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)

Family Planning
Range/choice of methods
Delayed childbirth for adolescents
Male responsibility
Attention to unmet need/demand
Research on safety/side effects
Sterilization reversal
Implant removal
Quality services
Pregnancy Care
Prenatal care
Tetanus toxoid
Iron folate/iodine supplements
Safe delivery Access to caesarean section
Access to blood transfusions
High-risk birth screening
Transport
Complications detection/ management/referral
Postpartum care
Postpartum contraception
Breastfeeding
As a family planning method
Lactation management
For newborn/child care
STD/AIDS Services
Prevention
Condom promotion/ distribution
Treatment/referral/ screening
Prenatal screening (syphilis)
Symptomatic case management
Adolescent treatment
Identification of high risk-takers
Policy dialogue
Data collection
Abortion-related Services
Management of complications
Post-abortion family planning
Improved sex education and family planning services where abortion is restricted
Infertility Services
Prevention and management
Provider Training
Technical competence
Gender sensitivity
Adolescent nutrition
Training for physicians, nurses, midwives and traditional birth attendants
Counseling on: Sex/sexuality education
Safe sex
Male support
Women's support
Parental/family support
Early adolescence
AIDS/STDs
Abortion
Family planning/methods
Sterilization
Public Education on: AIDS/STDs
Violence
Gender discrimination
Female genital mutilation
Legal matters
Nutrition
Sexual/reproductive rights
Unintended pregnancy
Smoking/substance abuse
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.

September 1999