Family Planning: A human rights perspective

By Vashni Benjamin

Family Planning 2020 (FP2020) Executive Director Beth Schlachter addressed the media recently stating: “Family planning saves lives.”

She moved on to add that in 2018, as a result of modern contraceptive use, in 69 FP2020-focused countries, 119 million unintended pregnancies were prevented, 20 million unsafe abortions were averted, and 137,000 maternal deaths were prevented.

FP2020 is a global partnership that is in collaboration with many nations across the world that aims to create a world where every pregnancy is wanted and where every couple and person is given a right to reach their full potential without anything holding them back, by providing them with access to lifesaving contraceptives.

In Sri Lanka, the UNFPA (United Nations Population Fund) together with FP2020 aims to make this a reality. The UNFPA, which launched the “Does She Travel Safe?” campaign earlier this year, has been a key partner in the FP2020 global partnership since 2018 to empower women and girls by investing in rights-based family planning. They, together with the Sri Lankan Government, aim to equip all Sri Lankans with not just the accessibility to family planning and knowledge regarding it, but also to comprehensive sex education and access to contraceptives.

In Sri Lanka, the topic of family planning has always been a sensitive one, with a lot of stigma and misunderstanding surrounding it. While family planning has been a component of maternal and childcare services in Sri Lanka since the 1960s, its efficiency has been questionable, leading to many doubts regarding the feasibility of FP2020 in the country. And so we reached out to UNFPA in Sri Lanka to look for answers to some of these pressing questions and here’s what they had to say.

The family planning programme was implemented in the country since the 1960s. What services were offered through it and what were the shortcomings that needed to be fixed?

The National Family Planning Programme (NFPP) has been largely successful in meeting the need for family planning in Sri Lanka. The Government of Sri Lanka affirmed the importance of family planning in reducing infant and maternal mortality by integrating maternal and child health, and family planning from the inception of the NFPP.

As a result, in the 1970s, one in three married women aged 15-49 were using contraceptives. By the mid-1980s, use of contraception increased to two in three women. During the period from 1993-2000, the overall contraceptive prevalence rate increased from 66% to 70%. This was largely due to an increase in the use of modern methods of contraception. This also contributed to the reduction of the maternal mortality rate which is 35 per 100,000 live births and the infant mortality rate of 9.5 per 1,000 live births.

However, in the last decade, a number of issues including the quality of family planning services and myths and misconceptions around the objective of family planning have posed challenges to the family planning programme in Sri Lanka.

In 2016, UNFPA supported the Family Health Bureau of the Ministry of Health in conducting the National Family Planning Programme (NFPP) review. It revealed that while the NFPP had made significant achievements in access to information and services of family planning, issues such as prevention and treatment of subfertility, post-abortion care, and services for vulnerable and marginalised groups needed further improvement. Additionally, the review noted certain social norms hindered efforts made to increase engagement of men in family planning decisions.

At its inception, the primary objective of the NFPP was to control population growth. However, at the International Conference on Human Rights in Tehran, family planning was declared a human right. This means that couples have a basic human right to freely decide the number and time in between births of their children. This also includes the right to education and information on sexual and reproductive health.

The International Conference on Population and Development (ICPD) in 1994 further represented a paradigm shift by recognising that individual rights and choices was a step down the path to sustainable development.

What are Sri Lanka’s personal goals when it comes to FP2020?

In 2018, Sri Lanka joined the FP2020 global movement. Sri Lanka’s objective is to increase the percentage of eligible families who have their need for family planning satisfied with modern methods of contraceptives from 74.2% to 79% by 2025, with focus on reducing regional disparities.

Is there a new family planning strategy in the making? What are some steps being taken to ensure its efficiency and success?

UNFPA is supporting the Ministry of Health in its efforts to promote family planning as an integral element of the national reproductive health programme by improving capacities of healthcare officers on family planning, and in better coordinating and monitoring family planning programmes conducted at a national level. UNFPA also works with the authorities to ensure equitable access to family planning services and information across the island.

In March 2019, the Government of Japan granted $ 1.4million to UNFPA to support Sri Lanka in improving access to comprehensive sexual and reproductive health information and services. The three-year programme also includes improving access to services for survivors of gender-based violence.

How are you currently working towards making the local education system more inclusive of sex and reproductive health education? And how can the need for sex education among adults be fulfilled?

Comprehensive Sexuality Education (CSE) enables young people to protect their health, well-being, and dignity. Decisions about their sexual and reproductive health are life-changing, and lack of access to accurate information leaves them vulnerable to coercion, discrimination, sexually-transmitted infections (STI), and unintended pregnancies.

The UNFPA works with the Ministry of Education and National Institute of Education to ensure that sex education is accurately taught in schools, and is tailored to the specific context and needs of each young person. It includes scientifically accurate information about human development, anatomy, and reproductive health as well as information about contraception, childbirth, and STIs. It goes beyond information to include discussions about family life, relationships, dignity, respect, consent, culture and gender roles, and also addresses human rights, gender equality, and threats such as discrimination and sexual abuse.

The UNFPA has also worked with government authorities to train pre and in-service teachers and teacher-trainers in national teacher training colleges. With the launch of the International Technical Guidance on CSE in 2018, the UNFPA plans to address gaps and challenges that still exist in delivering comprehensive sex education to every young person in Sri Lanka.

It is crucial to break the stigma around sexual and reproductive health and to facilitate an open discussion between students, teachers, young adults, the media, and the wider public.

Recently, UNFPA supported the Vocational Training Authority (VTA) to develop a training manual on sexual and reproductive health and rights for VTA trainers. The UNFPA has further supported the VTA in training trainers in all nine provinces, and advocated to ensure that education on sexual and reproductive health is integrated in the VTA curriculum.

Moreover, the UNFPA supported the University Grants Commission (UGC) to develop Road to Adulthood – an online platform to educate youth about sexual and reproductive health and rights. In September 2016, a circular was issued by the UGC instructing all universities to include the Road to Adulthood e-module in their respective orientation programmes for newly-enrolled students.

Lack of knowledge in sex and family planning has led to many problems like unsafe abortions, teen pregnancies, increased maternal mortality, and lack of postpartum and post-abortion care. Are there any others?

Lack of access to accurate information on sexual and reproductive health makes women and girls more vulnerable to sexual and gender-based violence including forced and unwanted pregnancies, and sexually-transmitted infections including HIV. According to a UNFPA study conducted in five provinces in Sri Lanka, one in three female homicides are related to intimate partner violence.

Although abortion is legally restricted in Sri Lanka, post-abortion care and post-abortion family planning are readily available to reduce maternal mortality and morbidity. However, awareness around this is quite low among women and girls.

The lack of access to family planning and contraceptives is a big problem, partly due to social stigma, in Sri Lanka. How can we change this?

Media, social media, and the arts play a crucial role in re-framing family planning and contraception, especially among youth. It needs to be normalised in society. Such discussions need to start at home.

Parents play an important role in discussing and guiding their children in making informed decisions about their bodies, including family planning methods and types of contraception.

Dr. Sanjeewa Godakanda of the Family Health Bureau, Ministry of Health, stated at the press briefing that family planning was not a population issue any longer. What is the importance of viewing family planning from a human/women’s rights perspective?

Family planning is not about population control. Family planning is a human right. It is central to gender equality and women’s empowerment as it enables women to exercise their basic right to control their own reproductive health.

Access to safe, voluntary family planning is fundamental to women’s autonomy. Individuals can aspire to a better life by making safe choices about reproductive health.

Empowering women and girls to make informed decisions about their bodies enables them to live a life free from sexual violence and discrimination, which is a root cause of gender inequality.

This enables women to freely make decisions relating to their education and employment, thereby contributing towards economic independence.

Dr. Godakanda also stated that fulfilling the goals of FP2020 will help fulfil the SDGs as well. How does FP2020 contribute?

FP2020 is based on the principle that all women, no matter where they live, should have access to life-saving contraceptives. The 2030 Agenda for Sustainable Development (Target 3.7) recognises universal access to sexual and reproductive healthcare services, including family planning, information and education, and the integration of reproductive health into national strategies.

A national focal point in the FP2020 global partnership is to empower women and girls by investing in rights-based family planning. These efforts directly contribute to the 2030 Agenda on Sustainable Development through Goal 3 on Good health and Well-being, Goal 4 on Education, and Goal 5 on Gender Equality. Ending the unmet need for family planning and achieving the FP2020 goal is therefore a critical milestone in ensuring sustainable development in Sri Lanka and around the world.

When women and girls have access to quality healthcare, they are empowered to stay in school and to earn an income. When these women are healthy, educated, and empowered, the next generation benefits, and when the next generation thrives, society prospers. This is how family planning can save lives and contribute towards a progressive and sustainably developed Sri Lanka.