Gender, Family Planning, and Health Financing Stakeholders Share a Common Goal—Now They Need to Find Common Ground (and Take Action)
By Stephanie Perlson
Despite progress in recent decades, gender inequality remains pervasive everywhere. Barriers constructed by gender inequality constrain individuals’ sexual and reproductive health intentions and hinder their agency to use family planning. Protecting one’s health and future, including reproductive intentions, is a human right of all individuals. Yet, because of gender-based barriers, many individuals seeking family planning information and services struggle to access it. Women may face reproductive coercion from partners they depend on financially and adolescent girls might not be able to afford family planning due to gender norms that hinder their economic opportunities.
Global evidence shows the advantages of gender equality and this extends to family planning and reproductive health. One step toward ensuring more gender-equitable family planning is to make it more affordable and accessible to everyone who wants it. Achieving gender-equitable family planning will require coordination with health financing systems and a recognition by gender and family planning advocates of the health budget constraints faced by health financing stakeholders. Helping these constituencies identify their mutual priorities and reach compromises to achieve their collective goals is crucial. Recent innovative work by the USAID-funded Health Policy Plus (HP+) project to bring together family planning, health financing, and gender experts provides a model for how these constituencies can come together to find common ground.
The Urgency of Finding Common Ground
With COVID-19 highlighting the urgent need for universal health coverage, countries are examining their investment in healthcare services and mobilizing public and private sector funds to improve access to affordable healthcare. This collective reflection creates an opportune moment to assess how family planning is financed so that government and private sector health financing system designers can institute realistic reforms to dismantle gender-based barriers, enabling gender-equitable family planning and expanding reproductive empowerment.
HP+ convened a group of experts with several objectives in mind. First, to build a foundational understanding among participants of the issue, its intersectionality, and its existing gaps, including how gender-based barriers in health financing systems restrict access to family planning and how resource constraints within health financing systems make incorporating a gender lens challenging. A second objective was to identify next steps in research and advocacy that stakeholders can take to advance the goal of reducing gender-based barriers within family planning through how it’s financed.
Viewing family planning financing through a gender lens is not a zero-sum game; it doesn’t only benefit individuals accessing family planning. Stakeholders focused on health financing and insurance schemes are concerned about stretching limited resources to cover as many of the population’s health needs as possible. Preventing additional unplanned health expenditures, such as unintended pregnancies—which gender inequality can cause—saves resources for other essential health services and improves health outcomes.
How to Make It Happen
To achieve gender-equitable family planning financing while increasing gender and family planning advocates’ understanding of the fiscal realities of having insufficient room in government budgets for health, and specifically family planning, we need to:
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Better understand each other’s challenges, i.e., the constraints faced by those designing health financing mechanisms and budgets (from government ministries setting health budgets and subnational agencies dispersing funds to providers serving patients directly) and the negative health and economic impacts of not addressing gender-based barriers in family planning.
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Consider approaches that increase financing flexibility and provide access to family planning across different contexts to ensure that anyone seeking family planning can obtain it without facing gender-based (or any) discrimination. For example, designing health financing and insurance schemes to be more affordable will help ensure inclusivity; in many contexts, women and adolescent girls do not have the means to access information and purchase family planning independent of a male partner. Progressive insurance systems cover all costs for the poorest populations and require incrementally increasing out-of-pocket expenditures across wealthier quintiles. This approach preserves health funds for those needing it most, and provides affordable high-quality family planning services, while reducing any gender-based barriers, since women and girls won’t be dependent on others for family planning.
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Bolster civil society organizations’ capacity to advocate with—and hold accountable—health and finance ministries to ensure all individuals can access family planning information and services. Civil society should also (1) work with citizens to help them understand available health and family planning financing options and how to overcome existing constraints and gender-based barriers and (2) support citizen advocacy efforts aimed at government and the private sector to achieve more affordable and gender equitable coverage of family planning.
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Pursue a rigorous research agenda, including more community-based and gender- and age-disaggregated research on client satisfaction, and pursue strategies for financing family planning services and resulting health outcomes, especially among the most marginalized groups. We need to use more context-specific indicators to measure gender equality outcomes in family planning programs and policies, such as young women’s agency in family planning decisions in rural, low-resource settings. More local research will enhance understanding of clients’ experiences and reveal ongoing gender-based gaps, helping convince policymakers and health and family planning financing mechanism designers to employ a gender lens—especially where evidence shows increased client satisfaction leads to long-term return on investment.
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Elevate a strong advocacy agenda that both enhances decisionmakers’ understanding of family planning clients’ needs and intentions based on the evidence generated and better influences—and holds accountable—stakeholders who can implement changes in health financing mechanisms (e.g., insurance coverage). When making the case for family planning coverage that takes gender-based barriers into account, the subsequent improved health and economic outcomes, and the cost-effectiveness of this approach, advocates need to be wary of widening the divide between gender and health financing stakeholders. We need to acknowledge health financing stakeholders’ legitimate concerns and recognize that compromises will be necessary, especially as resources and priorities continue to shift more toward COVID-19 and preparing for future pandemic threats.
Dismantling gender-based barriers and expanding access to family planning information and services requires the involvement of and action by multiple actors and disciplines, but the advantages to be gained are significant. Through collaboration among gender, family planning, and health financing stakeholders, individuals—especially women, adolescent girls, and other marginalized groups—could have more agency over their reproductive intentions, in turn improving their health, education, and economic opportunities. Governments could experience improved health, family planning, demographic, and economic outcomes that benefit more of their populations, and their already strained health budgets could stretch further by viewing gender-equitable family planning coverage as a form of preventive healthcare.
This blog follows from an expert meeting convened by HP+ to explore how to better integrate gender into family planning and health financing systems to make access to family planning information and services more gender-equitable for all clients. Read the summary brief.
