Why Policy Matters: Contraception and Family Planning
September 26, 2018
Health Policy Plus' Deputy Director of Family Planning and Reproductive Health, Jay Gribble discusses on World Contraception Day why policy matters for contraception and family planning.
Why is policy work important for contraceptive security, access, and use?
Many people think that family planning use starts at the facility—a woman talks to her provider and gets the method she wants. But to get to this scene, we must back up several steps and track how to get there.
Family Planning: Policy Behind the Scenes
- National policy establishes program
- Contraception included on essential medicines list
- Financing for family planning identified and released on time
- Supply chain gets commodities to providers
- Providers are hired and trained
- Clinical guidelines identify patient eligibility
- Health education policies include family planning messages
- Data systems in place, quality assurance policies operating
- Facilities open, clean, and functioning
- Women obtain family planning
Clinical guidelines—based on international best practices and adapted to local contexts —identify protocols for offering services: who is clinically eligible, what supplies are needed, and who can provide the service?
Operational policies establish many of the nuts and bolts of contraceptive security, access, and use. Keeping facilities clean, ensuring vehicles are running, and maintaining registries and data collection are all vital parts of making sure women can obtain the contraceptive methods they want.
Policies also allow behaviour change programs to operate. These programs reach women with information, so they can make an informed choice about using family planning in the first place. Without health education policies information doesn't reach the public; without engaging with education sectors, young people learn about reproductive health from their friends rather than through structured, informed programs.
These are just a few examples of polices that must be in place for a woman to be able to obtain the family planning method she wants. Other examples include policies that establish supply chains, allow staff to be hired and trained, and ensure family planning financing—to mention a few. So, the image we see of a provider meeting with a woman or couple about family planning can be viewed as a late-stage step in a complex process that includes a range of policy efforts at each step.
How do efforts to develop and implement policies on contraceptive security affect young couples in low- and middle-income countries? Are there any additional benefits for individuals, families, and communities?
Policies establish platforms through which family planning programs are designed and implemented. In many ways, getting a policy approved can be an easy step. Much more challenging is getting the necessary support to put a policy into action. Policies ensure that regulations, guidelines, training, financial support, supplies—and everything else needed to run a program—are in place to ensure that a contraceptive security policy is put into practice and achieves its goals.
Young people are a special priority for contraceptive security efforts. Helping individual young people stay in school and achieve their potential is a key reason for special attention to this segment of the population. Access to family planning also helps empower young women to take charge of different aspects of their lives. And at a national level, helping young people achieve their reproductive goals contributes to a healthier population and is a key element to achieving a demographic dividend.
A recent Health Policy Plus review of policies affecting access to family planning by young people included Malawi as an example of a country that has a strong policy environment for youth access to family planning. The review identified 11 laws, treaties, and conventions; 13 policies, plans, and strategies; and eight operational policies, standards, and guidelines that support improved youth access to family planning. Despite a strong policy environment, pregnancy among young women ages 15 to 19 in Malawi increased at the last Demographic and Health Survey. The point is that the existence of policies on paper doesn't mean that the goals of those policies are achieved. Rather, we need to focus on what it takes to put those policies into practice:
- Subnational decision-makers being aware of national policies and committing to those goals.
- Providers understanding their roles in providing high-quality services to young people.
- Young people themselves being aware of their rights under existing policies.
And of course, there is the matter of resources, infrastructure, and the political commitment needed to translate policy goals into realities.
Why should we care about policy work related to contraception?
When contraceptive security policies are effectively implemented, everyone benefits. These policies help girls avoid unintended pregnancies, allowing them to stay in school, pursue more meaningful work lives, and being more likely to achieve their desired family size. With better birth spacing, women and children experience lower rates of maternal and infant death, as well as numerous other health benefits. At the family level, smaller families mean more resources to invest in the education and health of children, thereby helping families and communities to be better off economically. It's all interrelated—and what's good for the person is often good for the family—as well as the community.
Can you share an anecdote with us of a time when you've seen policy work related to contraceptive security, access, and use really make a difference?
Through the work of advocates, Guatemala passed a law that required 15 percent of the taxes collected on alcoholic beverages be used for reproductive health; the law was later refined to ensure that 30 percent of the funds be used for the purchase of contraceptive commodities. This additional source of funds has meant that the government of Guatemala is buying more family planning supplies, and that women are more likely to find the method they want when they go to a facility.
Policies that allow for less skilled healthcare providers—including community health workers—to provide a wider range of family planning methods also have a positive effect. These types of policies have been approved in many countries with two related benefits—improving access to family planning by less skilled health workers and freeing up more time of skilled health workers to focus on providing more complex services. The use of community health workers has been identified as a high impact practice in family planning because they address shortages with health care workers, remove financial barriers, and address social barriers that are difficult to reach with other service delivery channels. And all this happens because the right policies are in place and commitment exists to put them into action.
What are some of the roadblocks stakeholders face when trying to implement family planning policy/policy reform?
One common roadblock is that stakeholders do not recognize the complexity of the situation. We tend to focus on our perspective and not do enough research to understand the decision-makers' priorities and positions. Family planning is one of many program areas within the health sector, so stakeholders need to show how it has an additive effect to improving health benefits. The ImpactNow model, for example, shows how investing in family planning saves lives and saves money for the health sector. The DemDiv model shows the role of family planning and other human capital inputs in accelerating economic growth. Know the issues decision-makers care about and generate evidence to make your case to them.
Timing is critical with advocacy. Understand when to make your move and be agile enough to take advantage of an opening. An area where many stakeholders focus attention is trying to increase funding for family planning. However, without understanding the planning and budgeting cycle, as well as how the ministry of finance releases money, advocacy efforts may not prove successful.
Another barrier is overestimating political commitment. The fact that a policy exists should demonstrate commitment to put it into action. Yet countless policies are developed without any guidelines or funding to support policy implementation. Stakeholders need to be vigilant and find ways to work through existing funding challenges. They must also work with champions within the different ministries and legislatures—national and subnational—who have insights into political processes.
Underestimating the roles of gender and cultural norms is also a barrier to policy reform. Working with religious leaders, as well as community and traditional leaders is critical to making changes. These people are gatekeepers, and getting their insight, respect, and support is critical to many types of policy reforms.