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Karen Hardee,1 Sandra Jordan2 1Executive Office, What Works Association, Arlington, VA, USA; 2Public Health Consulting, Bethesda, MD, USACorrespondence: Karen Hardee; Sandra Jordan Email KHardee@hardeeassociates.com; sandrajordan4@gmail.comIntroduction: An assessment in 2019 by Family Planning 2020 of progress on rights-based family planning since 2012 highlighted the development of tools and guidelines that identify and explain rights in relation to family planning, promotion of rights-based approaches to programing, strengthened accountability, and measurement of rights-focused outcomes. The assessment was also forward-looking, asking what aspects of rights-based family planning still need attention moving from 2020 to 2030.Methods: This paper draws on interviews with 23 key informants from governments, civil society, and youth focused organizations, implementing partners, and bi-lateral and multilateral organizations from Africa, Asia and the Pacific, Europe and North America, all working on family planning and engaged in various roles with the FP2020 partnership at global and national levels, along with documentation of FP2030 partnership plans. The interviews were conducted as part of the assessment and included questions to respondents for their recommendations on rights-based family planning moving towards 2030.Results: Respondents agreed that rights should be at the center of the vision for family planning, with attention to rights literacy, accountability and equity, including adolescent and youth leadership. They noted the need for consistent political and financial support, and incorporating rights into result-based financing programming. While respondents noted the need for development and dissemination of practical tools and training materials, along with rights metrics and implementation research, they stressed the importance of focusing work on rights at the country level. Respondents also acknowledged that institutionalizing rights-based family planning will require enhanced commitment and funding from both donors and countries to ensure programming – and success – over the long term. Amplifying civil society and particularly adolescent and youth voices will be key to engaging governments to support both rights-based programming and provide funding. Review of initial planning under FP2030 related to each of the recommendations suggests that the new partnership is seeking to addressing each of them.Discussion: As the family planning field looks beyond 2020 to 2030, this paper provides a roadmap for building on the gains made over the past decade to effectively tackle the challenges remaining to ensure that programming to achieve the vision of the FP2030 Partnership is rights-based.Keywords: human rights, family planning, contraception, accountability, FP2030

Context: Commonly used indicators of contraceptive behavior in a population—modern contraceptive prevalence (mCPR), unmet need for contraception, demand for contraception and demand satisfied—are not well-suited for evaluating the progress made by government family planning programs in helping women and men achieve their reproductive goals. Methods: Trends in these measures in 26 Sub-Saharan African countries between 1990 and 2014 were examined. Trends in a proposed new indicator, the public-sector family planning program impact score (PFPI), and its relationship to mCPR and the family planning effort score were also assessed. Case studies were used to review public family planning program development and implementation in four countries (Nigeria, Ethiopia, Rwanda and Kenya). Results: The four commonly used indicators capture the extent to which women use family planning and to which demand is satisfied, but shed no direct light on the role of family planning programs. PFPI provides evidence that can be used to hold governments accountable for meeting the demand for family planning, and was closely related to policy developments in the four case-study countries. Conclusions: PFPI provides a useful addition to the indicators currently used to assess progress in reproductive health and family planning programs.

SummaryThis article analyses male contraceptive use, both globally and for developing countries. Shares of all contraceptive use due to males are examined, in the context of female use and all use. Patterns according to wealth quintiles are analysed, as well as time trends and geographic variations. Data are drawn primarily from compilations by the UN Population Division and from the Demographic and Health Series and subjected to relatively simple statistical methods including correlation/regression applications. Contraceptive methods that men use directly, or that require their co-operation to use, including condoms, withdrawal, rhythm and male sterilization, account for one-quarter of all contraceptive use worldwide. This represents 13% of married/in-union women. Both the share and the prevalence of male methods vary widely by geography and by the four methods, as well as by quintile wealth groups. With greater wealth there is an unbroken rise for total use; among the male methods, the shares of condom use and rhythm rise by wealth quintiles, while the share of withdrawal drops. The share for male sterilization is highest in the lowest and highest wealth quintiles and dips for the middle quintiles. The overall time trend since the 1980s has been steady at one-quarter of all use involving men; moreover, the share is about the same at all levels of total use. The female-only methods continue to dominate: female sterilization, IUD, pill, injectable and implant, again with great diversity geographically. In surveys men report less total use but more condom use, while females report more injectable use. For the future the male share of one-quarter of use seems secure, with little prospect of an increase unless concerted programmatic efforts are made to expand access to male methods and promote their use as part of a broadened contraceptive method mix.

Is education the best contraceptive? Using the multistate human capital projection model, our analysis shows that the projected changes in India population vary depending on investments in education and helping women reduce unwanted fertility rates, that investments in both education and helping women in each education category—but particularly less educated women—meet their wanted fertility will have the largest impacts on India's population projections, and that the impact from investment in reducing unwanted fertility will be much more immediate and significant than only investments in education. Our analysis also reveals that an increasing education transition rate in India will not only help to achieve a population age structure that is favorable for economic growth, but also result in a larger share of skilled labor force that help to achieve higher economic growth rate. More importantly, investment in girls' education and achieving gender equality in education will be the most effective measure to increase India's population education level and improve its overall values of human capital.

SummarySurvey data on contraceptive use for about 80 countries are related to measures of contraceptive access, by method, from 1999 to 2009. Cross-tabulation and correlational methods are employed, with geographic comparisons and time trends. Total prevalence of use for five modern contraceptive methods correlates well to a variety of access measures. Greater access is also accompanied by a better balance among methods for both access and use. Sub-Saharan African countries show similar patterns though at lower levels. Improved access to multiple methods is consistently associated with higher levels of contraceptive use.

AbstractNearly three decades ago, Bruce articulated a client‐centered quality of care (QoC) framework for family planning services. The term quality has since then been used in many rights‐based frameworks for health, reproductive health, and family planning. This commentary compares the concept of quality used in many of these frameworks to reconcile the elements of the FP QoC framework with the use of quality in various rights frameworks. We propose five modifications to the original FP QoC framework to better align it with the treatment of quality in the rights‐based approaches and the way quality in family planning has been applied in practice.

It is important for governments, aid organizations, and researchers to understand how developing communities respond to climate change and how their efforts can be improved within a framework of resilience thinking. This review explores the definition of resilience and, more specifically, community resilience and its components, then presents four case studies of community response to extreme weather events to illustrate community resilience in action. The review is intended to provide context for and inform more detailed exploration of community resilience in integrated programming (specifically, programming designed to improve health, environment, and population outcomes). It is also intended to capture references to population dynamics and family planning in the literature on community resilience, but is not intended as a definitive guide to the links between community resilience and health or family planning.

Tropical cyclone Haruna made landfall in southwest Madagascar in February 2013; it was a powerful Category 2 storm with heavy rain and wind speeds of 150 km/h, making it the largest cyclone that this region had experienced in more than 35 years. Houses, schools, government buildings and health clinics throughout the communes of Befandefa and Morombe (home to approximately 15 000 people) were damaged, with many completely destroyed.

Current attention to increasing access to family planning has increased focus on ensuring that policy, programming, and practice are "evidence-based." This paper seeks to answer when, what types, and how evidence is used in decision-making related to family planning. Views of what constitutes evidence need to be more aligned: researchers should understand that "evidence-based" does not only mean "research evidence-based" to decision-makers; and decision-makers must understand the value of robust research evidence among other evidence they consider when making decisions. Decision-makers appreciate research but it is only one factor they take into consideration—and may not be the most influential factor in their decision-making. Research findings tend to be filtered through decision-makers' values and beliefs in addition to political, economic, and social considerations. Examples from the family planning field reinforce the persistence of other factors affecting decision-making. A number of promising interventions show that research evidence, vis a vis other factors, can inform decision-making. Expecting policy or program change from single studies is mostly unrealistic, but examples from decades of family planning programming described in this paper illustrate the incremental influence of evidence from research on family planning policies and programs.

Globally, women's access to modern contraception can be attributed to poor service conditions and care. Growing evidence from across the health sector has found that social accountability approaches have the potential to improve the quality of care and therefore the utilization of health services, little of this evidence relates to family planning and reproductive health programs. This paper therefore assessed the results of retrospective implementation research into a five-year social accountability project in Uganda that focused on family planning and reproductive health. A mix of methods was used examine the project's implementation in three districts in Uganda between 2009 to 2013, including political economy analysis, document review, and in-depth interviews. Interviews were coded using ATLAS.ti software and analyzed with a thematic framework, organized by stakeholder groups and across districts. The research found that while the project broadly delivered as intended in local accounts, a wider range of activities and outcomes also occurred. Community participants in the three districts were much more likely to remember more personal changes, such as increased confidence when interacting with health care providers, in their health seeking behavior or in their ability to represent themselves. The research revealed a web of accountability relationships at play. These ranged from formal opportunities for community participation in institutional processes, to the more personal direct relationship between the service users and the health care provider compared to the less direct relationship between the community and local officials. In addition, ways in which elements of social accountability can be combined with features of FP program were seen, such as including outreach activities with civic and rights education. This appears to extend the reach and credibility of these services among community members while also counteracting barriers to women's and young people's participation.