Achieving the goal of the London Summit on Family Planning by adhering to voluntary, rights-based family planning: what can we learn from past experiences with coercion?

Abstract

The 2012 London Summit on Family Planning refocused attention on family planning, garnering much-needed support for the goal of reenergizing and expanding programs in 69 low- and medium-income countries enable 120 million more women ... to use contraceptives by 2020. (1) Although the response to the summit's initiative (referred to as FP2020) was generally positive, reproductive health and rights advocates expressed concern that the focus on a numeric goal was a retreat from the 1994 consensus of the International Conference on Population and Development (ICPD), which promoted rights and repudiated targets. (2-5) Following the London Summit, some advocates questioned how the ambitious goal of the initiative might be achieved, and at least one commenter raised the specter of coercion--without the proper safeguards, would the rights of women, ostensibly the center of the initiative, be protected? (2) The international family planning movement was built on the foundation of the right of individuals and couples to decide freely and responsibly the number and spacing of their children and to obtain the information and services to do so, although the goal of several early family planning programs was to slow population growth. (6) The vast majority of family planning has been provided through programs that adhere to principles of voluntarism, but instances and allegations of coercion over the last several decades have dogged international family planning, and have evoked strong reactions. (7-15) Indeed, the family planning field has been wrestling with the issue of coercion for decades. (16) The purpose of this article is to answer the following questions: What constitutes coercion in family planning policy and program management and how do we use lessons of the past to prevent future instances of coercion? We contend that defining coercion and examining when it has occurred (or has been alleged to have occurred) in family planning programs will aid in the development of safeguards to reduce the incidence of coercion, will help protect or redeem programs that are falsely accused of coercion, and will help ensure that programming supported by the FP2020 initiative provides voluntary family planning services that respect, protect and fulfill human rights. METHODS This article is based on a review of the literature on alleged and documented cases of coercion in family planning programs, augmented by the authors' direct experience with and research on family planning programs, demography, quality of care and human rights since the 1970s. The literature for this article is supplemented by a wider review of literature conducted on voluntary, human rights-based family planning by Rodriguez et al. (17) While Rodriguez et al.'s literature review focused on the years 1995-2012, this article includes literature from family planning programming dating back to the 1960s, because some instances and allegations of coercive practices included here occurred at that time. What Constitutes Coercion? To inform this article, we looked for existing definitions and descriptions of coercion in family planning. (18,19) There is no commonly held definition, although instances of coercion are linked to violations of human rights and there is broad consensus that coercion is morally wrong and should be avoided by family planning programs. (18,20-22) To develop a definition of coercion, we found it instructive to review the three broad categories of reproductive rights described by Erdman and Cook--the right to reproductive self-determination; rights to sexual and reproductive health services, information and education; and rights to equality and nondiscrimination. (23) Defining coercion or coercive actions too broadly could incriminate all family planning programs, becoming a catchall term applied to poorly implemented programs that neglect or are unable to reach quality of care standards. …