Voluntary and Informed Choice
Ensuring that FP services are provided in a manner that fully respects the principles of voluntarism and informed choice is fundamental to all FP programs. This includes respecting an individual’s right to make decisions about whether to obtain or decline treatment or services, what treatment or services to select, whether to seek and follow up on a referral, and whether to continue to consider the options available. The informed choice process can occur alone or in consultation with health care providers, family, or friends. Informed choice occurs when people know about FP, have access to a broad range of methods, and have support for individual choice.
- Clients who make voluntary and informed choices are more likely to be satisfied and follow through with the method or course of treatment they have chosen.
- Women who receive their method of first choice from a range of options are more likely to continue with that method.
Services should support individual decision-making by supplying information the individual wants, by facilitating an evaluation of all information and options, and by offering the means to implement the decision made, while recognizing the different needs and circumstances of different clients. The following are required to ensure informed choice regardless of the specific situation:
- Good interpersonal communication between the client(s) and providers
- Respect for individual choice and autonomy
- Information about a broad range of relevant methods and services
- Counseling tailored to the client’s choice of method
- Sufficient time to consider options and the right to reconsider at any time
- Informed consent, especially for sterilization, implants, and intrauterine device (IUD) insertions
USAID Support to Voluntary Family Planning
Through its FP and reproductive health funds, USAID supports FP programs that promote and provide voluntary and informed FP and that reduce unintended pregnancies. It also supports the integration of other reproductive health components into FP programs. For example, USAID supports the integration of HIV/sexually transmitted infection (STI) prevention, postabortion care, basic education on reproductive health and FP for adolescents, and prevention of harmful practices, such as female genital cutting, into traditional FP programming.
Programs receiving USAID funds are required to meet certain criteria as summarized below:
- Service providers and referral agents may not implement or be subject to numerical targets or quotas for total number of births, number of FP acceptors, or acceptors of a specific method, although quantitative estimates or indicators can be used for budgeting or planning purposes.
- No incentives can be given to individuals in exchange for accepting FP or to program personnel for achievement of targets or quotas for total number of births, number of FP acceptors, or acceptors of a specific method.
- Individuals cannot be denied rights or benefits such as food or medical care based on their decision not to accept FP services.
- FP acceptors must be provided comprehensible information on the health benefits and risks of the method chosen.
- Experimental contraceptive drugs and devices and medical procedures may only be provided in the context of a scientific study in which participants are advised of potential risks and benefits.
The Foreign Assistance Act of 1961 (22 U.S.C. 2151b(f)(1)) prohibits the use of foreign assistance funds “to pay for the performance of abortions as a method of FP, or to motivate or coerce any person to practice abortions.” The August 1984 announcement by President Reagan of what has become known as the “Mexico City Policy” directed USAID to expand this limitation and withhold USAID funds from NGOs that use non-USAID funds to engage in a wide range of activities, including providing advice, counseling, or information regarding abortion, or lobbying a foreign government to legalize or make abortion available. The Mexico City Policy was rescinded under President Obama in 2009.
Key Voluntary and Informed Choice Resources:
- Guidance on the Definition and Use of the Global Health Programs Account: A Mandatory Reference for ADS Chapter 200 (USAID, 2013). For more information regarding USAID policies, refer to Chapter 9 “Family Planning and Reproductive Health.”
- Statutory Requirements & Policies Governing U.S. Global Family Planning and Reproductive Health Efforts (Kaiser Family Foundation, 2012).
 Studies in Family Planning; Nov./Dec. 1991.