FROM CLAIRE CHIVERS IN THE SCIENCE POLICY CENTRE

A joint report from the Centre for Reproductive Rights and the United Nations Population Fund (UNFPA) was presented at the UK parliament in July 2011.  Entitled ‘The right to contraceptive information and services for women and adolescents’, the briefing event involved two All-Party Parliamentary Groups (APPGs); the APPG on population, development and reproductive health, chaired by Baroness Tonge, and the APPG on human rights, chaired by Rt. Hon. Ann Clwyd MP.  The co-involvement of these two APPGs gives a clue as to the framing of the report; it links access to family planning services to human rights and lays out the legal framework underpinning this.  So how feasible is it to take a human rights-based approach to the provision of family planning services? Is there really a need for this?  And to what extent are governments legally obliged to provide contraceptive information and services? The topics discussed at the launch was of particular interest to the Royal Society’s ‘People and the Planet’ study, more information on which can be found here.

The launch started with a discussion of the barriers to contraceptive information and services that still exist in many countries today.  Most attendees agreed that family planning has become somewhat a victim of its own success in recent years, with investment levels declining over the last 15 years as it has slowly been pushed further down the list of many development agencies’ funding priorities (Speidel et al. 2009).  There was a general consensus at the launch that the provision of family planning information and services should be promoted back up the list of international development priorities.

The report begins with an overview of contraceptive access across the globe, with the figures giving a stark insight into the ‘unmet need’ for family planning.  For example:

  • 215 million women in developing countries who want to avoid pregnancy are either not using any contraception at all, or are relying on traditional methods, which have a high failure rate and do not protect against HIV and other sexually transmitted infections (STIs).
  • There are over 80 million estimated unintended pregnancies annually and over half of these are aborted, both legally and illegally.  Illegal abortions are frequently unsafe and are a leading cause of maternal morbidity.

In addition to calling for more funding to be put into the provision of family planning services, the Centre for Reproductive Rights hopes that governments can be encouraged to increase the provision of their family planning services by reminding them of their legal obligations to do so.  Many regional and international treaties have provisions related to contraceptive access.  These can include articles explicitly stating the right to family planning services, such as the ‘Convention on the Elimination of All Forms of Discrimination against Women’ which states in article 10, individuals should have access to “…specific educational information to help ensure the health and well-being of families, including information and advice on family planning”.  However, a perhaps more subtle approach is enforcing the numerous conventions on human rights that include a statement against discrimination by sex, such as the ‘African Charter on Human and Peoples’ Rights’, the ‘American Convention on Human Rights’ and the ‘European Convention on Human Rights’.  The report argues the removal of barriers to contraceptive services is a human right for gender equality, and so for countries that have signed any conventions containing an article against discrimination by sex, there is a legal obligation to ensure women are not discriminated against by inadequate provision of family planning services.

So how can this human rights-based approach be implemented? Ensuring governments understand and comply with their international legal obligations can be a difficult task, but the involvement of key stakeholders, such as NGOs, populations most affected by family planning policies, service providers, policy makers and government officials, is key.  Public awareness campaigns can help empower communities to enforce their rights, and NGOs can be supported and encouraged to monitor the effectiveness of family planning provision policies and to hold governments accountable.  For example, a petition has been filed against the government of Uganda by a Ugandan NGO for violating the Constitutional rights of Ugandans, by not providing essential medical services to pregnant women, resulting in an unacceptably high maternal death rate.

The demand for contraceptives is estimated to grow by 40 % in the next 15 years.  Unplanned births, an increasing prevalence of STIs and a high maternal mortality rate all have tremendous social, economic and public health consequences for countries that are often already struggling to meet the needs of the current population.  So giving women control of the number and spacing of their children and reducing the number of unplanned pregnancies, abortions and maternal deaths will become increasingly important.

Reference: Speidel, J.J., Weiss, D.C., Ethelston, S.A. and Gilbert, S.M. 2009.  Population policies, programmes and the environment.  Philos Trans R Soc Lond B Biol Sci. 364(1532) pp 3049–3065.

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