Leaving No One Behind in Family Planning: Introducing the New Family Planning Equity Tool
Expanding How We Conceptualize and Measure Inequity in Family Planning
Until recently, our investigations of inequity in family planning were too focused on contraceptive uptake alone, rather than the range of programmatic components that affect use, such as access to information and services, good quality of care, etc. Much of our inquiry was focused on inequities experienced by the poor, overlooking other key dimensions by which people vary and where unjust differences may hide. Some sophisticated analytical approaches were not easily replicable outside of the research space, holding limited benefits for local decision making and those implementing programs.
In recognition of these and other challenges, the USAID-funded Health Policy Plus (HP+) project has developed a tool for identifying inequity in family planning programs that can be applied in any country with a Demographic and Health Survey. Specifically, our FP Equity Tool identifies inequities in family planning:
- For a range of commonly disadvantaged subgroups
- For various components of family planning programming
- At the national level and across and within each subnational area, essential as decision making becomes increasingly devolved
This work builds on the concepts and recommendations from the recent Discussion Paper on Equity for the High Impact Practices Partnership and is an important initial step on the road to eliminating unjust conditions. A Strategic Planning Guide on equity and family planning, detailing the full set of steps from inequity identification to resolution, is forthcoming.
The Case for Dynamic Tools
The FP Equity Tool works by running a series of statistical computations for the user, examining the experience of seven commonly disadvantaged groups in five dimensions of family planning programming at national and subnational levels. In this way, the tool goes deeper than quick tabulations, which—while still insightful—don’t tell us whether the relationship among variables is significant. Findings are automatically generated in Microsoft Excel with signposts to help the user interpret the results, with accompanying maps and charts to easily visualize inequities. The tool thus answers the “who, what, and where” of inequities in family planning. This level of specificity is key to guiding national and subnational decision making on family planning beyond 2020, including decisions regarding:
- Policy and programmatic commitments, such as those that will be part of the FP2030 partnership, as well as goals within costed implementation plans
- Prioritizing limited funds across program activities and geographies
- Better tailoring and directing family planning program activities, particularly at subnational level.
Unexpected Groups of Women are Slipping Through the Cracks
In finalizing the tool, we applied it to Uganda, where we found pervasive family planning inequities that (1) affect a broad range of underserved groups, (2) extend beyond traditional measures of uptake, and (3) penetrate all regions.
The application of the tool showed that, at the national level, some unexpected groups of women are slipping through the cracks. Equity-sensitive family planning strategies most often direct services toward the poorest, youngest, and rural women—as in Uganda’s Family Planning Costed Implementation Plan, 2015–2020. However, this analysis shows that least-educated and unmarried women (in addition to the youngest) are some of the most disadvantaged. While there is a degree of overlap among these subgroups, failing to channel services to a diversity of women will leave many in need behind. Moreover, this analysis shows that inequity extends beyond use alone to the components that often impact our decision to use services—such as access to information and the quality of care. In traditional equity analyses focused on use and wealth quintile, this type of gap would go undetected.
Hope for the Coming Decade
We’ve made amazing progress as a community in expanding the reach of voluntary, rights-based family planning information and services in the last eight years. It’s our hope that instruments like the FP Equity Tool can help make what work remains easier, helping decision-makers and program staff choose which components to prioritize and where, thereby helping prevent women and girls from being left behind.
Kaja Jurczynska is a Senior Technical Advisor at Palladium, working on the USAID-funded Health Policy Plus project. Specializing in family planning and demography, Kaja contributes to generating new evidence, models, and tools to bolster health investments. She most recently led a team in the development of the Family Planning Equity Tool. Kaja has contributed to family planning and population programming in Nigeria for over six years, including leading one of the first ever projects to test the effects of implementing a voluntary, rights-based approach. Kaja earned her MSc in Population and Development from the London School of Economics.