Accelerating contraceptive choice post-2015

We have received the following from the International Planned Parenthood Federation: 

Jackson Chekweko, Executive Director of Reproductive Health Uganda, an IPPF Member Association, writes:

We must accelerate contraceptive choice Post-2015...

With the 47th Session of the Commission on Population and Development  (CPD47) now taking place, it's needless to emphasize how critical the issues that will be discussed are for people in developing countries and particularly in Africa. Today 90 per cent of women with unmet need for family planning live in developing countries with the greatest gap being in Africa. Although the continent has experienced much progress in universal access to family planning in the last decade, contraceptive choices are still largely limited to condoms, pills and injectables.

Much of the sexual and reproductive health programming today hangs on the fact that we recognise these issues as human rights. This means that choice is critical. Choice over contraceptive methods is about empowering women and men to make informed decisions that ensure convenience and suitability to them and their circumstances. By empowering people with information and giving them choice you begin to address resistance to using contraceptives. When both partners have access to the widest possible range of contraceptives and information about these methods, they are better able to make an informed decision that meets their needs. Choice promotes convenience and acceptability. If you can access your choice of contraception at any health facility or over the counter, this put the minds of women and their partners at ease.

Another critical issue related to accelerating choice is addressing the concerns of young people. All contraceptive methods, except the permanent methods for those who have not had their preferred number of children, are appropriate for young women. The world is now home to the largest generation of young people in history. Choice allows a sexually active young person to make an informed decision when planning their lives.

However, service provider bias remains one of the biggest barriers to contraceptive uptake among young sexually active women from ages 15 - 24 years. This is reinforced by community prejudice. We need to prioritize training and advocate for change in attitude among service providers. We must invest more in comprehensive sexuality education and life planning skills  because it helps young people develop the skills to build healthy relationships.  

We must have friendly and acceptable strategies targeting young people. Many universities, workplaces provide condoms and yet emergency contraception for women is still missing. Men should as well be deliberately targeted with accurate information on contraception. This will not only foster partner support in decision making, but empower them to champion contraceptive use in their relationships, be change agents among fellow peers and use their advantaged positions to advocate for contraception choices.

If we want to promote choice in Africa, we need service providers at all levels to offer a wide contraceptive mix, from condoms, pills, injectables, implants and other long term and permanent methods. We need to strengthen the contraceptive supply chain mechanism so that the full range of contraception is available where it is needed, when it is needed.

Governments must adopt new approaches to reduce the unmet family planning need. A first step would be to roll out community based distribution for comprehensive family planning - condoms, injectables, pills and referral for long term and permanent contraceptive methods.  Secondly, adopt and implement task sharing policies as recommended by the WHO to mitigate the high patient health worker ratios and increase access to permanent and long term contraceptives. To further widen choice, we are asking governments to invest money in new technologies such as sayana press - a three-month, progestin-only injectable contraceptive product packaged in the Uniject(tm) injection system, because of its convenience in administration and portability.

Women and men must have access to the widest possible range of contraceptives, accurate information on these methods to enable them to make informed and voluntary choices about which method best fulfils their desires and needs. It is only when sexual and reproductive rights are realised for everyone, and women and girls have control over their futures and bodies, that development will be truly sustainable and meaningful.