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We know three big truths about contraception and family planning.
First, family planning is one of the smartest investments a country can make in its own future. When a country strives to make sure that every pregnancy is wanted and mothers are able to space their children for optimal health, its population transforms.
More children finish school. The economy flourishes. Abortion rates and maternal deaths plummet as gender equality draws nearer. And everyone—especially young people—benefit.
In fact, meeting the world’s need for contraception and family planning would save the lives of at least 570,000 newborns and 79,000 mothers every year.
The second thing we know is that health workers are a vital part of the process.
They counsel us and administer the many contraceptive methods available today. They educate us about family planning’s health benefits for all members of our families, parents and children.
And they can even safeguard a young person’s health and future by preventing too-early pregnancy.
The third thing we know is a grimmer truth. We don’t often speak of it, especially at organizations like IntraHealth International, where we work every day to champion health workers around the world.
But let’s speak of it today.
The third thing is that while health workers can help overcome the many barriers they face in providing contraception and family planning services, health workers can also be part of the problem.
Provider bias against youth is a huge barrier.
Health workers are people, after all. When they come to work, they bring their cultural beliefs and biases along with them, just as we all do. We call this provider bias. It’s a problem all over the world.
Provider bias against youth, for example, is a huge barrier.
If a teenager comes to a facility for contraceptives, a health worker might feel the client is too young. This is especially true for teenage girls. “You must have your parents’ permission,” the provider might say, or, “Come back when you’re older.”
You can imagine how this ends. The young client often continues on her path—only now, she has no contraceptive method and an impression of health facilities as obstructive and inhospitable. She will likely hold that opinion for years to come.
The opportunity to provide future planning—rather than family planning—is lost.
Another issue is that too many of us tend to leave our contraceptive decisions up to the health worker. Here too provider bias can be damaging. If health workers advise clients based on personal beliefs or their own comfort with certain methods, rather than on solid training, clients may walk away with methods that don’t work for them—or with no method at all.
I don’t believe health workers go to work to do harm. Most are trying to care for and protect their clients. This is why sensitivity training and education for health workers are so very important.
Beyond the Three Big Truths of Family Planning
Of course there are other barriers as well. And many fall outside any individual’s control.
What’s a health worker to do if she provides contraceptives to a client, and later that client’s husband decides to sue?
Unreliable supply chains, for instance, plague family planning providers. When contraceptives and other supplies are chronically out of stock, clients will eventually stop asking for them—and may even stop using any method at all.It’s a problem we see often in Senegal. Our team there has responded with a system called the Informed Push Model, through which health facilities partner with private-sector distributors to make sure shelves are always stocked to meet the demands of the community.
Another barrier is inadequate laws and policies. What’s a health worker to do if she provides contraceptives to a client, and later that client’s husband decides to sue the health worker? And of course, a country’s laws may prohibit providing contraceptives to youth, and health workers must comply no matter what their communities’ needs are.
There are also economic and geographic barriers. And of course, there is our weak global health system and the global shortage of health workers—7.2 million, the World Health Organization estimates.
At IntraHealth, we work to address these issues in all of our work. But solutions must come from the top—through cooperation among country and global leaders—and are out of reach for individual health workers.
World Contraception Day 2014
As World Contraception Day approaches, let’s take this opportunity to talk about the real barriers to family planning progress around the world.
Let’s have difficult conversations about how we can help health workers to offer the best care and counsel they possibly can.
Let’s face the problem head on. And ultimately, let’s agree to make a smart investment, so that we can all benefit.
IntraHealth’s work in Senegal with the Informed Push Model is funded by Merck for Mothers and the Bill & Melinda Gates Foundation. Find more information on the family planning workforce at K4Health.
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