments from respondents in this paper, they are designated in three groups: Non-governmental organization (NGO), development partner, and national government. Quotes from respondents are italicized.
To place what steps FP2030 is taking related to each of the recommendations, the authors reviewed the FP2030 website, along with other literature on components of rights-based family planning. The relevant literature was identified as part of the 2019 cess to identify progress since 2012, through the authors' noesis of rights-based family planning activities and studies, and through Google searches.
Results
This section begins with a description of the advances fabricated through 2020 to promote rights, followed by primal recommendations from respondents to accelerate the momentum towards embedding rights in family planning programming.
Accomplishment in Rights-Based Family Planning Since 2012
Articulating Homo Rights for Family Planning
Although family planning had been proclaimed a human being right at the 1968 International Human Rights Conference,6 in 2012 in that location was not a common linguistic communication or understanding of rights concepts related to family planning explicitly (rather than implicitly) included under the umbrella of sexual reproductive health and rights SRHR), or most how to translate rhetoric almost rights at high levels into concrete, actionable steps required at different levels in the health system. There was a articulate need at the fourth dimension to bridge the
Chasm between theory and do … in translating human rights norms into concrete programming guidance applicable in diverse policy contexts and national circumstances.vii
In 2011, the United Nations Population Fund (UNFPA) and the Center for Reproductive Rights (CRR) produced a briefing newspaper that highlighted man rights related to contraceptioneight and UNFPA published its 2012–2020 family planning strategy that was underpinned by human rights.nine On the eve of the London Summit in 2012, Cottingham et al published an article with examples of how family unit planning programming could exist strengthened past infusing human rights values and concepts into all aspects of programming.10 This was followed in 2013 by publication of a conceptual framework providing a vision for what a voluntary, rights-based family planning programme entails at the policy, service delivery, customs, and individual levels.11 The framework illustrated a holistic family planning program that respects, protects, and fulfills human rights – expressed in programmatic terms and couched in family planning programming literature and experience.
 | Box i WHO'due south Ensuring Human Rights in the Provision of Contraceptive Information and Services |
The framework drew on human being rights piece of work past Erdman and Cook,12 who identified iii broad categories of reproductive rights among the composite of man rights that are
Guaranteed in national laws, constitutions, and regional and international treaties that can be applied to protect confronting the causes of sick health and promote sexual and reproductive well-being.
These categories, which clearly relate to family unit planning, include:
- Rights to reproductive self-decision (the rights of couples and individuals to decide freely and responsibly the number and spacing of their children)
- Rights to sexual and reproductive health services, information, and education (including contraception)
- Rights to equality and nondiscrimination (correct to make decisions concerning reproduction, including family planning, gratis of discrimination, coercion, and violence)
Noting its mandate to help member states reach the goal of the highest attainable standard of wellness for all, including sexual and reproductive wellness, and that respecting, protecting, and fulfilling human rights is critical for family planning services, WHO produced guidance on ensuring homo rights in contraceptive information and services.13 In 2015, FP2020 also published Rights and Empowerment Principles that reinforced its delivery to rights.14 Box 1 lists the rights highlighted past WHO.
UNFPA and WHO farther linked the rights principles and standards from WHO to eight categories of action that can exist taken at different levels of the health system to fulfill human rights in family planning programming, including, for example, advancing the human rights standard of availability through strengthening contraceptive bolt, logistics, and procurement; and promoting non-discrimination by ensuring access to contraceptive information and services for all.15 To further broaden its 2014 guidance, WHO published a checklist for wellness care providers working at the primary health care level who provide contraceptive information and services.xvi The checklist is intended to exist used to identify quality of care bug and link them with human rights standards, with suggestions for improvements. FP2020 produced an accompanying accountability tool for civil club to
To evaluate local and national contraceptive programs and empower activists to brainstorm or go on advocating with their governments for rights-based contraceptive data and services.17
Kumar et al explained that "applying a rights lens reframes the mode nosotros typically think nigh programs, including how we define goals, what nosotros value, and what we measure" and ideally should include incorporating rights principles and standards in all phases of programming – from assessment and design, to implementation, and to monitoring and evaluation.18
Convening Stakeholders to Share Experiences with Rights-Based Family unit Planning
FP2020 served as a conduit for socializing rights-based family planning, including through webinars, a dedicated page on its website, and co-hosting a series of meetings, including the latest at the 2018 International Conference on Family Planning focused on rights in do.19–21 Hailing from 10 countries, participants included human rights lawyers, clinic directors and practitioners, advocates, youth representatives, country development partners and foundations, researchers, midwives, and activists. Presentations highlighted successes at the legal and policy level, reaching marginalized groups, and expanding admission to services and identified continuing challenges, including the demand to bring rights discourse out of the realm of treaties and conventions to speak to people'due south lived experience and to strengthen rights literacy among both duty bearers (governments) and rights holders (individuals).
Implementing Programming
Piece of work to implement rights-based programming was undertaken at the country level, although documentation of this programming is scant. Two plan interventions, i in Nigeria and one in Uganda, attempted to incorporate all rights principles and standards related to family planning identified by WHOthirteen and FP2020xiv and to incorporate them at the service delivery level as identified in the Voluntary, Human Rights-based Conceptual Framework.11 Similar and/or adapted tools and approaches were used during the implementation and results measurement at the service delivery level in both countries' programs. The programs, implemented between 2016 and 2017, shared some common components, including building provider capacity, implementing facility level activeness plans, increasing clients' noesis of their rights, and strengthening health committee structures to back up voluntary rights-based-family planning. The interventions in both countries, which built on existing programs, resulted in benign outcomes, including improved quality of care, reduced provider bias, and greater sensation among providers and clients about what constitutes rights vulnerabilities and abuses and willingness to written report rights problems. Other common lessons that emerged included the continued importance of promoting rights literacy among all stakeholders; the demand to strengthen health systems; the importance of strong and supportive supervision to reinforce provider provision of rights-based information and services; and the need to work on rights at multiple levels, including policy, community, and private levels to reinforce interventions at the service level.22
Measurement
There take been advances over the past decade in monitoring and evaluating family planning programming from a human rights perspective to accost the challenge that
While many agencies and organizations piece of work to integrate man rights into public health policies and programs …. they frequently struggle to monitor and evaluate how well human rights are actually being addressed or fulfilled in these efforts.23
FP2020 included indicators to measure rights and empowerment in its core indicators and its quest to expand measurement of rights-based family unit planning (http://www.familyplanning2020.org/information-hub). Among their 18 core indicators, FP2020 monitored several indicators related to ensuring that women and girls take the power to make a full, free, voluntary, and informed choice in selecting the method that volition best meet their needs. Acknowledging early on that available indicators did not do justice to measuring rights-based family planning, questions related to aspects of rights, namely quality, disinterestedness, and accountability were added to the National Composite Index on Family unit Planning (NCIFP), which was fielded in 2014 and 2017.24,25 Through 22 questions beyond the 3 components of quality, equity, and accountability, the NCIFP was able to go in depth into these important aspects of rights-based family planning. For example, for equity respondents are asked the extent to which policies are in identify to prevent bigotry towards special sub-groups such as youth, the poor, people living with HIV, or those seeking mail service abortion care, and the extent to which providers discriminate confronting these groups. The accountability questions ask, as one example, most mechanisms in identify to monitor rights violations and if such violations are reviewed on a regular basis. The 22 questions related to quality, equity, and accountability are available at (http://www.track20.org/pages/data_analysis/policy/NCIFP.php). Comparison of scores from 2014 and 2017 showed that scores for quality, equity, and accountability all rose.25
Equally part of its work to identify and explain the human rights principles and standards associated with contraceptive information and services, WHO has published related indicators.13,26 To identify the indicators, Gruskin et al23 developed a methodology to assess indicators for their man rights sensitivity – forth with their public health validity. From this assay, WHO prioritized twenty indicators (with an additional 21 rights indicators listed in an annex) related to ensuring access for all; commodities, logistics and procurement; organization of health-care facilities, outreach and integration; quality of care; comprehensive sexuality didactics; participation by potential and actual users of services; and accountability to those using services.26
Since 2012, a number of studies have or are being conducted to advance understanding of right-based family unit planning and outcomes associated with it. Two implementation studies using a similar information collection package sought to accost all of the rights principles and standards (listed in Box 1) at the service commitment level in Nigeria and Uganda.22,27 Other studies take addressed aspects of rights-based family unit planning, including a written report on contraceptive autonomy that yielded a measure that incorporates a rights perspective by defining contraceptive autonomy;28 quality, rights-based counseling;29,thirty providing full, free and informed selection;31–33 measuring quality of intendance;34–36 reproductive empowerment;37,38 and reproductive compulsion.39 Show is likewise emerging from studies on social accountability.40–43 The Performance Monitoring and Accountability (PMA) Project, formerly PMA2020, includes measures of access, equity, quality, and choice in their surveys (https://www.pmadata.org/).
Reflections of Respondents Nearly Achievements from 2012–2019
Respondents agreed that FP2020 had provided a potent platform for promoting rights-based family unit planning, including through "translation of the man rights conventions into practical tools and guidance for implementation" (NGO respondent), through elevating the discourse on rights-based family planning, and through serving as a "resource center for materials on rights-based family planning and for coordinating partners" (development partner respondent). One NGO respondent cautioned that we should non malign programming before 2012 every bit though none of it was rights-based, but they reflected that "the platform has provided an opportunity to interrogate information technology and to heighten its visibility. The Superlative gave the issue elevator and added resources."
Respondents noted that the emphasis on rights afterward 2012 has helped the field articulate how taking a human rights-based approach goes beyond attending to quality of care. NGO respondents explained that said "Before the London Summit, there was more of a QOC perspective to programming," "Quality of care was the condolement zone for the family unit planning field," and
Introduction of the rights framework, and particularly 'AAAQ' [availability, accessibility, acceptability, and quality], caused a mind shift, helping us move beyond just a focus on quality.
Indeed, the focus on quality of care in family planning started in the 1980s and gained momentum in 1990s and 2000s equally a fashion to offering more customer-centered intendance afterwards ICPD.44–48 Quality of intendance is yet a disquisitional office of human being rights-based family planning,49− with the landmark quality of care framework first published in 1990 updated in the context of human rights.50 An NGO respondent summed up FP2020'due south contribution by proverb that "While ICPD formed the foundation of rights, FP2020 has moved rights-based family planning forward." Another NGO respondent agreed, saying "Rights-based family unit planning was there, merely information technology was embedded in SRHR. The "how" of rights-based planning had not been articulated."
Recommendations Moving Forwards to 2030 with Rights-Based Family Planning
Box ii shows seven key recommendations from respondents. Each of these recommendations is discussed below, along with steps FP2030 is taking to address the recommendations.
 | Box ii Fundamental Recommendations on Rights-Based Family Planning Moving to 2030 |
Keep Rights at the Middle of the Vision for Family Planning, Promote Rights Literacy, and Exist Flexible with Language
Respondents were articulate that rights should be at the center of family planning moving to 2030. One evolution partner respondent echoed all respondents' certainty that rights, with a focus on women's autonomy, must be at the core of family unit planning:
Rights must remain front end and center. Nosotros also have to remind people that family unit planning is not just a matter of getting products out in that location, essential and circuitous equally that is. It's besides virtually the dispensary setting and how people are treated in the clinic … It's about the policies, laws, and social norms that uphold rights, that give women the admission, the quality of care, the respect, the ability to make informed decisions.
A first pace is the need to increase rights literacy amongst all stakeholders, from policymakers down to communities and clients, in addition to plan implementers and donors. An implementing partner respondent reflected that "there is and then much more to exercise to ensure citizens' rights; demanding rights; educating people that they have rights." Respondents noted that it is non reasonable to expect providers to adhere to rights if they practice not know what clients' rights are. An NGO respondent added that services need to continue footstep with rights literacy and increasing need within communities, saying,
It is one thing to requite information about rights-based family planning and all of the bachelor bolt/method mix, but it is a totally unlike thing to get to the health facilities to access the same bolt and they are not in supply. The supply chain should lucifer up with the demand generation/creation.
Some other NGO respondent noted the need to link supply and demand strategies and to link rights to family planning and SRH to other rights, such equally economical and social rights, noting that "Demand = agency in many areas of life – not but family unit planning or fifty-fifty SRH." Another evolution partner respondent agreed that the focus on rights in relation to services is too narrow a view of rights, which is "more about ability than programs …. the focus should exist on autonomy, agency, participation, and voice."
Some respondents cautioned about existence flexible most rights language and to focus on language that is context-appropriate. Ane NGO respondent explained that "some countries don't want to talk almost rights" while some other NGO respondent noted the challenge that "the concept of 'rights' may not go political will." Another claiming could include the level of understanding about rights among unlike partners. While rights language is common among ceremonious order in talking with some governments and donors, information technology may prove more than productive to talk nearly the components of rights, such as voluntarism, access, quality, or equity. Promoting rights literacy volition be further achieved through flexibility in use of rights language. One NGO respondent explained that when talking with the regime in their country,
Rather than talking near rights, they stressed voluntarism for family planning to ensure that there was no pressure put on clients and they used the cafeteria approach to promote contraceptive choice, including natural methods.
This combination of direct and indirect reference to rights is evident throughout the FP2030 partnership. An articulation of the FP2030 vision equally a results statement that is measurable includes more dimensions of rights, once again without mentioning the term rights:
The change we wish in the world is 'Voluntary modern contraceptive use by everyone who wants it, achieved through individuals' informed selection and agency, responsive, and sustainable systems providing a range of contraceptives, and a supportive policy surround.]'. (https://familyplanning2020.org/Building2030)
One of four principles underpinning FP2030 mentions rights straight:
Voluntary, person-centered, rights-based approaches, with equity at the cadre: ….Every decision, action, and investment made by the partnership will reflect this belief – that each person has the same right to quality family unit planning, regardless of their geography, socioeconomic status, gender, or civilization.
On its commitments page, FP2030 "invites governments to make rights-based family planning commitments to support the partnership'south vision" and further asks "that all commitment makers include rights-based approaches and accountability mechanisms or agreements" (https://commitments.fp2030.org/). The commitments page includes information on anchoring country commitments in rights-based approaches. The page includes a framework to prove countries and implementers what a Comprehensive Human being Rights-based Voluntary Family Planning Program would look similar, building on work since 2012 to identify rights principles and standards related to family planning and operationalizing rights-based family unit planning at all levels, including policy, service delivery, community, and individual.51]
Focus at the State Level
Respondents stressed that considerable conceptual piece of work and development of guidance and tools on rights-based family planning has taken identify since 2012 and that work moving forwards should continue to focus on country implementation of rights-based programming, with careful consideration of country context. A development partner respondent said that the global discussion needs to permeate down to countries, noting "I've heard some countries say that if they provide the right family planning services, they are providing rights-based FP – and so what'due south the problem?"
Recommendations included further socializing rights from the national to local level being cognizant of turnover and the need for connected discussion about rights, taking a systems approach to implementing rights-based family planning, and making rights a norm through investing in advocacy. An NGO partner respondent noted advocacy is needed "because rights won't be fully integrated until [they are] in the public health system." A development partner respondent explained the need to "pour it downward to countries, understanding cultural contexts and using data to interrogate issues and identify enablers and segment the market for equity." Some other development partner added, "information technology would exist good to do an audit or mapping of rights-based family planning in FP2020 countries so support the countries to address problems." An NGO respondent noted that "there are structural barriers specific to countries that demand to exist addressed as rights barriers."
In addition to countries making commitments to rights-based family planning through FP2030, they can also ensure that rights are enshrined in policies and strategies and are embedded in costed implementation plans CIPs) that serve every bit a multi-year actionable roadmap designed to assistance governments reach their family unit planning goals. As of mid-2019, more forty CIPs had been developed, largely focused at the national level. Eight countries had completed their first-round CIPs and developed second round CIPs (https://www.familyplanning2020.org/countries). The CIPs adult from 2012 to 2013 show few mentions of rights. However, those created in 2014 and later showed increased attending to rights, although the plans independent little item about how they would exist operationalized in family planning programs. CIPs developed since 2016 tend to include more than detailed language on human rights. For example, Kenya'south 2017–2020 CIP notes that rights-based programming
Aim[s] to fulfill the rights of all individuals to choose whether, when, and how many children to have to act on those choices through loftier quality SRH services and information and education; and to admission those services complimentary from discrimination, coercion, and violence.52
This is significant advance from Kenya'south kickoff CIP (2012–2016) which made no mention of rights.
As another example, Republic of mali'due south first CIP (2014–2018) mentioned rights in relation to the country'south 2002 Reproductive health Police No. 02–044 that recognized women'south rights to reproductive health and family planning. The CIP noted that more than than ten years after its promulgation the law exists simply is insufficiently implemented.53 The CIP sought to strengthen stakeholders' understanding of the rights of women, and specifically included providers, noting their need for preparation that incorporates rights. Mali's second CIP (2019–2023) also mentions the 2002 RH police but includes more item about rights-based family program planning.54 Republic of mali's CIP references incorporates components of FP2020's Rightsizing Family Planning toolkit that was developed in 2018 whatever to help guide programs.55 The vision of Mali'due south 2d CIP is that the family planning needs of women, young people, vulnerable groups, and couples would be met by 2023 through bolt and services that respect human rights through programing that is answerable to beneficiaries. Activities in Republic of mali'southward 2nd CIP related to rights include attention to ensuring availability of contraceptives, training of staff, and supervision, among other initiatives.
Respondents noted that NGOs have been more flexible in incorporating rights into their programming. One youth NGO respondent explained:
Being a youth-led advocacy organization on family planning, rights-based family planning has been at the core of our programming as nosotros stand up for access to not only accurate, comprehensive data just besides access to services with a wide range of methods/commodities to select/cull from. In our programs and activities, nosotros e'er put the client first, nosotros don't discriminate, or segregate, and information is taken as a right of anybody including adolescents.
A dissimilar NGO respondent reported they adjusted their programming to more clearly put clients at the heart to run into their rights, while another said their arrangement used the Voluntary Rights-based Family unit Planning Conceptual Frameworkeleven to develop a road map for their programs and to acquit a rights audit of their piece of work. Another NGO respondent noted that they talked about rights related to family planning in their state before 2012, but this was reinforced because of FP2020, which "provided a constancy of the application of the rights arroyo …. including in the focus on young people."
Promote Political and Financial Support for Rights-Based Family unit Planning at the Global and Country Levels
Cognizant of how much the political landscape changed betwixt 2012 and 2019 when they were interviewed, both development partner and NGO respondents noted that work on rights-based family unit planning received varied support through the FP2020 timeframe. They also observed that donors have not been consistent in funding rights-based initiatives, noting that rights were viewed past some at the global and national levels as an expensive add-on. A evolution partner respondent noted that attention to and funding for rights-based family planning has been "too picayune, uncoordinated, and disruptive to follow." Additionally promising programming was losing funding given shifting political sands and irresolute donor priorities. Respondents stressed that "continued advancement for political and financial support for rights-based family unit planning at the global and national country levels will be important" (evolution partner respondent). An NGO respondent added, "Nosotros need to mobilize the community to invest in advancement because rights won't be fully integrated until [they are] in the public health organization." Some other development partner respondent noted that "if donors demand that rights-based family planning is a requirement for funding, it will become the norm."
Some respondents said that budgets for family planning do not currently reverberate rights equally a priority. An NGO respondent focused on country level concerns, request,
How practise we embed the rights into the plan and so that when countries stand and begin paying for FP, they embrace rights and AAAQ [availability, accessibility, acceptability, and quality] as their ain?
An NGO respondent described the need for
Shifting attention abroad from just budgeting for commodities, to budgeting for things that will improve rights. For example, how tin can nosotros incentivize rights-based approaches, such as providers reaching out to youth?
Other respondents underscored the demand for ceremonious lodge organizations (CSO) to exist more than fluent with budget advocacy work, to strengthen their effectiveness in advocating for reproductive health budgets.
Some respondents encouraged coordinating results-based financing and rights-based family planning. One development partner respondent said,
We have an urgent need for guidance on how to ensure rights in results-based financing/operation-based financing work. How do we measure progress, outcome, and bear upon through the eyes of clients— women and girls? What exercise we practise to avoid perverse incentives?
This includes perverse incentives created, even if inadvertently, by programs that push certain methods of contraception. Failing to utilize contraception should too exist a pick. Some other evolution partner explained that rights means
Selection, control for and by the individual to use – or not use – family planning. If someone decides not to utilize family unit planning, it should exist on the basis of having information about FP on which to make up one's mind – not due to ignorance. That a user can stop or switch methods with no pressure.
The demand to ensure that family planning programs funded through Performance Based Financing (PBF) mechanisms are underpinned with rights-based approaches has also been highlighted by advocates, plan implementers, donors, and researchers. Promoting voluntary rights-based family planning is crucial to ensure that family unit planning clients are non pressured to employ services by providers expected to meet targets set by PBF programming.56–58
Eichler et al59 provided guidance on ensuring adherence to rights in PBF, noting that:
Strategic purchasing should reflect rights-based principles of voluntarism, informed choice, quality, and accountability. In many cases, these rights-based principles are specified in policy statements and not well translated into the operational documents that govern the details of strategic purchasing.
Similarly, the button to expand access to family planning within Universal Wellness Coverage (UHC) is underpinned by human rights.60,61
Pay More Attention to Accountability
A number of respondents said that more piece of work is needed to promote accountability, including policy and budget accountability,62,63 and social accountability, for citizens and communities as rights-holders to hold duty-bearers, including officials and providers, to business relationship. Several respondents underscored the demand for accountability, but each pointed to the responsibilities of others, showing that a more holistic and comprehensive arroyo is needed. For example, ane development partner respondent described social accountability as "rights realization on the front lines." Yet, an implementing partner described work on social accountability every bit "just scratching the surface. Donors aren't giving enough attention to or providing funding for social accountability work related to family unit planning." A development partner respondent added,
We haven't engaged plenty with civil society at the land level. If nosotros leave it to clinical and plan staff, it might non happen. We demand civil society to advocate for what rights-based family planning ways and how to implement it. We demand this to hold governments answerable.
Another recommendation is to work with man rights mechanisms, to "have this to the Homo Rights Council to give it more visibility and to link it with larger human rights processes," as noted by a development partner respondent. UNFPA has been engaged with National Human Rights Institutions (NHRI) to strengthen their capacity to include SRHR, including family planning, in their monitoring effects.64 Countries report into the Universal Periodic Review (UPR), a mechanism put in identify by the United Nations since 2006 to assesses the fulfillment of human rights obligations and commitments by each United nations Member State every four and a half years. In reviews of the kickoff two cycles of the UPR to assess attention to SRHR issues, UNFPA identified that contraception gets scant attention compared to some other components of SRHR.65,66 Still, the UPR process offers a platform to bring together state and not-land actors together and provides civil society an opportunity to advocate for issues raised during the procedure.
FP2030 has renewed focus on accountability, emphasizing the demand for robust mutual accountability mechanisms that include both governments and ceremonious society and promote rights. FP2030's commitments page describes making a commitment to the FP2030 partnership as an opportunity to help make accountability mechanisms stronger, more systematic, and more than transparent. Accountability is as well a way of ensuring that laws, policies, programs, and services fulfill the needs and rights of intended beneficiaries and do no harm" (https://commitments.fp2030.org/accountability-approach). A cursory on social accountability is being developed by the Family unit Planning High Affect Do Initiative (HIPs), ready in early 2022, to guide programs interested in implementing social accountability initiatives.
Focus on Equity and Highlight Adolescent and Youth Leadership
Some respondents stressed the demand to focus on meeting the needs of marginalized groups and those overlooked in programming, such as adolescents, commencement-time parents, and men, in addition to people in humanitarian settings. An NGO respondent explained that
At that place is a trend to dismiss the poorer, more marginalized women. This is what is missing from rights-based family planning. We demand to exist more than refined in looking at the kinds of marginalization they experience and and so figure out how we see their specific needs and challenges.
FP2030 includes equity in 3 of its guiding principles (http://www.familyplanning2020.org/Building2030). The first principle is: Voluntary, person-centered, rights-based approaches, with equity at the core. Some other principle is "Empowering women and girls along with engaging men, boys, and communities" as part of an equity approach. A third principle highlights
Building intentional and equitable partnerships with adolescents, youth, and marginalized populations to run into their needs, including for authentic and disaggregated data collection and use.
Tools, including a measurement framework to help identify groups facing inequities and that were linked with the rights principles of AAAQ as well every bit diverse social characteristics of sub-groups, were developed by the Health Policy Plus (HP+) project (http://world wide web.healthpolicyplus.com/fpEquity.cfm). Using data from the Demographic and Health Survey (DHS) in Republic of uganda, they identified inequities in admission, acceptability, and quality health care and in need satisfied, based on age, education, marital condition, wealth, residence, religion, and ethnic status.
Respondents noted that rights-based family unit planning should continue to focus on youth as key drivers of change and of the future. Respondents gave FP2020 credit for its work to appoint youth, including having youth members of FP2020'south Reference Group and equally part of country focal point structures. An NGO respondent noted that
Youth can advance rights—they are the audience where all these 'taboo' topics come upwards. This is where all the rights issues are actually launched …. Advancement and conversations take to happen at the national level and creating contacts and developing relationships tin create change.
Some other NGO respondent reinforced that without youth every bit the center of discussion of rights and FP2030, "zilch will exist achieved."
FP2030 is strengthening the focus on adolescents, including that more stringent commitments will exist requested of countries. The commitments page reinforces that meeting FP2030 goals will require partners to intensify efforts promote adolescent and youth (AY) sexual and reproductive health (SRH) services, which includes contraception.
Strong commitments … send a clear message virtually the vital importance of improving adolescent and youth SRH cognition, fostering their agency and ability to make informed decisions, facilitating their access to high-quality SRH services … and ensuring a supportive policy and social surroundings.
Support Evolution and Dissemination of Practical Tools and Training Materials
While in that location are many available global tools on rights-based family unit planning, some respondents thought countries could benefit from an array of simpler tools to guide implementation, advocacy, and training. A national government respondent also noted that disseminating the tools and providing help for using them will exist important. A development partner respondent said reflected that "information technology would be skillful to have a tool, but something short, to aid countries with rights-based family planning." Some other respondents cautioned near simple tools, as explained by a evolution partner respondent, who said that "there is a view that rights should exist reduced to a checklist, but that is unrealistic."
FP2030 is updating its CIP toolkit to help guide development of state CIPs. A program cess tool focused on rights-based family planning will be available to countries and is existence included in the CIP toolkit. This tool emphasizes that a human being rights-based arroyo to family planning is:
A systematic procedure to ensure that attention to human rights principles related to FP is embedded in all programmatic phases (i.e. needs cess, plan pattern, workplan development, implementation, monitoring and evaluation) at all levels of the programme (i.e. policy, service commitment, community and individual).67
Training and supervision materials focused on rights-based family unit planning will be published in 2021 through a project funded by the Bill and Melinda Gates Foundation. Other tools related to dimensions of rights have been noted throughout this newspaper, although these are not intended to be an exhaustive listing of tools.
Keep Working on Rights Metrics and Studies and Disseminate Results
Respondents stressed the need to advance work on indicators for rights-based family planning, in add-on to metrics and information, with attending to the subnational level.
If the family planning customs is going to hold governments answerable, in that location is a need for a clearly-defined rights-based family planning framework and indicators that can exist tracked at the global and national levels,
noted ane development partner respondent, adding
Program success is still being judged by mCPR, but that doesn't highlight what the family unit planning customs is trying to address with rights-based family unit planning programming.
Respondents stressed the importance of research on rights-based family planning and disseminating the findings to a range of stakeholders. Said one NGO respondent, "in that location would be stronger appreciation if policymakers learn about evidence that the rights-based approach works." Another NGO respondent added,
The results should be disseminated not merely to government officials and technocrats, but besides downwards to communities, family unit planning services providers, and users in elementary language, because these are the stakeholders who really need to understand rights-based family planning to change their ideation and societal perspective.
While the rights-based family planning measurement agenda has advanced significantly over the by decade, boosted work is needed on enhanced measures of rights-based family unit planning – both indicators for monitoring the fulfillment of rights in family planning programming, and more than studies must be undertaken to assess the outcomes of such programming. Countries would benefit from guidance on the range of indicators available to measure rights. Furthermore, equally noted past the respondents, wide broadcasting of the findings from the studies is likewise needed. Measurement of rights-based family planning volition continue under FP2030, with core and other indicators for FP2030 being developed in 2021.
Empathize That Institutionalizing Rights Will Take Time
Respondents stressed that institutionalizing rights in programming will have time. Ane development partner respondent compared information technology to the fourth dimension gender mainstreaming has taken, noting "that same time and energy will be needed to integrate rights-based family planning." Another speculated that realistically, an investment is needed for the long term, 10 to xx years rather than thinking of rights as a silverish bullet or a quick fix. Coordination amongst donors and programmers is essential as a comprehensive, rights based approach effectively requires considerable resource and expertise from providers.
COVID Has Reinforced the Importance of Family unit Planning and Rights
The global COVID-xix pandemic had not begun when the respondent interviews were conducted in 2019 thus its effect is non reflected in the recommendations. Feel since the pandemic started has reinforced the importance of ensuring reproductive rights and admission to contraception as an essential part of SRH services. When services are deemed non-essential, "health systems may be unable to fulfill these rights, and communities will lose a formal justification for claiming them."68 The language – and legal teeth – of human rights provide the foundation for taking action to ensure access to including family planning as part of SRH:
Through fostering community participation; focusing on non-bigotry; working to ensure the availability, accessibility, acceptability, and quality of services; providing access to information; and striving to ensure transparency and accountability in the response to the pandemic.69
Contraceptive education and availability also is a crucial component. An estimated fifteen million unintended pregnancies over a year could result from a 10% reduction in the proportional use of short- and long-acting contraception in lower and centre income countries.70 Plans for ensuring access to contraception has implications for providing clients with full, complimentary, and informed choice of methods and should include a renewed focus on contraceptive methods conducive to self-care.71
Discussion
As this paper shows, the 2012 London Summit on Family Planning was, launched somewhat controversially with a numeric goal, but with pressure from activists and other members of the global family planning customs, FP2020 became instrumental in sparking work to ensure that achieving the goal was undertaken in through programming that respects, protects, and fulfills human rights.
Work since 2012 has provided the guidance, tools, and language to strengthen family planning programs through a human rights lens and to hold governments accountable for programs that back up individuals and couples to practice their rights to choose the timing and spacing of their pregnancies, to have the information, services, and agency to deed on that right, and to exist treated respectfully, as, and without bigotry by providers. Equally the family planning field looks across to 2030, this paper provides a roadmap for not only building on the gains made over the past decade, just likewise to finer tackle the challenges remaining to ensure that programming to achieve the vision of the FP2030 Partnership is indeed rights-based.
The recommendations in this paper come from respondents securely steeped in family planning policies, programming, advancement, monitoring and evaluation, and research. They conspicuously and consistently underscored the need to keep rights at the centre of family planning – and to go along working to garner stable global support, including amongst donors, programmers, clinic providers, and the public, for rights-based programming. The feel from the past decade shows both how fragile political back up for family planning and SRH tin be and the harm wide shifts in political winds can accept on programming and on individuals' wellbeing. Furthermore, while the concluding decade has seen a flurry of work at the global level to define rights-based family unit planning and to develop tools and evidence, at that place is a clear need to focus on rights and implementation at the land level, including promoting political and financial support and ensuring through funding, policies, guidance, training, and supervision that customer autonomy and choice among a range of methods are central, avoiding overpromotion of any particular methods. At both the global and land level, rights have too often been seen as an add-on to family unit planning programming rather than every bit an umbrella under which all programming should autumn. Amplifying boyish and youth voices volition be important since they are most frequently afflicted by cutback of their rights related to family unit planning. Strengthening civil society, including adolescent and youth voices, will be fundamental to engaging governments to both support and fund rights-based programming. Ensuring rights literacy will give stakeholders flexibility to address rights directly if possible given the context, and indirectly if necessary past highlighting the dimensions of rights, as needed.
Respondents articulated the need to strengthen accountability mechanisms throughout all levels of the public health system:, governments must uphold their policy and program commitments and communities should exist supported to engage in social accountability that links communities with local government and providers at the local level. Work should continue to develop metrics and generate evidence and to brand certain that stakeholders, notably policymakers and other leaders, are have the evidence of the efficacy of rights-based programming and can ensure the tools needed to measure programs are widely available. More documentation of rights-based programming will provide lessons learned and exemplify successful programming.
Institutionalizing rights-based family planning volition take enhanced commitment from both donors and countries for programming over the long term. Feel effectually the globe has highlighted the particular effects of the global COVID-xix pandemic on women and has reinforced the importance of ensuring reproductive rights and admission to SRH services, including contraception, as essential services. The language – and legal teeth – of human rights provide the foundation for ensuring access to family planning. The momentum from 2012–2020 provides a foundation for further strengthening and advancing rights-based family planning programming through 2030 to support individuals and couples to exercise their rights to cull the timing and spacing of their pregnancies, to have the data, services and agency to act on that right, and to exist treated respectfully, equally, and without bigotry past providers.
Limitations
This analysis has some limitations. While an attempt was made to include a range of respondent types, key informant interviews primarily represented civil society, implementing partners, and bilateral/multilateral organizations, with few government representatives. Given that governments are duty-bearers for ensuring rights are and in most countries, the majority of services are delivered by the public sector, having more representation from governments would have been useful to inform rights-based programming. Additionally, this analysis was conducted from the perspective of the FP2020 Partnership. An assessment of the perspectives of land implementers who may or may not be enlightened of global partnerships would provide a more robust picture of rights-based family unit planning at the country level.
Acknowledgments
Funding for the information used in this newspaper was provided by the Bill and Melinda Gates Foundation to the United Nations Foundation, Family Planning 2020 Secretariat.
Disclosure
The authors report no conflicts of interest in this work.
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