Reproductive Health and Family Planning
Since the ICPD, UNFPA has worked to improve the
quality of care, increase access to services, ensure
adequate supplies and equipment, and upgrade the
technical, managerial and interpersonal skills of
health staff by providing technical support, equipment
More recently, attention has also focused on mobilizing
communities to push for higher quality health
services and more participation of women in their
management. UNFPA is supporting “Stronger Voices for
Reproductive Health”, an innovative initiative that aims
to empower users with knowledge about their reproductive
health and rights and supporting community
mechanisms so they will have a “stronger voice” to
ensure steps are taken to improve reproductive health
care. UNFPA partners with the International Labour
Organization, UNICEF and WHO in this initiative.
COMMUNITIES OF EDUCATED CLIENTS. The premise
is that better-informed users will have improved
interactions with providers and will also be more
likely to mobilize for change at the community level.
Promoting the collective action of communities to
demand quality care can also help ensure that the
decentralization of health services under way in
many countries does not result in a reduction of
resources for reproductive health care.
The Stronger Voices project has built bridges
between organizations that have previously not
worked together—reproductive rights advocates,
organized women’s groups, health care providers and
organizations focusing on community financing or
Stronger Voices started in India, Kyrgyzstan,
Mauritania, Nepal, Peru and the United Republic of
Tanzania. Activities included participatory approaches
to increase women’s access to reproductive health
services, linking women’s groups with providers to
promote better care and mobilizing young people
to work with providers on youth-friendly services.
In Kyrgyzstan, community groups raised funds
and renovated field obstetric stations; community
women are speaking out against the old tradition of
“bride-napping” as a violation of reproductive rights.
In Mauritania, two community-based micro health insurance schemes were created to ensure poor women
have access to maternity services. Project partners in
Nepal developed a groundbreaking National Strategy
for Quality of Care for Reproductive Health Services,
which incorporates “demand” and reproductive rights
as essential to delivering good quality services.
In the United Republic of Tanzania, project partners
have established the country’s first rights-based
approach to quality of care, with an emphasis on local
capacity building and community monitoring of services
that dovetails with decentralization efforts.
PAYING FOR SERVICES. Many countries are assessing
means of charging for services, given shortfalls in
government and donor funding for reproductive
health. Cost-recovery efforts have had mixed results.
In Bangladesh, for example, the 1997 Health and
Population Sector Strategy prompted NGOs to move
away from home-based provision of family planning
and to charge modest fees for services that were previously
free. At the same time, the NGOs worked to
upgrade their services.
An assessment of the changes found that clients
appreciated the services provided and felt they were
treated with kindness and respect in the NGO clinics.
It also found, however, that the changes resulted in
“a widespread feeling that poor people face discrimination
in health facilities and quality services are out
of their reach because they cannot pay for them”. (50)