Transcript Foundation PowerPoint Template

Voluntary, Rights-based Family
Planning Framework:
What, Why, and How?
Module 1: Orientation
Agenda
 Opening Remarks—[name, title]
 Ice breaker
 Presentation: Introduce the VRBFP Framework
 Discussion
 Case Studies
 Discussion
Facilitator: [name, title]
Objectives
1. Explain what a rights-based approach in FP
means
2. Explain why it is important for FP programs to
take a voluntary, rights-based approach
3. Introduce the VRBFP framework and describe how
it can be used in programs
4. Provide a hands-on opportunity to apply the
framework using case studies
WHAT
is a rights-based approach?
What Are Human Rights?
 Human rights are internationally agreed-on
entitlements that all people have by virtue of being
human.
 They are articulated in international treaties,
conventions, protocols, and other instruments that
have the status of international law (i.e., they are
legal obligations).
 Individual human dignity is at the core.
Right to Health: Governments have an
obligation to provide health services with the
following elements:
Rights
elements
Program implications
Available
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Accessible
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Acceptable
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Quality
Broad choice of methods offered
Sufficient number and needs-based distribution of functioning
service delivery points
Information available in language/terms people can understand
Geographic access, financial access, policy access
Continuous contraceptive security; convenient service hours;
service integration increases access
Cultural acceptability of FP and specific methods
Community/family supports women’s right to choose
Tolerance of side effects
Client satisfaction with services
Clinical quality/technical competence
Good client-provider interactions and counseling
Privacy, dignity, respect demonstrated in service delivery
Continuity of care
General Comment 14, Article 12 from the UN Committee on Economic, Social and Cultural
Rights. 2000.
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)
Reproductive and human rights re: FP
The rights of individuals and couples:
“These (reproductive) rights rest on the recognition of the basic
rights of all couples and individuals to decide freely and responsibly
the number, spacing, and timing of their children, and to have the
information and means to do so…” “ The principle of informed free
choice is essential to the long-term success of family planning
programmes.”
ICPD, 1994
"The human rights of women include their right to have control over
and decide freely and responsibly on matters related to their
sexuality, including sexual and reproductive health, free of coercion,
discrimination and violence.”
Beijing Women’s Conference, 1995
Rights-based programs…
 Respect (refrain from interfering with or curtailing
the enjoyment of human rights)
 Protect (guard against human rights abuses)
 Fulfill (take action to facilitate the enjoyment of…)
…human rights for both clients and potential clients
in the way the program is designed, implemented,
monitored, and evaluated
Progressive realization
 The status of human rights varies among countries and
FP programs.
 Political, cultural, and resource constraints may hinder some
elements of a rights-based approach.
 Governments and implementers should take whatever steps
possible to advance the protection and fulfillment of human
rights in their FP programs over time.
 Incremental steps continue to leave many people vulnerable
to human rights violations; sustain advances to gradually
realize rights for all.
Checkpoints for Choice, EngenderHealth, 2014
Human Rights Principles (PANEL)
Principle
Action
Participation
Engage communities and individuals in planning and monitoring programs.
Accountability
Fulfill (governments) obligations to respect, protect, and fulfill rights enshrined in
treaties they have signed.
Nondiscrimination
Increase focus on barriers that lead to inequities in access and quality, particularly
for marginalized, disadvantaged, and vulnerable groups.
and Equality
Empowerment
Inform people of their human rights and to increase their capability to demand and
exercise those rights.
Linked to
Align programs with standards set by international human rights bodies and
mechanisms.
standards
( UNESCO, 2008)
Additional Principles
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
Public Health Programming:
• Beneficence
• Equity
• Autonomy/Agency
• Verify client’s voluntary and informed
consent for sterilization in a written
consent document signed by the client
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WHY?
The importance of taking a voluntary,
rights-based approach to
family planning
Why take a rights approach ?
1. Governments have a legal obligation to protect and
fulfill the human rights of their citizens.
2. There are practical benefits: both health and rights
outcomes benefit both individuals and programs.
(HRA contributes to improved health outcomes for
women and children, WHO 2013)
3. Rights violations persist in some programs and a
human rights-based approach to FP can prevent
violations in the future.
Practical benefits of a rights-based approach
 Improves 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
 Expands access to family planning without discrimination or
coercion; removes barriers to reach groups not currently being served
 Demands effective monitoring and accountability mechanisms to
identify and address violations
 Informs program design or strengthening to ensure respect for
individual dignity and promotion of individual agency
Violations persist
 Coercion in family planning = actions or factors that
compromise individual autonomy, agency, or liberty in
relation to contraceptive use or reproductive decision
making through force, violence, intimidation, or
manipulation.
Hardee et al., publication pending 2014*
 Access barriers prevent many people—
particularly the underserved, hard to reach, unmarried
youth—from getting the contraception they want.
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Coercion in family planning
 Excessive social pressure
 Enforced policies limiting
the number of births
 Involuntary contraceptive
use
 Targets and performance
management indicators linked to
numbers of acceptors
 Incentives and disincentives
Hardee et al., publication pending 2014*
Challenges to rights—it’s about more than
blatant coercion
Barriers
Coercion
Subtle
Overt
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Provider bias for specific methods
Incentives to providers or clients
Targets and quotas
Community/family pressure
Lack of capacity of the health system to
ensure the availability of all methods at all
levels of the health system
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•
Provider bias against specific methods or
population groups
Misinterpretation of eligibility criteria
Lack of :
o Accurate information
o Community or spousal support for FP or
specific methods
o Access to new/innovative contraceptive
technologies
Poor quality of services
Gender norms and low status of women
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Involuntary sterilization of ethnic minorities,
the poor, and HIV-positive persons
Postpartum IUD insertion without consent
Provider incentive payments
Withholding of benefits for non-acceptance
Refusal to remove IUD and/or implants
Limited choice of methods available (e.g.,
specific methods not offered, stock-outs)
Lack of equitable distribution of FP outlets
Lack of trained providers
Costly, unaffordable services
Denial of FP to unmarried youth
Challenges to rights—it’s about more than
blatant coercion
Coercion
Subtle
•
•
•
•
•
Barriers
•
•
•
•
•
Overt
Provider bias for specific methods
Incentives to providers or clients
Targets and quotas
Community/family pressure
Lack of capacity of the health system to
ensure the availability of all methods at all
levels of the health system
•
Provider bias against specific methods or
population groups
Misinterpretation of eligibility criteria
Lack of :
o Accurate information
o Community or spousal support for FP or
specific methods
o Access to new/innovative contraceptive
technologies
Poor quality of services
Gender norms and low status of women
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Involuntary sterilization of ethnic minorities,
the poor, and HIV-positive persons
Postpartum IUD insertion without consent
Provider incentive payments
Withholding of benefits for non-acceptance
Refusal to remove IUD and/or implants
A rights-based approach can
address each of these
challenges
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Limited choice of methods available (e.g.,
specific methods not offered, stock-outs)
Lack of equitable distribution of FP outlets
Lack of trained providers
Costly, unaffordable services
Denial of FP to unmarried youth
Finding common ground
Public health
promotes and protects
health and prevents
premature mortality,
seeking the greatest good
for the greatest number of
people.
Human rights
promote and protect the
well-being of individuals by
ensuring respect for
individual entitlements and
dignity.
A human rights–based approach can
enhance both health
and human rights outcomes.
Checkpoints for Choice, EngenderHealth, 2014
HOW
to operationalize rights in
family planning programs
Operationalizing human rights in
family planning programs
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?
Framework for Voluntary Family Planning Programs that Respect, Protect, and Fulfill Human Rights
INPUTS/ACTIVITIES
COUNTRY
CONTEXT
Policy Level
Service Level
OUTPUTS
OUTCOMES
IMPACT
Community
Level
Individual
Level
Citation: Hardee, K., et al. 2013. Voluntary Family Planning Programs that Respect, Protect, and Fulfill Human Rights: A Conceptual
Framework. Washington, DC: Futures Group.
August 2013
Framework for Voluntary Family Planning Programs that Respect, Protect, and Fulfill Human Rights
INPUTS & ACTIVITIES
POLICY LEVEL
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)
OUTPUTS
Illustrative
•
 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; highquality client-provider
interactions; follow-up and
continuity mechanisms; and
appropriate constellation of
services)
COUNTRY CONTEXT
Assess to inform interventions
SERVICE LEVEL
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)
•
COMMUNITY LEVEL
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)
INDIVIDUAL LEVEL
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)
Family planning services are
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
OUTCOMES
IMPACT
Illustrative
Decreased
• 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
• 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
* Reproductive rights:
R1: reproductive selfdetermination
R2: access to sexual and
reproductive health
services, commodities,
information, and
education
R3: equality and nondiscrimination
(“All Rs” indicates that all
rights are encompassed)
• Agency of individuals is increased
to enable them to make and act on
reproductive health decisions
Citation: Hardee, K., et al. 2013. Voluntary Family Planning Programs that Respect, Protect, and Fulfill Human Rights: A Conceptual Framework. Washington, DC: Futures Group.
August 2013
A detailed framework
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Using the framework in FP programming
Phase of the
Program Cycle
Illustrative Actions that Incorporate Rights Principles
Assess needs
•
Ask new questions (i.e., who are we not reaching and
why?)
Design
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Engage a wide range of stakeholders more deliberately
Systematically think through interventions’ impact on rights
Implement
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Make rights and responsibilities explicit
Offer a full, free, and informed contraceptive choice
Expand concept of demand to include rights
Monitor and
evaluate
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Incorporate indicators specific to human rights
Monitor human rights outcomes as well as FP outcomes
Engage, empower communities and clients in monitoring
Routinely track for and manage program vulnerabilities
and risk factors
Promote accountability throughout the system
•
Sustain
•
Engage communities to improve services and outcomes
and achieve lasting behavior change
Need to partner across sectors, service
modes, and disciplines
RIGHTS
EDUCATION
Public sector
Facility-based
services
Private
commercial
sector
Community-based
services
NGOs
Social marketing
HEALTH
Checkpoints for Choice, EngenderHealth, 2014
Publications
Systematic reviews of tools and interventions are
summarized in additional publications
Discussion
 Questions?
 Observations?
 What challenges do you envision
 Related to what you are already doing—it may not
be as difficult as you think.
Build on the good work you are
already doing
Gender equity
Youth-friendly services
Access
An extraordinary opportunity for
voluntary family planning
 Pledge of political will and
resources with FP2020
 Opportunities offered by
the costed implementation
plan development process
that is underway
 Availability of new tools to
apply abstract human
rights concepts in actual
practice
Applying the
Framework to Case
Studies
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.
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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?
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Next steps
**Tailor this slide to the context of the presentation**
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