October 1, 2015 |

An implementer’s perspective on family planning as a human right

We can say that family planning is a basic human right, but how do we translate that into action?
Woman showing injectable contraceptive to another woman.
How do we promote and protect everyone’s human right to family planning? Photo: PATH/Will Boase.

Editor’s note: Sara Tifft, associate director in PATH’s Reproductive Health Program, shares her perspective on how the human right to health and family planning intersects with our work at PATH. Sara is a member of the Human Right to Family Planning Conference (HR2FP) steering committee at the University of Washington and will also speak at this fall’s event. 

From where I sit at PATH as a program implementer—and based on my 30-plus years of experience in global health—the human right to family planning can feel like an abstract concept.  We can say that family planning is a basic human right, but how do we translate that into action?

More concretely, how do we ensure that every person can access a full range of family planning options—no matter who they are or where they live?

From abstract concept to concrete implementation

Globally, there are a number of factors that limit women’s access to contraception—and that limit their human rights. They may not know what options are available. They may lack knowledge about where to obtain contraceptives. There are cultural and religious traditions, as well as poverty and a scarcity of services that can limit women’s access to contraception. For these reasons, contraceptives are often most readily available to women who are educated, have financial means, and know that family planning options exist.

So how do we promote and protect everyone’s human right to family planning? I believe that innovation can offer concrete solutions that make that human right a reality.

A man shows a group of men and women how to give an injection with a Sayana Press device.
“Access to safe, voluntary family planning is a human right. Family planning is central to gender equality and women’s empowerment, and it is a key factor in reducing poverty.”—United Nations Population Fund (UNFPA). Photo: PATH/Will Boase.

In a 2006  Harvard Business Review article, Clayton Christensen suggests that “an innovation is disruptive when a new population has access to products and services that previously were only affordable for the few or the wealthy.” Christensen calls this “disruptive innovation for social change.”

In other words, disruptive innovation in family planning can promote and protect human rights in the following ways:

  • A wider, more affordable range of family planning choices are made available.
  • Products and services are distributed and delivered at times and places convenient to women.
  • Women have more direct control over how and when they choose to use contraceptives.
A woman shows a Sayana Press contraceptive device to another woman.
Sayana® Press is one promising innovation that is striving to increase women’s access to and choice of family planning methods. Photo: PATH/Will Boase.

Increasing family planning access through innovative technologies

Injectable contraceptives are in especially high demand in sub-Saharan Africa and parts of South Asia. These are particularly popular because they offer safety, efficacy, convenience, and privacy.

However, access constraints to these injectables disproportionately impact poor and marginalized women, who may find it difficult to get to health centers with staff qualified to give the injections. These constraints are especially severe in sub-Saharan Africa, which the World Health Organization says has under 3 percent of the global health workforce, but 33 percent of the world’s burden of maternal, newborn, and child disease.

At PATH, Sayana® Press is one promising innovation we’re working on that is striving to increase women’s access to and choice of family planning methods. Sayana Press, an all-in-one product that combines the Depo-Provera® contraceptive and needle together in the PATH-developed Uniject™ injection device. Through a project that I direct at PATH, we are coordinating pilot introduction of Sayana Press in four countries in sub-Saharan Africa.

A hand holds up a Sayana Press contraceptive device and packaging.
“You know an innovation is disruptive when a new population has access to products and services that previously were only affordable to a few or the wealthy.” —Clayton Christensen, professor, Harvard University. A close-up of Sayana Press. Photo: PATH/Will Boase.

Like the Depo-Provera brand of the depot medroxyprogesterone acetate (DMPA) contraceptive, Sayana Press offers three months of safe, effective contraceptive protection with a single injection. It is small, easy to transport, and easy to use with minimal training. This makes Sayana Press ideal for community-based health workers to administer in village health clinics and even in women’s homes. Our pilot introduction experiences are showing that women and health providers really like Sayana Press. So far, we are seeing that first-time users of family planning are choosing this method, as are younger women—the very women who have the most challenges getting access to family planning.

And because of Sayana Press’ unique design—which lends itself to easy, safe self-injection—we’re poised to take this concept one step further by researching how to support women to self-inject Sayana Press independently, safely, and effectively  outside clinics in the privacy of their own homes, giving them even more autonomy.

A woman stands in front of two homes.
Annet, 41 and mother of 7 children, is a village health worker trained by PATH’s Sayana Press pilot introduction program. During the training she decided to become the first woman to receive Sayana Press in Uganda. Photo: PATH/Will Boase.

Self-injection: increasing women’s access through empowerment

In low-resource regions, self-injection of Sayana Press has the potential to empower women by providing them with another family planning option. As a program leader involved with developing family planning options for women who need them most, this is how I see the human right to family planning concretely realized in women’s and couples’ daily lives.

This October, I will join academicians, practitioners, and students in public and global health, medicine, and law, from organizations representing the Global North and South at the Human Right to Family Planning (HR2FP) conference at University of Washington. While there, we will explore how we can build more of these bridges to family planning access.  We encourage all who are interested in this topic to attend.

Depo-Provera and Sayana Press are registered trademarks of Pfizer, Inc. Uniject is a trademark of BD.

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  • Sara Tifft is an associate director in the Reproductive Health Program at PATH.