Increasingly, public health, including reproductive health care provision, is being seen as a system — a changing dynamic of entitlement and obligations between people, communities, providers and governments. Within this new lens, community participation, health promotion, social support and empowerment of individuals (especially of women) are seen as critical to achieving sustainable improvements in reproductive health care.
In other words, good reproductive health requires partnership. While governments are obliged to make quality reproductive services and information widely accessible, users should be encouraged to articulate what they need and expect in terms of services. Users can also provide valuable input into monitoring and evaluation efforts that can improve quality of care. In this way, users can provide a feedback mechanism to support services appropriate to their needs.
The health care system can be seen as an interaction between supply (trained personnel, equipment and services) and demand (active participation from individuals, groups and communities for quality services). Interaction between these two parts of the system can improve the reproductive health needs of users.
The idea of human rights underpins this whole model. The rights of individuals to exert control over their own lives and their reproductive and sexual health needs have been acknowledged by the international community. But people need information, as well as affirmation and support, in articulating and exercising their rights and in creating demand for the services they need.
That’s why UNFPA works on many levels. In addition to supporting reproductive health services, the Fund also promotes behaviour change communications, advocacy, education and empowerment of women. These kinds of interventions can encourage individuals and communities to increase demand and support for quality reproductive health services.
A UNFPA-supported programme, Stronger Voices for Reproductive Health exemplifies how programming can strengthen reproductive health services through a focus on the interaction between supply and demand.
As an example of how this systematic approach can work, consider the goal of reducing maternal mortality, one of the priorities selected by the international community for inclusion in the Millennium Development Goals. Reducing maternal mortality will require specific inputs, such as the availability of skilled birth attendants and access to emergency obstetric care. But progress can be accelerated if pregnant women are empowered to make informed decisions about childbirth. In many parts of the world, male relatives or in-laws decide where a woman will give birth, or when she should get emergency care.
Educating women, and giving them more opportunities, can help change this power balance. Communities that are fully informed about the needs and vulnerabilities of pregnant women can be a part of this as well. For example, they can work to build awareness of the danger signs of pregnancy, pool resources to help out in an emergency, or find ways to safely transport women in labour to an appropriate facility if complications develop.