Twenty-five years ago, The Lancet published a seminal article by Jim Shelton, Marcia Angle and Roy Jacobstein. “Medical Barriers to Access to Family Planning”1 had a huge influence, galvanizing global efforts to improve access to contraceptive services. That same year, 1992, Depo Provera (depot medroxyprogesterone acetate [DMPA]) was finally approved for contraceptive use by the U.S. Food and Drug Administration, after decades of controversy.
When it comes to doing family planning work in low- and middle-income countries, where there is so much (and so many different types of) work to be done, where do you start? How do you decide where to focus your efforts, or how to make sure you aren’t repeating the same research or offering the same services as another group?
The DRC needs a family planning program that works for all women. Photo: PATH/Georgina Goodwin
In November 2016, PATH partnered with the Democratic Republic of the Congo’s Ministry of Health to hold a three-day workshop in Kinshasa that brought together the public, commercial, and private nonprofit sectors to advance a total market approach to family planning. A total market approach is a process that combines the strengths of all marketplace sectors to ensure that women get the supplies and services they need, through the right channels, and at the right price. In the DRC, aligning marketplace sectors can help to solve the inequities in our current system—where many poor women can’t access or afford family planning services. This lack of access contributes in part to the DRC’s high rates of maternal mortality and unmet need for contraception.
There are now more than 300 million women and girls using modern contraception in the world’s 69 poorest countries, with more than 30 million of those users added since 2012. That’s the good news. The more challenging news is that despite this progress, health markets in low- and middle-income countries often operate inefficiently, failing millions of potential family planning (FP) consumers.
Pathfinder International | Technical Advisor for Capacity Building
Younger women having their first or second child may not recognize access to health services as a right and as something that could improve their lives. Photo: Pathfinder.
Evidence-based interventions. High-impact practices. Using data for decision-making.
As program implementers, we (rightly) spend a lot of time focusing on these concepts. But, sometimes, we get so caught up in trying to implement development strategies and interventions “correctly” that we lose sight of the perspectives of the people that our projects are intended to support—local partners, service clients, and community members. Evidence across sectors shows that the people best able to solve problems are often those closest to the situation itself. Thus, effectively removing barriers to sexual and reproductive health services use means taking a step back from our checklists and our data and actually talking to community members to understand what is getting in their way.