Written by Marge Berer for RH Reality Check. This diary is cross-posted; commenters wishing to engage directly with the author should do so at the original post.

See all our coverage of the 2012 Global Family Planning Summit here.

Poster: Faviana Rodriguez / ihadanabortion.org

One in three women in the UK will have an abortion in her lifetime, most of whom will have been using contraception of some kind. Yet since as long ago as the late 1930s, there has been a split in the UK between those who insisted on promoting contraception on its own because they thought abortion was too controversial and would hold back acceptance of family planning, and those who insisted that the two go hand in hand. This split exists in many countries, not just the UK, and also within many organizations with a large membership in different countries, such as the International Planned Parenthood Federation (IPPF). It is reflected most recently in a comparison of the list of 600 groups and individuals who have endorsed the International Campaign for Women’s Right to Safe Abortion this year, and the 1300 that signed a letter circulated by the IPPF supporting the Family Planning Initiative – very different groups are on those lists. Yet all of them support the right to control fertility.

In 1994, the ICPD Programme of Action, a consensus document on the integration of sexual and reproductive health and rights, was only able to be passed if it included a “compromise” clause that called for abortion to be safe only if it was legal. This compromise was and remains a violation of public health principles and women’s human rights. ICPD failed to condemn the often 19th century, often colonial laws on abortion still in place in the criminal code in many countries. However, the Programme of Action did recognise that unsafe abortion was a major public health problem, one which to this day still affects some 22 million women every year, among whom 5 million end up in hospital with complications annually and tens of thousands die (WHO, Guttmacher). And young women, whom everyone wants to be  seen to be supporting these days, are in fact most at risk of unsafe abortion and also have the least access to contraception (Shah & Åhman, RHM, May 2012).

The answer is not to promote contraception in order to reduce unsafe abortion, as the FP Summit did. The answer is to promote contraception to reduce unwanted pregnancy and provide safe abortion to every woman who finds herself with an unwanted pregnancy. That is the way to make unsafe abortion history. Abortion will not go away unless men and women stop having sex with each other or everyone is sterilised. So forget it!

The growing number of countries in both the north and south, east and west, where there is 60 to 80 percent contraceptive prevalence proves that. Research shows that women and men take up contraception in large numbers if they feel they have the right to control their fertility and have access to the means to do so. There is a huge need for information, because every new generation of young women and men will know nothing about contraception or abortion unless they have access to this information. But there is no need for “demand creation,” a retrograde concept which implies lack of interest. The steadily falling fertility rate globally, falling since the 1970s, proves that, and in every country, abortion is in there, safe or unsafe, reducing the number of births. Forty-four million abortions globally and hundreds of millions of people using contraception and sterilisation prove the huge demand for the means of fertility control. “Unmet need” is more than just lack of knowledge or interest on the part of the women and men who aren’t using contraception, or using it erratically or unsuccessfully.

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Written by Rajat Khosla for RH Reality Check. This diary is cross-posted; commenters wishing to engage directly with the author should do so at the original post.

Cross-posted with permission from Amnesty International.

See all our coverage of the 2012 Global Family Planning Summit here.

Arriving at the summit (organised by the UK Department for International Development and Bill and Melinda Gates Foundation) this morning I was reminded of the testimony of a woman living in Ouagadougou, interviewed by Amnesty International a few years ago:

“After seven pregnancies and five live children, I told my husband that I wanted to use contraceptive methods but my husband refused and told me that if I did this, I should return to my mother’s home. I therefore had to obey him.”

In Burkina Faso, Amnesty International collected numerous testimonies of women who were denied the right to decide on contraceptive use. In many cases husbands and male relatives opposed the use of contraceptives and criticized medical professionals for providing contraceptive products and advice to their wives or other female members of their families.

Amnesty International has documented similar experiences in other countries as well. In Indonesia, for instance a human rights activist told Amnesty International, “[It] is very taboo for an unmarried person to look for contraceptives… S/he will be seen as looking for free sex.”

Laws in Indonesia provide that access to sexual and reproductive health services may only be given to legally married couples. Unmarried individuals are simply denied access to these services.

Nearly 20 years ago, governments at the International Conference on Population and Development agreed by consensus that respect for women’s reproductive autonomy is the cornerstone of population policy. This was a vital step as this moved the debate away from a narrow focus on demographic targets and family planning methods towards a more comprehensive approach to sexual and reproductive health.

However, women and girls around the world are systematically denied the right to make decisions about their sexual and reproductive lives free of discrimination, coercion, and violence. As I listened to leaders from different countries express their commitments towards family planning and meeting the unmet need of millions of women for contraception, I was desperate to hear them reaffirm the commitment they made 20 years ago. I waited to hear them recognise the centrality of women’s human rights, their sexual and reproductive rights to this initiative. But disappointingly, although a few notable references were made to these issues by some leaders, women’s human rights were not appropriately addressed.

I spoke to Prof Gita Sen (of the Southern feminist network, DAWN, and the Indian Institute of Management Bangalore) about her thoughts on the Summit and she said “The reason we all got together in Cairo 20 years ago was a collective recognition in the women’s human rights community and among family planning policy people in governments/agencies that top-down family planning approaches, as in India during the political Emergency of the mid-1970s and after, have serious potential for coercion.”

“Such approaches have done incalculable harm to the legitimacy of family planning and therefore to the rights and access of millions of women and men, young and old, married and unmarried, to safe and effective contraception. If money and attention are coming back to this field, it would be prudent if not wise for funders, agencies and governments and I may add, the large community of international and national NGOs to refocus on those lessons, and to bring human rights into the centre of this renewed agenda. Not just in the form of principles but of practical methodologies for how policies and programmes are implemented and monitored, how health workers are motivated, rewarded or punished, and how accountability for non-coercion, equity and access are built in.”

There is overwhelming evidence that a silo-ed approach to family planning just does not work. What is needed is an integrated approach within the framework of comprehensive sexual and reproductive health and rights. To meet the unmet sexual and reproductive health needs of millions of women and girls around the world sexual and reproductive health services must be provided with attention to quality of care and with full recognition of human rights.

The ICPD Programme of Action unequivocally recognizes that population targets and quotas should not condition whether and how services are delivered and that no one should be coerced in any way regarding their sexuality and reproductive lives. A target driven approach -– such as one which focuses exclusively on meeting family planning targets and fails to include protection for women’s human rights is likely to result in more harm than good.

I spoke to Francoise Girard, President of the International Women’s Health Coalition, about her thoughts on the focus on targets and incentives as key drivers for the Summit.

She said:

“Renewed attention to contraception is a good development, but the commitments made this morning by governments run the gamut from providing increased access – which is good – to meeting specific targets for contraceptive use. These are very different ways of approaching program design and implementation. If the end result is to be 80 percent contraceptive prevalence rate, as was mentioned by Bangladesh this morning, how will this be done in practice? By setting targets for providers and health institutions to “put women on contraceptives.”"

“We also heard quite a few Ministers discuss post-partum contraception,” Girard continued. “The power dynamic after childbirth can and does lead to women being sterilized or fitted with an IUD without choice or information -– witness recent scandals in India, Namibia, Kenya. That worries us greatly.”

As I listened to discussions through the day I kept on thinking “What about accountability?” The issue was the focus of discussion in a parallel session in the afternoon. While the panelists spoke about indicators, data and drivers for progress, accountability for human rights was mentioned as an “optional feature.”

While quantitative evaluations and hard data are necessary to measure progress, they fail to address the barriers and challenges faced by women and girls in their attempts to realise their sexual and reproductive rights. The discussions today did not go a long way in addressing the need to develop an accountability framework that is responsive to the root causes of high unmet need for sexual and reproductive health. A framework that tracks governments’ human rights obligations and not just resources and results. Much more needs to be done to ensure that these issues are not sidelined.

The writing on the wall is clear: women’s human rights and quality of care must be at the core of any such initiative. Any failure to do that will result in more harm than good being done and will undermine the sustainability of this initiative.

Read Joint Civil Society Declaration, endorsed by over 300 organizations globally.

Written by Suzanne Ehlers for RH Reality Check. This diary is cross-posted; commenters wishing to engage directly with the author should do so at the original post.

See all our coverage of the 2012 Global Family Planning Summit here.

Photo: Brains the Head / Flickr

Albert Einstein once said, “Never memorize something that you can look up.” As we head into the July 11th London Summit on Family Planning, we can focus more on concepts than numbers, because we know this: 222 million women in developing countries want to avoid pregnancy, but lack effective contraception. The London Summit will aim to meet the contraceptive needs of 120 million women in the world’s poorest countries. These “new users” will cost an additional $4 billion in resources over the next eight years.

What we don’t know, or rather have a hard time remembering, is that opportunities like this can become their own special universe. More attention (and criticism) is placed on the inputs —- such as framing, messaging, and logistics –- than on the more important outputs, meaning those 120 million women and their needs.

First, this groundbreaking global convening is adding something substantial, so let’s calibrate our expectations while trying to hit it out of the park. Those close to the planning of the Summit have said from the beginning: July 11th is the promise; what follows is the fulfillment of that promise. I take this to mean that the real work happens after we leave London. This will be accountability for donors, follow-up on pledges, and the design of a funding mechanism that promotes and protects rights, access, equity, choice and quality of care.

I haven’t before seen an opportunity like this, and we must be unified behind our shared agenda that every girl and woman deserves the opportunity to determine her own future. It is up to us to talk about these interventions as life-saving for individuals, transformative for communities, and cost-effective and multiplier investments for nations. It is up to us to make it work, in real time, and in real terms.

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Written by Louise Finer for RH Reality Check. This diary is cross-posted; commenters wishing to engage directly with the author should do so at the original post.

See all our coverage of the 2012 Global Family Planning Summit here.

In 1996, a Peruvian woman named María Mamérita Mestanza Chávez died from complications of a forced sterilization in Peru. She was a low-income, indigenous Peruvian woman, who was coerced into agreeing to sterilization by government officials and was repeatedly denied follow-up medical care when complications ensued. María died from post-surgical medical complications seven days after her surgery.

María’s story was only one of many cases of coercive sterilizations in Peru — the tragic and cruel consequences of family planning practices that leave women’s human rights out of the equation. Her story reminds us how important it is that the government officials, global advocates and donors participating in this week’s Family Planning Summit in London keep stories like María’s in mind.

This week’s summit is a crucial opportunity to re-invigorate international efforts to provide millions of women with access to the contraception they so desperately need. Yet increasing the availability of contraception is just one aspect of ensuring reproductive health, and cannot be seen in isolation. The summit must recognize women’s right to a full range of comprehensive sexual and reproductive health services. Without access to sexuality education, safe and legal abortion, and a range of other essential services, women’s reproductive rights will still be far from being achieved.

Last month, the Center for Reproductive Rights joined 326 other organizations and individuals from around the world to issue a joint statement highlighting the urgent need for family planning policies to recognize and protect women’s autonomy and human rights. For 20 years, the Center has documented the devastating consequences — both intended and unintended — of reproductive health policies that fail to do so.  And we have fought legal battles in courts and the UN on behalf of the women who have suffered egregious human rights abuses and violations of their basic reproductive rights, including discrimination against marginalized women seeking access to care, mistreatment by health workers, not being provided information on family planning and involuntary sterilization of women.

While contraceptive information and services are an essential part of the health services that women need throughout their lives, efforts to simply increase the use of contraceptives can have negative consequences if women are not empowered to decide for themselves when and how to use them. If the initiative put forth in London this week fails to tackle the myriad obstacles women face in accessing sexual and reproductive health services – lack of information, requirements that their spouses or parents give their consent, bans on certain methods, discrimination, unavailability of services in certain areas, inadequate systems to deliver services – it will stop far short of addressing the real barriers to women’s reproductive rights.

And international human rights bodies agree.

In María’s case, the Center for Reproductive Rights filed a case with local and regional partners on behalf of her family at the Inter-American Commission on Human Rights (IACHR). As a result, the Peruvian government agreed to pay moral damages to María’s husband and seven children, as well as significant compensation for their health care, education and housing. The government also agreed to conduct an in-depth investigation and to punish those responsible for the violations of Peruvian and international legal standards.

But Peru isn’t the only place these violations have occurred. In 2009, the Center filed a complaint against Chile before the IACHR on behalf of F.S., a young woman living with HIV who was sterilized without her knowledge or consent. F.S. was diagnosed with HIV in 2002 soon after learning she was pregnant. She was referred to a state hospital for HIV treatment during pregnancy. She and her husband had plans to have more children and F.S. never requested sterilization. She was forcibly sterilized at the hospital immediately after giving birth. This is another example of a government failing to protect a woman’s reproductive rights, her human rights.

States must ensure that women can exercise their reproductive rights.  The decision to use contraceptive methods is voluntary and should never be forced on any woman, no matter her ethnicity or socioeconomic background.

But local activists, global advocates and civil society organizations cannot act alone as a watchdog for reproductive rights. States – as donors and implementers of family planning policies – and international donors must ensure that there are monitoring and accountability systems in place to ensure the kinds of violations María suffered are not repeated. I’ll be in attendance at this week’s Family Planning Summit and will be calling for human rights to be front and center of the discussions, moving the conversation from contraceptives alone to reproductive rights as human rights.

Written by Marianne Møllman for RH Reality Check. This diary is cross-posted; commenters wishing to engage directly with the author should do so at the original post.

Photo: Bill McElligott / Flickr

In mid-July, world leaders will gather in London to discuss a real and urgent need: increased funding for family planning. Over the past 15 years, the United States—one of the largest foreign aid donors in the world—has cut its funding level for family planning by at least 25 percent. Meanwhile, the demand for modern contraception and family planning information has only increased. By most accounts, an investment of approximately $6.7 billion is needed annually to meet current needs for family planning.

The summit documents, which is co-hosted by the Bill and Melinda Gates Foundation and the UK Department for International Development and supported by the US Agency for International Development and the UN Fund for Population Action, link the dearth of contraceptives and health services to poverty: women in “rich countries” have what they need, whereas women in “poor countries” don’t. This notion is supported by the fact that over 99 percent of maternal mortality happens in so-called developing countries.

This vision is not so much wrong as it is incomplete.

In early 2010, the medical journal The Lancet published new research on maternal mortality and morbidity. The research showed that improvements in maternal health — a good indicator for women’s access to health services overall — depend on 4 key factors, only one of which has to do with family planning: 1) lower fertility; 2) higher education levels for women and girls; 3) rising per capita income overall; and 4) access to skilled birth attendants.

Importantly, both the Global Family Planning Summit and research published in The Lancet potentially obscure the fact that adequate access to contraceptives and health services is a question of income rather than geography. To be blunt, a wealthy woman in a poor country is likely to have better access to care than a poor woman in a wealthy country.

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