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FOR IMMEDIATE RELEASE
July 26, 2001
Hopkins Report: New Informed Choice Strategy for Developing
Countries Guides People to Better Family Planning Decisions
Researchers at the Johns Hopkins Bloomberg School of Public Health are calling for a new, broader strategy to help people make well-informed choices about family planning and protection against HIV/AIDS and other sexually transmitted infections (STIs).
The new strategy urges efforts in five areas: government policies, communication programs, access to contraception, family planning program leadership and management, and counseling. The proposal, addressed to policy-makers and health care providers working in and for developing countries, appears in the latest issue of Population Reports published by the Johns Hopkins Population Information Program.
The new strategy broadens efforts to assure people's informed choice in family planning. “Informed choice” means that individuals and couples can make their own free decisions about using family planning based on accurate information and access to services and supplies to carry out their decisions. This principle has long been fundamental to family planning programs around the world.
"While counseling has long been considered a key to ensuring informed choice, what happens before people visit a service provider may be even more important," writes author Ushma D. Upadhyay in calling for the new strategy. For example, in all 50 developing countries surveyed at least 80 % of women who planned to start using family planning in the next year already had a specific method in mind. In 26 of those countries the percentage was over 90%.
"The principle of informed choice focuses on the individual. Yet most people's family planning decisions also reflect a range of outside influences. These include household influences and community norms, government laws and policies, information available, and access to family planning and services,” writes Upadhyay.
Good communication between clients and providers during counseling remains essential, the report notes. Many people want help thinking through the decision-making process and learning how to use a method correctly. Providers also can help clients assess whether they are at risk of HIV/AIDS and other STIs. In view of the AIDS epidemic, “it is more important than ever for people…to consider dual protection” against unintended pregnancy and STIs, according to the report. “Making a family planning choice without considering STI risk and protection is not a fully informed choice.”
Whether people can make their own choices is key to their satisfaction with family planning. An Indonesian study, for example, found that 91% of women who received the family planning method they wanted were still using that method a year later. By comparison, only 28% of those who did not get their preferred method were using the method they received after a year.
The proposed comprehensive strategy includes:
- Setting supportive policies. Endorsement at the top sets the tone for the entire health care system. National policies in Malaysia, Mexico, Peru, and Zambia intend to protect people's rights and ability to making informed choices. For example, Mexico's constitution states that “every individual has the right to decide in a free, responsible, and informed manner the number and spacing of his or her children.”
- Widespread communication programs. Information campaigns in the mass media and in the community can inform people of their right to make their own decisions, explain their options, and direct them to health care providers who can help. For example, Bolivia's “Las Manitos” (“Little Hands”) campaign advised people that their reproductive health was in their own hands and that there is a range of contraceptive methods to choose from, including condoms which protect against HIV/AIDS.
- Improving access. A range of contraceptive methods and outlets helps people carry out their choices. In nine countries surveyed, from 11% of women in Mauritius to 48% in Costa Rica said they would rather use a different family planning method. Most often, their preferred method was too expensive, too difficult to obtain, or not available at all. Falling funding levels make better access increasingly difficult, however. Donor governments and international organizations are contributing less toward the cost of contraceptives. In 1999, the last year for which data are available, donor support for contraceptives totaled US$130.8 million, down 9% from the previous year. This continues a trend of falling funds that began in 1996.
- Stronger management and leadership. Program management that improves quality of care enhances clients' choices. In Kenya, after new service delivery guidelines were instituted, the percentage of clients unnecessarily denied family planning services because they were not menstruating declined from 47% to 29%.
- Improving counseling. Counseling can be crucial to helping some people think through their decisions. It is a partnership of not one, but two experts—the provider as the medical expert and the client as the expert on her or his own situation and needs. The “Smart Patient” program in Indonesia, a pilot project carried out by the Johns Hopkins Center for Communication Programs, helped clients prepare their questions for counselors. These clients asked an average of 5.5 questions per session, compared with 3.5 among clients who were not coached.
Ushma Upadhyay prepared the report, Informed Choice in Family Planning: Helping People Decide. Population Reports is an international review journal of important issues in population, family planning, and related matters. It is published four times a year in four languages by the Population Information Program at the Johns Hopkins Center for Communication Programs for more than 170,000 family planning and other health professionals worldwide, with support from the US Agency for International Development (USAID). USAID administers the US foreign assistance program, providing economic and humanitarian assistance in more than 80 countries worldwide.
For more information contact: Kim Martin at Johns Hopkins Center for Communication Programs, 111 Market Place, Suite 310, Baltimore, Maryland 21202, USA. Tel: 410 659-6300; Fax: 410 659-6266 e-mail: press@jhuccp.org.
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