What is contraceptive choice?
In simple terms, contraceptive choice is the ability of an individual to determine whether and when to practice contraception freely, with neither constraint nor pressure; and to select and obtain a safe and effective method that most suits her/his reproductive goals and intentions to delay, space, or limit a future birth. Contraceptive choice has been considered a “sine qua non” of international reproductive health and family planning programs for decades, yet in reality, few countries have achieved a balanced method mix, leaving millions of women and couples with few real options. The reemergence of family planning as a global health priority, as evidenced by the recent London Summit on Family Planning, makes this a good time to examine the meaning of contraceptive choice and how to make it a reality.
Why is contraceptive choice still out of reach for so many women?
There are many reasons why contraceptive choice remains elusive. While there is no “ideal method mix” recognized by international experts, most agree that quality family planning programs must offer an array of methods that meet individuals’ different preferences and serve their changing needs throughout their reproductive life cycle. However, in many countries, only one or two methods predominate. This can be the result of such factors as government policy and promotion, program history, health system capacity, provider bias, women’s status, and community norms. Contraceptive security, defined as “the ability of people to choose, obtain, and use high-quality contraceptives and condoms whenever they want them,” remains one of the biggest challenges for family planning programs today.
What options are available for women who want to limit future births?
All women should be able to adopt a method that suits their circumstances, preferences, and reproductive intentions and to switch methods when their circumstances and needs change. Women with a reproductive intent to limit future births can use any method of contraception. However, it is important that their options include effective, long-acting methods of contraception (i.e., the hormonal implant and the intrauterine device [IUD]), as well as permanent options (i.e., female sterilization and vasectomy). These methods are characterized by high levels of effectiveness and continued use, resulting in fewer unintended pregnancies and adverse health consequences. However, they also tend to be the most difficult to offer in low-resource settings, given the inadequacies of facilities and the lack of trained personnel. As a result, programs tend to rely on short-acting methods (such as the pill and injectables), since they are easier to provide.
What challenges do women who want to limit future births face?
Women who want to limit births face the same access barriers to contraception as women with other reproductive intentions. Moreover, these “limiters” have unique characteristics and needs that are often not adequately addressed by family planning programs and providers. Particularly in Africa, where family planning programs tend to be organized around the health benefits for mothers and children of the healthy timing and spacing of births, information and services are rarely geared toward women who have completed their childbearing. Enabling these women to end the fear of unwanted pregnancy and to be free of the side effects and return visits associated with short- and long-acting methods are not priorities in many programs. Current trends indicate that the numbers of women who intend to limit future births will only continue to grow.
What were the top three findings from the comprehensive literature review on female sterilization?
In 2012, RESPOND conducted a literature review on female sterilization in preparation for the Bellagio consultation, focusing on articles published since 2000. The top three major findings were:
What common themes arose from key informant interviews on contraceptive choice and female sterilization?
In addition to the literature review, as part of the evidence base for the consultation in Bellagio, RESPOND interviewed 18 key informants from international donor and technical assistance agencies working in reproductive health and family planning. Three important themes consistently emerged:
What is the purpose of the Bellagio consultation?
EngenderHealth’s RESPOND Project is convening multidisciplinary experts at the Rockefeller Foundation’s Bellagio Conference Center in September 2012 to deliberate on what can be done to move from rhetoric to reality about matters of choice. We will be looking at these issues through the lens of female sterilization. The purpose of the Bellagio consultation is to explore what contraceptive choice means in programmatic and operational terms, why it is important, and how to advocate to policymakers and other leaders about the need to broaden method options in their programs. With specific regard to female sterilization, we expect to examine whether there is a rationale for continued attention and investment in ensuring that it remains a viable option in family planning programs.
Why is there a particular focus on the role of female sterilization at the meeting?
Issues of choice are heightened with this method, since it the most widely contraceptive used among women worldwide, but its availability varies across regions and countries, and it is the method most often at the heart of reproductive rights abuses.
What are the anticipated outcomes of the Bellagio consultation?
We expect to produce:
Who is attending the Bellagio consultation?
The consultation will include 18 global and national experts from public-sector, nongovernmental, academic, donor, and rights organizations, representing nine countries.
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References
U.S. Agency for International Development. [No date.] Contraceptive security ready lessons: Overview. Washington, DC: INFO Project/Johns Hopkins Bloomberg School of Public Health Center for Communication Programs.
Verkuyl DA. Sterilisation during unplanned caesarean sections for women likely to have a completed family--should they be offered? Experience in a country with limited health resources. BJOG. 2002 Aug; 109(8):900-4.