From choice to agency in family planning services

Abstract

Reproductive choice has been a central refrain in calls for women's sexual and reproductive health and rights and reproductive justice globally. 1 Dehlendorf C Reed R Fox E Seidman D Hall C Steinauer J Ensuring our research reflects our values: the role of family planning research in advancing reproductive autonomy. Contraception. 2018; 98: 4-7 Summary Full Text Full Text PDF PubMed Scopus (16) Google Scholar , 2 Gilliam ML Neustadt A Gordon R A call to incorporate a reproductive justice agenda into reproductive health clinical practice and policy. Contraception. 2009; 79: 243-246 Summary Full Text Full Text PDF PubMed Scopus (32) Google Scholar However, family planning programmes too often define reproductive choice on the basis of the availability and uptake of contraceptives. These indicators are not necessarily indicative of choice, nor do they ensure that choice leads to reproductive agency—ie, the ability and action to achieve one's own health, wellbeing, and fertility goals. Given the history of population control efforts under the flag of family planning, particularly against socially and economically vulnerable women and girls, emphasis on contraceptive targets and outcomes could impede reproductive choice and agency. 3 May JF The politics of family planning policies and programs in sub-Saharan Africa. Pop Develop Rev. 2017; 43: 308-329 Crossref Scopus (25) Google Scholar There is a need to change outcomes of success and prioritise women's and girls' fertility and contraceptive preferences (choice) and capacity to act on these preferences (agency). 4 Starrs AM Ezeh AC Barker G et al. Accelerate progress—sexual and reproductive health and rights for all: report of the Guttmacher–Lancet Commission. Lancet. 2018; 391: 2642-2692 Summary Full Text Full Text PDF PubMed Scopus (190) Google Scholar Furthermore, we call for a gendered perspective in recognising the value of women's and girls' choice and agency in family planning and elimination of the sexism, classism, and ethnocentrism that can persist in the field and sustain population control approaches in family planning.