Karen Hardee

Voluntary, Human Rights–Based Family Planning: A Conceptual Framework

At the 2012 Family Planning Summit in London, world leaders committed to providing effective family planning information and services to 120 million additional women and girls by the year 2020. Amid positive response, some expressed concern that the numeric goal could signal a retreat from the human rights-centered approach that underpinned the 1994 International Conference on Population and Development. Achieving the FP2020 goal will take concerted and coordinated efforts among diverse stakeholders and a new programmatic approach supported by the public health and human rights communities. This article presents a new conceptual framework designed to serve as a path toward fulfilling the FP2020 goal. This new unifying framework, which incorporates human rights laws and principles within family-planning-program and quality-of-care frameworks, brings what have been parallel lines of thought together in one construct to make human rights issues related to family planning practical.

What works to meet the sexual and reproductive health needs of women living with HIV/AIDS

It is critical to include a sexual and reproductive health lens in HIV programming as most HIV transmission occurs through sexual intercourse. As global attention is focusing on the sexual and reproductive health needs of women living with HIV, identifying which interventions work becomes vitally important. What evidence exists to support sexual and reproductive health programming related to HIV programmes?This article reviews the evidence of what works to meet the sexual and reproductive health needs of women living with HIV in developing countries and includes 35 studies and evaluations of eight general interventions using various methods of implementation science from 15 countries. Data are primarily from 2000-2009. Searches to identify effective evaluations used SCOPUS, Popline, Medline, websites and consultations with experts. Evidence was ranked using the Gray Scale.A range of successful and promising interventions to improve the sexual and reproductive health and rights of women living with HIV include: providing contraceptives and family planning counselling as part of HIV services; ensuring early postpartum visits providing family planning and HIV information and services; providing youth-friendly services; supporting information and skills building; supporting disclosure; providing cervical cancer screening; and promoting condom use for dual protection against pregnancy and HIV. Provision of antiretrovirals can also increase protective behaviours, including condom use.While many gaps in programming and research remain, much can be done now to operationalize evidence-based effective interventions to meet the sexual and reproductive health needs of women living with HIV.

What HIV programs work for adolescent girls

Background:Adolescent girls face unique challenges in reducing their risk of acquiring HIV because of gender inequalities, but much of HIV programming and evaluation lacks a specific focus on female adolescents. Methods:This article, based on a review of 150 studies and evaluations from 2001 to June 2013, reviews evidence on programming for adolescents that is effective for girls or could be adapted to be effective for girls. Results:The evidence suggests specific interventions for adolescent girls across 3 critical areas: (1) an enabling environment, including keeping girls in school, promoting gender equity, strengthening protective legal norms, and reducing gender-based violence; (2) information and service needs, including provision of age-appropriate comprehensive sex education, increasing knowledge about and access to information and services, and expanding harm reduction programs for adolescent girls who inject drugs; and (3) social support, including promoting caring relationships with adults and providing support for adolescent female orphans and vulnerable children. Discussion:Numerous gaps remain in evidence-based programming for adolescent girls, including a lack of sex- and age-disaggregated data and the fact that many programs are not explicitly designed or evaluated with adolescents in mind. However, evidence reinforces bolstering critical areas such as education, services, and support for adolescent girls. Conclusions:This article contributes to the growing body of literature on HIV and adolescent girls and reviews the vulnerabilities of girls, articulates the challenges of programming, develops a framework for addressing the needs of girls, and reviews the evidence for successful programming for adolescent girls.

Are men well served by family planning programs

Although the range of contraceptives includes methods for men, namely condoms, vasectomy and withdrawal that men use directly, and the Standard Days Method (SDM) that requires their participation, family planning programming has primarily focused on women. What is known about reaching men as contraceptive users? This paper draws from a review of 47 interventions that reached men and proposes 10 key considerations for strengthening programming for men as contraceptive users. A review of programming shows that men and boys are not particularly well served by programs. Most programs operate from the perspective that women are contraceptive users and that men should support their partners, with insufficient attention to reaching men as contraceptive users in their own right. The notion that family planning is women’s business only is outdated. There is sufficient evidence demonstrating men’s desire for information and services, as well as men’s positive response to existing programming to warrant further programming for men as FP users. The key considerations focus on getting information and services where men and boys need it; addressing gender norms that affect men’s attitudes and use while respecting women’s autonomy; reaching adolescent boys; including men as users in policies and guidelines; scaling up successful programming; filling gaps with implementation research and monitoring & evaluation; and creating more contraceptive options for men.

Women’s Education, Family Planning, or Both? Application of Multistate Demographic Projections in India

Is education the best contraceptive? Using the multistate human capital projection model, our analysis shows that the projected changes in India population vary depending on investments in education and helping women reduce unwanted fertility rates, that investments in both education and helping women in each education category—but particularly less educated women—meet their wanted fertility will have the largest impacts on India’s population projections, and that the impact from investment in reducing unwanted fertility will be much more immediate and significant than only investments in education. Our analysis also reveals that an increasing education transition rate in India will not only help to achieve a population age structure that is favorable for economic growth, but also result in a larger share of skilled labor force that help to achieve higher economic growth rate. More importantly, investment in girls’ education and achieving gender equality in education will be the most effective measure to increase India’s population education level and improve its overall values of human capital.

Measuring and monitoring quality of care in family planning: are we ignoring negative experiences?

Despite decades of emphasis on quality of care, qualitative research continues to describe incidents of poor quality client–provider interactions in family planning provision. Using an emerging framework on disrespect and abuse (D and A) in maternal health services, we reviewed the global published literature for quantitative tools that could be used to measure the prevalence of negative client experiences in family planning programs. The search returned over 7,000 articles, but only 12 quantitative tools included measures related to four types of D and A (non-confidential care, non-dignified care, non-consented care, or discrimination). We mapped individual measurement items to D and A constructs from the maternal health field to identify measurement gaps for family planning. We found significant gaps; current tools are not adequate for determining the prevalence or impact of negative client experiences in family planning programs. Programs need to invest in tools that describe all aspects of client experiences, including negative experiences, to increase accountability and maximize the impact of current investments in family planning programs.

Closing the gap between people and programs: lessons from implementation of social accountability for family planning and reproductive health in Uganda.

Globally, womens access to modern contraception can be attributed to poor service conditions and care. Growing evidence from across the health sector has found that social accountability approaches have the potential to improve the quality of care and therefore the utilization of health services, little of this evidence relates to family planning and reproductive health programs. This paper therefore assessed the results of retrospective implementation research into a five-year social accountability project in Uganda that focused on family planning and reproductive health. A mix of methods was used examine the projects implementation in three districts in Uganda between 2009 to 2013, including political economy analysis, document review, and in-depth interviews. Interviews were coded using ATLAS.ti software and analyzed with a thematic framework, organized by stakeholder groups and across districts. The research found that while the project broadly delivered as intended in local accounts, a wider range of activities and outcomes also occurred. Community participants in the three districts were much more likely to remember more personal changes, such as increased confidence when interacting with health care providers, in their health seeking behavior or in their ability to represent themselves. The research revealed a web of accountability relationships at play. These ranged from formal opportunities for community participation in institutional processes, to the more personal direct relationship between the service users and the health care provider compared to the less direct relationship between the community and local officials. In addition, ways in which elements of social accountability can be combined with features of FP program were seen, such as including outreach activities with civic and rights education. This appears to extend the reach and credibility of these services among community members while also counteracting barriers to womens and young peoples participation.

The Role of Public-Sector Family Planning Programs in Meeting the Demand for Contraception in Sub-Saharan Africa

CONTEXT Commonly used indicators of contraceptive behavior in a population-modern contraceptive prevalence (mCPR), unmet need for contraception, demand for contraception and demand satisfied-are not well-suited for evaluating the progress made by government family planning programs in helping women and men achieve their reproductive goals. METHODS Trends in these measures in 26 Sub-Saharan African countries between 1990 and 2014 were examined. Trends in a proposed new indicator, the public-sector family planning program impact score (PFPI), and its relationship to mCPR and the family planning effort score were also assessed. Case studies were used to review public family planning program development and implementation in four countries (Nigeria, Ethiopia, Rwanda and Kenya). RESULTS The four commonly used indicators capture the extent to which women use family planning and to which demand is satisfied, but shed no direct light on the role of family planning programs. PFPI provides evidence that can be used to hold governments accountable for meeting the demand for family planning, and was closely related to policy developments in the four case-study countries. CONCLUSIONS PFPI provides a useful addition to the indicators currently used to assess progress in reproductive health and family planning programs.