From Family Planning to Reproductive Health
The 1994 International Conference on Population and Development Programme of Action
calls for an approach to reproductive health that is comprehensive and client-centered.
Family planning groups stressed providing services in a more inclusive and empowering way.
Advocates for women, realized that the ability to make responsible and informed choices
about sexual and reproductive health is both a condition and a vehicle for improving the
status of women.
Service providers worldwide, facing the spread of HIV/AIDS, found it increasingly
irresponsible to provide the means of family planning without counseling clients on
sexually transmitted diseases (STDs). The Cairo consensus rejected coercion in any form in
reproductive health services. Ideally, reproductive health services should include: (1)
Range/choice of methods
Delayed childbirth for adolescents
Attention to unmet need/demand
Research on safety/side effects
Iron folate/iodine supplements
Safe delivery Access to caesarean section
Access to blood transfusions
High-risk birth screening
Complications detection/ management/referral
As a family planning method
For newborn/child care
Condom promotion/ distribution
Prenatal screening (syphilis)
Symptomatic case management
Identification of high risk-takers
Management of complications
Post-abortion family planning
Improved sex education and family planning services where abortion is restricted
Prevention and management
Training for physicians, nurses, midwives and traditional birth attendants
Counseling on: Sex/sexuality education
Public Education on: AIDS/STDs
Female genital mutilation
Management Information System (MIS) for male/female clients
Advocacy: Political will and commitment are needed at every level.
The support of community leaders is effective if not essential for the success of
reproductive health programs.
- In South Africa, reproductive rights are now part of the constitution.
- In Uganda, government officials implemented the new system with support from community
and religious leaders.
- Among the Sabiny people in northern Uganda, elders were included in a campaign to
eradicate female genital mutilation.
Program development: The process can be as important as the outcome. Those involved
should range from grassroots organizations and client representatives through service
providers and policymakers.
Setting priorities: Providers may need to choose between providing basic services for
everybody in an area or a broad range of services for fewer people. They may need to make
crucial choices at the clinic level - for example, whether or not to provide IUDs where no
screening is available for reproductive tract infections. Clients' involvement is
essential, as their priorities are not necessarily the same as those of service providers.
A clinic in Indonesia, for example, learned that clients saw information supported by
drawings on family planning as more important than blood pressure testing, which was
available at the market for little money.
Infrastructure, referral and logistics: Reproductive health providers function properly
only with a guaranteed regular supply of drugs and equipment. Clients lose interest when
they make time and effort to visit a clinic, only to find nothing available for them.
Referrals can direct clients to other providers. For example, birth assistants in some
areas have been trained to diagnose complications at an early stage of pregnancy.
Training: Service providers need continuous training and support to face their new
challenges. Issues to be covered include quality and continuity of care, technical
competence, sensitivity to client needs, and commitment to informed choice.
Monitoring and evaluation: As for any new concept, monitoring and evaluation at every
level will ensure that follow-up visits are useful for clients and that timely Programme
adjustments can be made.
Sources: (1) This list was compiled from documents of the
International Planned Parenthood Federation; USAID; the World Bank; UNFPA; The
International Projects Assistance League; International Women's Health Coalition; the
Older Women's League; Population Action International; the Rockefeller Foundation; and the
World Health Organization.