50th Session Issues
Family Planning
by
Erin Brooks
In the interest of furthering equality and justice in the coming century, access to quality family planning is a key component in the World Health Organization's (WHO) "Health for All" global strategy. Family planning interests impact diverse cross-sections of the population through issues such as: maternal health, child mortality, and the spread of sexually transmitted diseases. For example, an estimated 120 million married women in developing nations lack family planning information regarding reproductive health, contraception, and the spacing of births. The objective of this paper is to outline opportunities for responding to unmet needs, setting norms and standards of health, as well as providing sufficient support for the implementation of family planning programs.
Family Planning and the International Protection of Human Rights
Issues of reproductive and sexual autonomy lie at the core of ideological, religious, and cultural beliefs, and hence can be controversial areas of action. The 1993 World Conference on Human Rights declared:
. . while the significance of national and regional particularities and various historical, cultural, and religious backgrounds must be borne in mind, it is the duty of states--regardless of their political, economic and cultural systems-to promote all human rights and fundamental freedoms.
The right of couples and individuals to found a family and make decisions regarding the number and spacing of children was elaborated on in the Convention on the Elimination of All Forums of Discrimination Against Women (CEDAW). Article 16 of CEDAW provides that:
States parties shall take all appropriate measures to ensure on a basis of equality of men and women the same rights to decide freely and responsibly on the number and spacing of their children and to have access to the information, education and means to enable them to exercise these rights.
Some human rights organizations have raised concerns that the relationship to state interest (e.g., economic, national security, environmental conservation) have given rise to population control strategies that incorporate gross abuses of human rights.
Most recently, member states met in the spring of 1999 in the Hague for the fifth year review of the International Conference on Population and Development (ICPD). This process afforded member states a chance to reaffirm their prior commitments and reflect on the relationship of family planning to larger issues of health, population, and development. In 1994, the ICPD condemned in particular the use of violence, coercion, and discrimination in family planning. Representatives from governments all over the world spoke-developing countries as well as donor nations-- and outlined national plans of action, generating momentum to the ICPD implementation process.
Areas for Action
Many family planning specialists believe that the existing demand for family planning and reproductive health services is already so strong that, if individuals' needs could be met with services, fertility rates would decline as much as or more than most governments call for in their development plans.
One area for greater attention is maternal health. An estimated 600,000 women die each year in developing countries from complications of pregnancy or childbirth. Up to 25% of all maternal deaths are due to pregnancies in certain groups of women: very young women, very old women, pregnancy within short birth intervals and women with more than four children or existing health problems. Family planning services can reduce these maternal deaths and improve women's health by preventing unplanned, unintended and high-risk pregnancies.
Rates of both maternal and child death are particularly high in areas where the social status of women is low. Education and other activities designed to improve the status of women are mutually reinforcing if pursued simultaneously with those focused on health and family planning.
A variety of traditions, institutional and political barriers, and myths about sexuality have made it difficult to develop effective programs that provide accurate reproductive health information and useful services to young people. In the 1990s, young people were largely left out of family planning programs and while this may be consistent with the cultural and religious norms of some groups, statistics show that as countries have become more urban and economically developed premarital sexual experience is coming more common. Young people with children, particularly women, are less likely to finish their education and face greater economic instability in the future. The WHO has identified the goal in this area stating: "meeting the reproductive health needs of young people requires not only providing services, but also building understanding and educating people on their reproductive health." Setting Norms and Standards
For the family planning programs to be truly effective, a more holistic and normative understanding of the importance of these programs is needed. Speaking for the Organization of African Unity (OAU), Chairman Chris Ugowkwe spoke to this issue: "Many states are realizing that population policies can be addressed only by combating poverty, involving communities, improving maternal and child health and raising the status of women." For example, Nigeria has crafted a plan called "The Vision 2010", which includes targets for reducing infant and child mortality, raising life expectancy, reducing adult illiteracy and increasing per capita income. Reproductive health is being placed in the wider context of primary health care and offered to women, adolescents and men. This may serve as a helpful model for other member states examining ways to implement effective family planning programs.
Technical Support
The Family Planning and Population Unit of WHO collaborates closely with other UN agencies such as UNFPA, UNHCR, UNAIDS, and international organization to develop guidelines, standards, and documents on family planning and reproductive health. Collaboration and coordination are important activities to see that harmonized messages and safe guidelines are sent to countries, as well as ensuring that work is not duplicated.
Access to family planning care is impeded by a number of obstacles, which prevent full use of family planning services even when they exist in a community. Some of these factors represent logistic, social and behavioral obstacles to meeting the needs of couples and individuals. However, there are also several medical and procedural obstacles represented by the use of cumbersome criteria or tests that may discourage women from using the methods of their choice. A WHO study found:
In many regions, family planning programs are still guided by policies and pre scribing practices based on studies of contraceptive products no longer widely used or on theoretical method-related health risks that have never been substantiated.
Millions of individuals who want and need family planning care still do not have access to quality services that would ensure the safe and effective provision of methods based on the informed choice of the user.
Questions
- How can health and human rights' rationales of family planning be strengthened to eliminate discriminatory practices?
- How can the unmet needs of residents in rural areas be served to overcome the disparities in access to family planning?
- How can existing infrastructure be utilized to encourage the full cooperation and participation's of all actors (i.e., local, national and international organizations, public and private sectors, NGOs)?
Sources
- 1 http://www.who.int/rht/fpp
- 2 United Nations, "Compilation of General Comments and General Recommendations Adopted by the Human Rights Treaty Bodies," UN document HRI/GEN/1/Rev.1, July 29, 1994, pp29-30.
- 3 United Nations, CEDAW, UN document A/49/38.
- 4 http://www.hrw.org/about/projects/womrep/General
- 5 United Nations, Press Release: "More Assistance Needed for Reproductive Health Programmes, Developing Countries Countries Tell Hague Forum" February 11 1999.
- 6 http://www.who.rht/fpp/fpp_recentachievements.html
- 7 http://www.undp.org/health.html
- 8 United Nations, Press Release.
- 9 http://www.who.rht/fpp/fpp_recentachievements.html