VOLUNTARY FAMILY

PLANNING PROGRAMS
THAT RESPECT, PROTECT,
AND FULFILL HUMAN RIGHTS
A Conceptual Framework

AUGUST 2013

Cover photo credits (clockwise): Davis Dennis, Bill & Melinda Gates Foundation, Shreyans Bhansali
Suggested citation: Hardee, K., K. Newman, L. Bakamjian, J. Kumar, S. Harris, M. Rodriguez, and K. Willson.
2013. Voluntary Family Planning Programs that Respect, Protect, and Fulfill Human Rights: A Conceptual
Framework. Washington, DC: Futures Group.
ISBN: 978-1-59560-015-8
This report is based on research funded by the Bill & Melinda Gates Foundation. The findings and
conclusions contained within are those of the authors and do not necessarily reflect positions or policies of
the Bill & Melinda Gates Foundation.

VOLUNTARY FAMILY PLANNING PROGRAMS

THAT RESPECT, PROTECT, AND FULFILL
HUMAN RIGHTS
A Conceptual Framework
By
Karen Hardee
Karen Newman
Lynn Bakamjian
Jan Kumar
Shannon Harris
Mariela Rodrguez
Kay Willson

August 2013

CONTENTS
Acknowledgments ..................................................................................................................iv
Executive Summary................................................................................................................. v
Abbreviations.........................................................................................................................viii
I.

Introduction ........................................................................................................................ 1

II. Human Rights and Health and the Foundation for Voluntary, Rights-Based Family
Planning .............................................................................................................................. 3

III. Human Rights-based and Public Health Programming .................................................. 6

IV. Programming Voluntary, Rights-based Family Planning ................................................ 8


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V. The Framework for Voluntary, Right-based Family Planning........................................ 12

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VI. Summary and Recommendations.................................................................................. 27

Annex 1. Treaties, Declarations, and Conventions Establishing Reproductive Rights...... 29
References ............................................................................................................................. 34
Glossary of Terms................................................................................................................... 43

ACKNOWLEDGMENTS


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EXECUTIVE SUMMARY

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Emergence of a New Conceptual Framework for Voluntary, Human

Rights-Based Family Planning


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How can we
ensure public health programs oriented toward increasing voluntary family planning access and
use respect, protect, and fulfill human rights in the way they are designed, implemented, and
evaluated?

Framework for Voluntary, Family Planning

Programs that Respect, Protect, and Fulfill Human Rights


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policy, service, community



outcomes,

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inputs

activities

outputs,

individual levels

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Application of the Framework and Recommended Next Steps



Foster additional dialogue



Use the conceptual framework as a guide for country programming and donor
assistance under FP2020.
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impacts

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Foster innovation in rights-based, public health approaches

interventions

Identify a comprehensive set of indicators



Update and expand the accompanying reviews of evidence and tools



Develop guidance and tools to apply the framework

Further document and evaluate rights-based approaches

additional investment in

ABBREVIATIONS
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I.

INTRODUCTION

Background


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When I travel and talk to women around

the world, they tell me that access to
contraceptives can often be the difference
between life and death. Today is about
listening to their voices, about meeting their
aspirations, and giving them the power to
create a better life for themselves and their
families.

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Melinda Gates, co-chair of the Bill & Melinda

Gates Foundation at the London Family
Planning Summit, July 11, 2012

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Box 1. Family Planning and Sexual

Reproductive Health and Rights in the
London FP Summit

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The Summit and its follow-up will align fully

with the broader SRHR [sexual reproductive
health and rights] framework established by
the [ICPD] almost 20 years ago. The Summit
will have a strong focus on equity and rights
and will emphasise freedom of access to a
range of contraceptives for married and
unmarried women, marginalized
communities, and adolescents.

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London Summit on Family Planning, 2012: 2



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Forging of a New Conceptual Framework



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II.

HUMAN RIGHTS AND HEALTH AND THE FOUNDATION FOR

VOLUNTARY, RIGHTS-BASED FAMILY PLANNING

Human Rights and Health

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right to the highest attainable standard of health

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four

interrelated and essential elements

availability, accessibility, acceptability, and quality


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The Foundation for Voluntary and Human Rights-Based Family

Planning


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three broad
categories of reproductive rights


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Reproductive rights refer to the composite

of human rights that protect against the
causes of ill health and promote sexual and
reproductive wellbeing.

1. Rights to reproductive self-determination

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Erdman and Cook, 2008: 532

2. Rights to sexual and reproductive health services, information, and education



3. Rights to equality and nondiscrimination



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The Range of Violations of Reproductive Rights and Contraceptive

Choice


By focusing only on blatant

violationssuch as sterilization without
consenthuman rights
methodologies also can miss subtler
but more widespread and persistent
violations of human rights.

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Jacobson, 2001: 56


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III.


HUMAN RIGHTS-BASED AND PUBLIC HEALTH

PROGRAMMING

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The underlying assumption is that in a

human rights approach individual rights
are protected at all costs.Yet a rightsbased approach does not privilege
protection of individual rights over the
public good.

three standard
ethical principles of public health programming


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Gruskin and Loff, 2002: 1880

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Beneficence
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Equity
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Autonomy
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In trying to make the world a better place,

there are merits to using both the public
health approach and the rights-based
approach. Although we look at the world
through different lenses, we must look for
ways to harmonize our efforts.

Shelton, 2001: 22

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Needs to
improve PH
quality

Excellent HR
and PH
quality
(best case)

Poor HR and
PH quality
(worst case)

Needs to
improve HR
quality

Poor

Human Rights Quality

Excellent

Figure 1: The Quality of Human Rights and Public Health in a Program

Poor

Excellent

Public Health Quality

Source: International Federation of Red Cross and Red Crescent Societies and the Franois-Xavier Bagnoud Centre for
Health and Human Rights, 1999; cited in WHO, 2001.

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IV. PROGRAMMING VOLUNTARY, RIGHTS-BASED FAMILY

PLANNING


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opportunity to choose

offered

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access to information

a broad range of methods and

voluntary and informed consent

principles of voluntarism and informed choice

services

verified

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Box 2. Access, Quality, and Medical Barriers to Family Planning

Access to family planning, quality of care, and medical barriers to services are key factors in the
adoption of contraceptive care. Access helps determine whether the individual makes contact with
the family planning provider, while quality of care greatly affects the clients decision to accept a
method and the motivation to continue using it. Medical barriers are scientifically unjustified policies or
practicesthat inappropriately prevent clients from receiving the contractive method of their choice or
impose unnecessary process barriers to access to family planning services.
Bertrand et al., 1995: 64

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Box 3. IPPFs Rights of the Clients Poster and

Charter of Sexual and Reproductive Rights

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Applying Human Rights to Voluntary Family Planning in Practice

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Box 4. Describing a Human Rights-based

Approach

In recent years, two distinct but

complementary approaches have
evolved. The first is a legal approach. This
uses human rights standards, the formal
system of international human rights law, to
emphasize legal obligations to respect,
protect and fulfill rights. The second is a
broader development-centered approach.
This draws from the standards and
principles of human rights and demands
adherence to good development
practices such as participation and
inclusion.

based approach

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human rights-

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DFID, 2005: 2

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legally required priorities



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Box 5. Principles to Support the Goal of Reaching 120 Million Additional Women by 2020

Protection of the human rights of women and girls, including through policies and mechanisms
to ensure informed choice of a broad range of high-quality, safe, effective, acceptable, and
affordable contraceptive methods; nondiscrimination, and assurance that women and girls are
fully informed and not coerced by any means.

Integration of family planning within the continuum of care for women and children (including
HIV-related services); and development of mechanisms that address barriers to access to
affordable and high-quality information, supplies, and services for family planning, yet are
adaptable and can be expanded to meet a broader set of unmet health and development
needs of women and children.

Universal access to voluntary contraceptive information, services, and supplies, within the
context of integrated programmes to achieve sexual and reproductive health and rights and
the health-related MDGs.

Equity in policies and program design and implementation, such as the removal of policy and
financial barriers and the development of public and private delivery mechanisms, so that the
poorest and most vulnerable women and girls have ready access to affordable, high-quality
family planning information, supplies, and services.

Empowering women to decide whether and when they wish to become pregnant as well as
how many children they wish to have.

Participatory development of country plans based on consultations with, and the views of, all
stakeholders, especially poor and marginalised girls and women.

Strong partnerships among and between a broad base of stakeholderscommunity,

governments, political leaders, civil society organisations (including faith-based organisations),
the private sector, donors, and multilateralsto help ensure high-quality service delivery,
outreach to more disadvantaged groups, [the] building [of] community support, and
programme accountability to the people served.

Commitment to results, transparency, and accountability to ensure countries and the global
community track progress towards results, as well as [to] monitoring and assessing [the]
protection of human rights and the extent to which the poor and marginalised women and
adolescent girls are reached.

London Summit on Family Planning, 2012: 5

V.

THE FRAMEWORK FOR VOLUNTARY, RIGHT-BASED FAMILY

PLANNING

Development and Purpose of the Framework



Framework for Voluntary, Family Planning Programs that

Respect, Protect, and Fulfill Human Rights

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Considerations


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Components of the Framework

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outcomes

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impacts

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inputs

activities

outputs

policy, service, community,

individual levels

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Review of Supportive Evidence and Tools

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literature review

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review of available FP-related tools

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Increased

IMPACT


































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Illustrative





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Agency of individuals is increased






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Accountability systems are in

place

Family planning services are

















































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9 Accessible
















9 Highest quality



9 Available

Illustrative

OUTPUTS























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health and rights

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INDIVIDUAL LEVEL

COMMUNITY LEVEL

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Citation: Hardee, K., et al. 2013. Voluntary Family Planning Programs that Respect, Protect, and Fulfill Human Rights: A Conceptual Framework. Washington, DC: Futures Group.

OUTCOMES

COUNTRY CONTEXT

Figure 2. Framework for Voluntary Family Planning Programs that Respect, Protect, and Fulfill Human Rights

August 2013

(All Rs indicates that all

rights are encompassed)

R1: reproductive selfdetermination

* Reproductive rights:

R3: equality and nondiscrimination

R2: access to sexual and

reproductive health
services, commodities,
information, and
education

Inputs and Activities

Country Context


x


Overall country governance

Health governance

Financing/resources

Health policy environment

Global accountability

National accountability mechanisms

Policy Level
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Adherence to global human rights agreements

Diverse stakeholder participation

Sociocultural context and gender norms

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Create an enabling environment for family planning programs

A. Develop/revise/implement policies to respect/protect/fulfill rights and eliminate policies
that create unnecessary barriers to access (All Rs)

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B. Develop/revise/implement policies to ensure contraceptive security, including access to

a range of methods and service modalities, including public, private, and NGO (R2)

x
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C. Create processes and an environment that supports participation of diverse stakeholders

(e.g., policymakers, advocacy groups, community members)
R

x
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(R2/R3)

D. Support and actively participate in monitoring and accountability processes, including

commitments to international treaties (All Rs)

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Guarantee financing options to maximize access, equity, nondiscrimination, and quality

in all settings (R2/R3)

Service Level


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Provide equitable, high-quality family planning information, services, and supplies

A. Inform and counsel all clients in high-quality interactions that ensure accurate, unbiased,
and comprehensible information and protect clients dignity, confidentiality, and privacy
and refer to other SRH services (All Rs)

x
x

B. Ensure high-quality care through effective training and supervision and performance
improvement and recognize providers for respecting clients and their rights (All Rs)

C. Ensure equitable service access for all, including disadvantaged and marginalized,
discriminated against, and hard-to-reach populations, through various service models
(including integrated, mobile, and/or youthfriendly services) and effective referral to
other SRH services (All Rs)

x
x

D. Routinely provide a wide choice of methods, and services for their proper removal, by
ensuring a sufficient supply and the necessary equipment and infrastructure (R2)

E.

Establish and maintain effective monitoring and accountability systems, with community
input; and strengthen HMIS and QA/QI processes (All Rs)

x
x

Community Level


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Ensure equitable participation/engagement in policy and program development,

implementation, and monitoring
A. Engage diverse groups in participatory program development and implementation
processes (R2/R3)

B. Build/strengthen community capacity in monitoring and accountability and ensure

robust means of redress for violations of rights (R2/R3)

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C. Empower and mobilize the community to advocate for reproductive health funding and
an improved country context and enabling environment for family planning access and
use (All Rs)

D. Transform gender norms and power imbalances and reduce community-, family-, and
partner-level barriers that affect the realization of reproductive rights (R3)

E.

'

Support healthy transitions from adolescence to adulthood (All Rs)

x
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Individual Level


Enable individuals to exercise reproductive rights

A. Increase access to information on reproductive rights, contraceptive choices (All Rs)

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B. Empower, through education and training about reproductive health, self-esteem, rights,
life-skills, and interpersonal communication (R1/R2)

x
x
x
x

C. Foster demand for high-quality services and supplies through IEC/BCC and empower
individuals to demand their rights be respected, protected, and fulfilled (R2)

Outputs


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Availability
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Acceptability

Accessibility


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Quality


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Outcomes and Impacts



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VI. SUMMARY AND RECOMMENDATIONS

Summary


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Recommendations


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Foster additional dialogue



Use the conceptual framework as a guide for country programming and donor
assistance under FP2020.
#

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Foster innovation in rights-based, public health approaches

interventions

Identify a comprehensive set of indicators



Update and expand the accompanying reviews of evidence and tools



Develop guidance and tools to apply the framework

Further document and evaluate rights-based approaches

additional investment in

ANNEX 1. TREATIES, DECLARATIONS, AND CONVENTIONS

ESTABLISHING REPRODUCTIVE RIGHTS

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Box 1. Treaties, Declarations, and Conventions with Particular Relevance for Reproductive Health and
Rights, Including Family Planning
Treaties (have the status of international law)
x
International Covenant on Economic, Social and Cultural Rights (1966)
x
International Covenant on Civil and Political Rights (1966)
x
Convention on the Elimination of all Forms of Racial Discrimination (1969)
x
Convention on the Elimination of all forms of Discrimination Against Women (1979)
x
Convention on the Rights of the Child (1989)
Conference Documents (add content and meaning to human rights)
x
Tehran Conference on Human Rights (1968)
x
World Population Plan of Action (1974, 1984)
x
International Conference on Population and Development Programme of Action (1994)
x
Fourth World Conference on Women Beijing Declaration and Platform for Action (1995)
x
United Nations World Conference on Human Rights (1993)
Declarations (no legal status, but have undeniable moral force and provide practical guidance to
States in their conduct [UNHCRH, n.d.])
x
Universal Declaration of Human Rights (1948)
x
Millennium Declaration (2000) and related Millennium Development Goals (2001), which
included Target 5b (universal access to reproductive health) in 2007
For a more complete list of relevant treaties, conventions, and agreements related to reproductive
health and rights, see UNFPA, 2012: 45. Also see OHCHR, n.d./b and n.d./c, for an explanation of the
legal force of these instruments.

Forging the Cairo Consensus



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The Cairo Consensus at 20



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Reproductive Health vs. Family Planning



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REFERENCES
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9
8

/


GLOSSARY OF TERMS
Accountability:


Coercion:

1
*

Equality:


Discrimination:


Disadvantaged/vulnerable/marginalized groups:


/
S

Contraceptive choice:


Equity (in health):

>

Family planning client:



Family planning user:

N
F

Family planning program:



Health system:

Gender equality:


F


5
p

<

Informed choice:

'

H
t

H
t

Human rights-based family planning:

Policy:

&

Reproductive rights:


Participation:


Rights-based approach:

Right to health:

'

5

5


'

5


:


>

H
t

State obligations (human rights obligations):

x
x

0


Voluntarism in family planning:

N
1

Stigma:

H
t

Futures Group
One Thomas Circle, Suite 200
Washington, DC 20005
202.775.9680
www.futuresgroup.com